Recalibrating the barometer: is it time to take a critical look at noninvasive approaches to measuring filling pressures?

The ability to measure pressures within the heart has been one of the most important diagnostic and therapeutic tools within the cardiologist’s armamentarium over the past half century. Whereas this measurement initially required direct left ventricular puncture,1 transeptal catheterization,2 or retrograde placement of a catheter into the left ventricle, the advent of the Swan-Ganz catheter allowed for accurate estimation of leftsided filling pressures without requiring arterial or intraventricular access. These measurements have been useful to diagnose and treat hemodynamic compromise resulting from cardiac and pulmonary disease and other critical conditions associated with abnormal or unknown volume status.