Role of invasive monitoring in heart failure: Pulmonary artery catheters in the post-ESCAPE era

Hemodynamic derangement is a consistent finding in patients presenting with congestive heart failure. Elevated intracardiac pressure as a result of impaired ejection or filling of the left ventricle is associated with poor long-term prognosis, even in the contemporary era of heart failure management (1). It is now recognized that reduction of these pressures may improve symptoms, decrease valvular regurgitation, and can actually improve forward cardiac output. Clinical assessment of filling pressures provides reasonable targets for therapy in the hospital, although more precise measurement may lead to further reduction of valvular regurgitation and symptom improvement. Hence over the past decades, many attempts have been made to facilitate safe and accurate quantification of hemodynamic derangements across the spectrum of heart failure. The technique of bedside pulmonary artery catheterization (PAC) introduced in the early 1970s has evolved to routine clinical use. This advancement has led to many insights regarding acute myocardial infarction, cardiogenic shock, and acute heart failure.