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Decoding PH Monitoring, Testing, and Referral, With Susanne McDevitt, DNP
Beyond hemodynamics and treatment targets, McDevitt says the most important conversations APPs have with patients are often the ones that don't appear in guidelines.
Right heart catheterization is not just a diagnostic entry point in Pulmonary hypertension (PH) — it is a longitudinal management tool, and using it well requires understanding not only the basics of hemodynamic assessment but the nuances of provocative testing, patient phenotyping, and treatment goal monitoring. At the Association of Pulmonary Advanced Practice Providers (APAPP) National Conference, held June 28-20 in Las Vegas, Nevada, Susanne McDevitt, DNP, ACNP-BC, Acute Care Nurse Practitioner in the Pulmonary Hypertension Program at Michigan Medicine, University of Michigan, Ann Arbor, co-presented a session titled Decoding Pulmonary Hypertension with Mindy Rivera, MSN, APRN, CNS-BC, covering the evolving role of hemodynamics in PH diagnosis and management.1
The session reviewed right heart catheterization fundamentals alongside its current place in the diagnostic algorithm — which has shifted meaningfully with updated hemodynamic definitions lowering the mean pulmonary arterial pressure threshold to >20 mmHg — and dedicated substantial time to provocative testing in the catheterization laboratory.1 Comprehensive provocative testing is central to accurate patient phenotyping: distinguishing WHO group classifications, identifying exercise-induced PH, and uncovering left heart disease as a contributor to hemodynamic abnormalities are all critical to treatment selection, and none of these can be reliably accomplished without a thorough catheterization.2
"Doing a comprehensive right heart cath is imperative to getting the correct diagnosis for the patient, and that impacts the entire treatment plan," McDevitt said.
On monitoring strategy, McDevitt described her center's standard approach: a thorough index right heart catheterization at diagnosis, followed by repeat catheterization within 6–12 months of initiating therapy to evaluate hemodynamic response against treatment goals — including normalization of cardiac output and pulmonary vascular resistance — alongside echocardiography, 6-minute hall walk, functional class assessment, and biomarkers including BNP or NT-proBNP. Once low-risk status and treatment goals are achieved, echocardiography-based surveillance may suffice, but any clinical change, unexplained biomarker rise, or concern for new comorbidity — including diastolic dysfunction or heart failure with preserved ejection fraction, which can develop over decades of therapy in long-surviving patients — warrants repeat hemodynamic evaluation. "When in doubt, we repeat a right heart cath for sure," she said.
Despite advances in awareness and screening in higher-risk populations such as those with scleroderma, interstitial Lung Disease, or chronic thromboembolic disease, late referral to PH specialty centers remains a persistent problem for WHO group 1 pulmonary arterial hypertension.1 McDevitt expressed cautious optimism that artificial intelligence and machine learning tools applied to echocardiographic screening may help identify patients with unexplained dyspnea earlier — before hemodynamic compromise and right ventricular remodeling are advanced — though she acknowledged the field is still working toward that reality.
McDevitt had no relevant disclosures to report.
References
McDevitt S, Rivera M. Hemodynamic deep dive: decoding pulmonary hypertension. Presented at: Association of Pulmonary Advanced Practice Providers Annual Meeting (APAPP 2026); Las Vegas, NV.
Humbert M, Kovacs G, Hoeper MM, et al; ESC/ERS Scientific Document Group. 2022 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2022;43(38):3618–3731. doi:10.1093/eurheartj/ehac237
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