Cardiac Catheterization of Left Heart
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Although the technique and accuracy of noninvasive testing continue to improve, cardiac catheterization (see the image below) remains the standard for the evaluation of hemodynamics. Cardiac catheterization helps provide not only intracardiac pressure measurements but also measurements of oxygen saturation and cardiac output [1] (see the Cardiac Output calculator). Hemodynamic measurements usually are coupled with left ventriculography for the evaluation of left ventricular function and coronary angiography.
Coronary angiography remains the criterion standard for diagnosing coronary artery disease (CAD) and is the primary method used to help delineate coronary anatomy. [2] In addition to defining the site, severity, and morphology of lesions, coronary angiography helps provide a qualitative assessment of coronary blood flow and helps identify collateral vessels.
Correlation of the findings from coronary angiography with those from left ventriculography permits identification of potentially viable areas of the myocardium that may benefit from a revascularization procedure. Left ventricular function can be further evaluated during stress by using atrial pacing, dynamic exercise, or pharmacologic agents.
Cardiac catheterization is undertaken for the diagnosis of a variety of cardiac diseases. As with any invasive procedure that is associated with important complications, the decision to recommend cardiac catheterization must be based on a careful evaluation of the risks and benefits to the patient.
Indications for cardiac catheterization are as follows:
Many patients undergo cardiac catheterization before noncardiac surgery, even though it is not routinely indicated. In a report from the National Cardiovascular Data Registry CathPCI Registry, most of the patients undergoing diagnostic catheterization before noncardiac surgery were found to be asymptomatic. [3] Discovery of obstructive CAD was common, and revascularization was recommended in nearly half of these patients.
With the exception of patient refusal, there are no absolute contraindications for cardiac catheterization. Clearly, the risk-to-benefit ratio must be considered: Any procedure that is associated with some degree of risk should be contraindicated if the information derived from it will be of no benefit to the patient.
Relative contraindications are as follows:
Note that many of these factors can be corrected before the procedure, which lowers the risk. Preprocedural risk factor correction always should be considered unless the procedure is being performed in an emergency situation.
Absolute contraindications to radial artery access for left-heart cardiac catheterization include the following:
Relative contraindications to radial artery access for left-heart cardiac catheterization include the following:
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Schulman-Marcus J, Feldman DN, Rao SV, Prasad A, McCoy L, Garratt K, et al. Characteristics of Patients Undergoing Cardiac Catheterization Before Noncardiac Surgery: A Report From the National Cardiovascular Data Registry CathPCI Registry. JAMA Intern Med. 2016 Mar 28. [Medline].
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Scott DA, Evered LA, Gerraty RP, MacIsaac A, Lai-Kwon J, Silbert BS. Cognitive dysfunction follows left heart catheterisation but is not related to microembolic count. Int J Cardiol. 2014 Jul 15. 175 (1):67-71. [Medline].
Scanlon PJ, Faxon DP, Audet AM, et al. ACC/AHA guidelines for coronary angiography. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on Coronary Angiography). Developed in collaboration with the Society for Cardiac Angiography and Interventions. J Am Coll Cardiol. 1999 May. 33(6):1756-824. [Medline].
Chen JY, Liu Y, Zhou YL, Tan N, Zhang B, Chen PY, et al. Safety and tolerability of iopromide in patients undergoing cardiac catheterization: real-world multicenter experience with 17,513 patients from the TRUST trial. Int J Cardiovasc Imaging. 2015 Oct. 31 (7):1281-91. [Medline].
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Liu Y, Chen JY, Huo Y, Ge JB, Xian Y, Duan CY, et al. Aggressive hydraTion in patients with ST-Elevation Myocardial infarction undergoing Primary percutaneous coronary intervention to prevenT contrast-induced nephropathy (ATTEMPT): Study design and protocol for the randomized, controlled trial, the ATTEMPT, RESCIND 1 (First study for REduction of contraSt-induCed nephropathy followINg carDiac catheterization) trial. Am Heart J. 2016 Feb. 172:88-95. [Medline].
Drost H, Buis B, Haan D, Hillers JA. Cholesterol embolism as a complication of left heart catheterisation. Report of seven cases. Br Heart J. 1984 Sep. 52 (3):339-42. [Medline].
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Roger B Olade, MD, MPH Medical Director, Genesis Health Group
Roger B Olade, MD, MPH is a member of the following medical societies: American College of Occupational and Environmental Medicine, American College of Physicians
Disclosure: Nothing to disclose.
Arshad Safi, MD Interventional Cardiologist, Franklin County Heart Center
Disclosure: Nothing to disclose.
Olurotimi J Badero, MD, FACP, FASN, FASNC, FACC, FSCAI Interventional Cardiologist, Nephrologist, and Executive Director, Cardiac Renal and Vascular Associates, PC
Olurotimi J Badero, MD, FACP, FASN, FASNC, FACC, FSCAI is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, American Society of Diagnostic and Interventional Nephrology, American Society of Nephrology, Association of Black Cardiologists, National Kidney Foundation, Renal Physicians Association
Disclosure: Nothing to disclose.
Karlheinz Peter, MD, PhD Professor of Medicine, Monash University; Head of Centre of Thrombosis and Myocardial Infarction, Head of Division of Atherothrombosis and Vascular Biology, Associate Director, Baker Heart Research Institute; Interventional Cardiologist, The Alfred Hospital, Australia
Karlheinz Peter, MD, PhD is a member of the following medical societies: American Heart Association, German Cardiac Society, Cardiac Society of Australia and New Zealand
Disclosure: Nothing to disclose.
Gregory J Dehmer, MD Director, Division of Cardiology, Scott & White Healthcare; Professor of Medicine, Texas A&M Health Science Center College of Medicine
Gregory J Dehmer, MD is a member of the following medical societies: American College of Cardiology, American Heart Association, Society for Cardiac Angiography and Interventions, and Society of Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.
George A Stouffer III, MD Henry A Foscue Distinguished Professor of Medicine and Cardiology, Director of Interventional Cardiology, Cardiac Catheterization Laboratory, Chief of Clinical Cardiology, Division of Cardiology, University of North Carolina Medical Center
George A Stouffer III, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American College of Physicians, American Heart Association, Phi Beta Kappa, and Society for Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Medscape Reference Salary Employment
Cardiac Catheterization of Left Heart
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