When would be your threshold to consider obtaining an exercise RHC for undifferentiated dyspnea to help diagnose HFpEF?

When would you consider obtaining an exercise right heart catheterization (RHC) for undifferentiated dyspnea to help diagnose HFpEF?

• When patients have persistent, unexplained dyspnea not attributed to common conditions such as COPD, anemia, or obesity
• When non-invasive tests (e.g., echocardiography, BNP/NT-proBNP, pulmonary function tests) fail to identify the cause, and clinical suspicion for HFpEF remains high despite normal resting hemodynamics
• To correlate exercise-induced pulmonary capillary wedge pressure (PCWP) changes with symptoms and functional impairment
• Other