ESC/ERS guidelines: recommendations for right heart catheterisation (RHC) (A) and vasoreactivity testing (B)
| Class# | Level¶ | |
| A. RHC | ||
| RHC is indicated in all patients with PAH to confirm the diagnosis, to evaluate the severity and when PAH specific drug therapy is considered | I | C |
| RHC should be performed for confirmation of efficacy of PAH-specific drug therapy | IIa | C |
| RHC should be performed for confirmation of clinical deterioration and as baseline for the evaluation of the effect of treatment escalation and/or combination therapy | IIa | C |
| B. Vasoreactivity testing | ||
| Vasoreactivity testing is indicated in patients with IPAH, heritable PAH and PAH associated with anorexigen use to detect patients who can be treated with high doses of a CCB | I | C |
| A positive response to vasoreactivity testing is defined as a reduction of P̄pa ≥10 mmHg to reach an absolute value of P̄pa ≤40 mmHg with an increased or unchanged CO | I | C |
| Vasoreactivity testing should be performed only in referral centres | IIa | C |
| Vasoreactivity testing should be performed using nitric oxide as vasodilator | IIa | C |
| Vasoreactivity testing may be performed in other types of PAH | IIb | C |
| Vasoreactivity testing may be performed using i.v. epoprostenol or i.v. adenosine | IIb | C |
| The use of an oral or i.v. CCB in acute vasoreactivity testing is not recommended | III | C |
| Vasoreactivity testing to detect patients who can be safely treated with high doses of a CCB is not recommended in patients with other PH groups (groups 2, 3, 4 and 5) | III | C |
PAH: pulmonary arterial hypertension; IPAH: idiopathic pulmonary arterial hypertension; CCB: calcium channel blocker; P̄pa: mean pulmonary arterial pressure; CO: cardiac output; PH: pulmonary hypertension. #: class of recommendation; ¶: level of evidence. Reproduced from 1 with permission from the publisher.