Routine repeat measurement of LV function assessment in the absence of clinical status change or treatment inter- ventions should not be performed (125,126). (Level of Evidence: B) 5.5. Invasive Evaluation See Table 8 for a summary of recommendations from this section. CLASS I 1. Invasive hemodynamic monitoring with a pulmonary artery catheter should be performed to guide therapy in patients who have respiratory distress or clinical evidence of impaired perfusion in whom the adequacy or excess of intracardiac lling pressures cannot be determined from clinical assessment. (Level of Evidence: C) CLASS IIa 1. Invasive hemodynamic monitoring can be useful for carefully selected patients with acute HF who have persistent symp- toms despite empiric adjustment of standard therapies and a. whose uid status, perfusion, or systemic or pulmonary vascular resistance is uncertain; b. whose systolic pressure remains low, or is associated with symptoms, despite initial therapy; c. whose renal function is worsening with therapy; d. who require parenteral vasoactive agents; or e. who may need consideration for mechanical circulatory support (MCS) or transplantation. (Level of Evidence: C) 2. When ischemia may be contributing to HF, coronary arteri- ography is reasonable for patients eligible for revasculari- zation. (Level of Evidence: C) 3. Endomyocardial biopsy can be useful in patients presenting with HF when a speci c diagnosis is suspected that would in uence therapy. (Level of Evidence: C) CLASS III: NO BENEFIT 1. Routine use of invasive hemodynamic monitoring is not recommended in normotensive patients with acute decom- pensated HF and congestion with symptomatic response to diuretics and vasodilators (127). (Level of Evidence: B) CLASS III: HARM 1. Endomyocardial biopsy should not be performed in the routine evaluation of patients with HF. (Level of Evidence: C) 6. Treatment of Stages A to D: Recommendations 6.1. Stage A CLASS I 1. 