Cath-Lab Hemodynamics

What it does

Cath-Lab Hemodynamics reads the pressure tracings recorded during a catheterisation: aortic and left-ventricular pressures, pressure-wire recordings with their pullbacks, simultaneous tracings across a valve, and right-heart catheterisation. Every channel is identified (Ao, LV, Pd, Pa, RA, RV, PA, PCWP) and every beat detected before any value is computed.

The read returns pressures, gradients, cardiac output-based indices and resistances, and it checks the tracings themselves: damping, drift, ventricularisation of the catheter and a wrong zero level are flagged, because they change the numbers that drive the decision.

Intended use

Decision support for physicians who report invasive hemodynamics: quality control of the tracings, interpretation of the pressure-wire pullback pattern, and a structured hemodynamic section for the cath report. Consoles already display FFR; this read adds the checks and the structure around it.

Who it is for

Interventional cardiologists, heart-failure and pulmonary-hypertension physicians who perform right-heart catheterisation, structural-heart teams, and cath-lab staff who audit recordings.

Accepted input

• DICOM: Hemodynamic Waveform objects from the cath-lab recording system.
• Vendor exports: CSV, XML or PDF exports of the hemodynamic system or pressure-wire console, when no DICOM waveform is available.
• All tracings of one procedure are read together, so a pressure-wire run and the left- and right-heart recordings of the same case form one result.

Requirements

Requirement	Why
Labelled pressure channels or recognisable waveforms	Each value depends on knowing which chamber or vessel a channel records
Simultaneous Pd and Pa for FFR, with hyperaemia when induced	FFR is the hyperaemic Pd/Pa ratio
Simultaneous LV–Ao (or LA/PCWP–LV) tracings for gradients	Peak-to-peak and mean gradients need both sides at once
A cardiac output measurement	Needed for valve area, cardiac index and resistances

Optional context

The indication, the vessel studied with the pressure wire, height and weight for indexed values, and blood oxygen saturations for the shunt ratio can be passed in clinical_context.

The result

One structured result per procedure with measurements, classifications and waveform-quality flags, each linked to the beats it came from.

Section	Content
Pressure-wire FFR	FFR, resting indices, pullback gradient pattern (focal or diffuse), drift and damping flags
Valve gradients	Peak-to-peak and mean gradients from simultaneous tracings, Gorlin valve area
Right heart catheterisation	RA, RV, PA and PCWP pressures with mean PA pressure, cardiac index, PVR, shunt ratio (Qp/Qs) and PH classification
Draft report	Opt-in (options.report): an English narrative that interprets the result for the reader (findings, impression, limitations); every number is checked against the findings

Standards

• DICOM: Hemodynamics Report TID 3500, with hemodynamic findings in TID 3812 of the TID 3800 Cardiac Catheterization Report; the cardiac output method is coded with CID 3628.
• Physiology: FFR ≤ 0.80 is reported as ischaemic.
• Pulmonary hypertension: 2022 ESC/ERS definitions: mean PA pressure > 20 mmHg; pre-capillary when PAWP ≤ 15 mmHg and PVR > 2 WU; isolated post-capillary when PAWP > 15 mmHg and PVR ≤ 2 WU; combined when both are raised.

Quality flags

Drift, damping, catheter ventricularisation and zero-level errors are reported per tracing, with the beats concerned. A value computed from a flagged tracing carries the flag with it.