Department of Medicine, Section of Cardiology, University of Chicago, Chicago, Illinois.
Division of Cardiology, Inova Heart and Vascular Institute, Fairfax Virginia.
J Card Fail. 2023 Nov;29(11):1507-1518. doi: 10.1016/j.cardfail.2023.06.009. Epub 2023 Jun 22.
Invasive hemodynamic measurement via right heart catheterization has shown divergent data in its role in the treatment of patients with heart failure (HF) and cardiogenic shock. We hypothesized that variation in data acquisition technique and interpretation might contribute to these observations. We sought to assess differences in hemodynamic acquisition and interpretation by operator subspecialty as well as level of experience.
Individual-level responses to how physicians both collect and interpret hemodynamic data at the time of right heart catheterization was solicited via a survey distributed to international professional societies in HF and interventional cardiology. Data were stratified both by operator subspecialty (HF specialists or interventional cardiologists [IC]) and operator experience (early career [≤10 years from training] or late career [>10 years from training]) to determine variations in clinical practice. For the sensitivity analysis, we also look at differences in each subgroup. A total of 261 responses were received. There were 141 clinicians (52%) who self-identified as HF specialists, 99 (38%) identified as IC, and 20 (8%) identified as other. There were 142 early career providers (54%) and late career providers (119 [46%]). When recording hemodynamic values, there was considerable variation in practice patterns, regardless of subspecialty or level of experience for the majority of the intracardiac variables. There was no agreement or mild agreement among HF and IC as to when to record right atrial pressures or pulmonary capillary wedge pressures. HF cardiologists were more likely to routinely measure both Fick and thermodilution cardiac output compared with IC (51% vs 29%, P < .001), something mirrored in early career vs later career cardiologists.
Significant variation exists between the acquisition and interpretation of right heart catheterization measurements between HF and IC, as well as those early and late in their careers. With the growth of the heart team approach to management of patients in cardiogenic shock, standardization of both assessment and management practices is needed.
通过右心导管术进行有创血流动力学测量在心力衰竭（HF）和心源性休克患者的治疗中显示出不同的数据。我们假设数据采集技术和解释的差异可能导致了这些观察结果。我们试图评估操作人员专业领域和经验水平对血流动力学采集和解释的差异。
通过向 HF 和介入心脏病学国际专业协会分发的一项调查，征求了医生在右心导管术时收集和解释血流动力学数据的个人水平反应。数据按操作人员专业领域（HF 专家或介入心脏病专家 [IC]）和操作人员经验（早期职业生涯 [从培训开始≤10 年] 或晚期职业生涯 [从培训开始>10 年]）进行分层，以确定临床实践中的差异。为了进行敏感性分析，我们还观察了每个亚组的差异。共收到 261 份回复。141 名临床医生（52%）自我认定为 HF 专家，99 名（38%）认定为 IC，20 名（8%）认定为其他。有 142 名早期职业生涯提供者（54%）和晚期职业生涯提供者（119 名 [46%]）。记录血流动力学值时，无论专业领域或经验水平如何，大多数心内变量的实践模式都存在很大差异。HF 和 IC 之间在何时记录右心房压力或肺毛细血管楔压方面没有一致或轻度一致意见。HF 心脏病专家比 IC 更有可能常规测量 Fick 和热稀释心输出量（51%比 29%，P<0.001），这在早期职业生涯和晚期职业生涯的心脏病专家中也是如此。
HF 和 IC 之间，以及职业生涯早期和晚期的医生之间，在右心导管测量的获取和解释方面存在显著差异。随着心团队方法在管理心源性休克患者方面的发展，需要标准化评估和管理实践。
