Prominent V waves in right heart catheterisation as a marker of left atrial stiffness in pulmonary hypertension.

Introduction: Stiff left atrium (LA) is important in the pathophysiology and progression of heart failure with preserved ejection fraction. Non-invasive techniques used to measure stiff LA have significant limitations. Prominent V waves seen during right heart catheterisation (RHC) have been linked to a stiff LA; however, there are no studies exploring the prevalence of this in patients with pulmonary hypertension (PH). We present the first study assessing stiff LA using invasive techniques in patients with PH using V wave measurements on RHC.

Methods: 50 patients with PH (66.9±14.5 years, 30% male) and 18 controls were studied. Patients with left ventricular (LV) dysfunction, moderate or greater mitral regurgitation or atrial fibrillation were excluded. Echocardiographic (LA area, E/E' average, LV hypertrophy) and RHC (peak/mean pulmonary artery pressures, mean pulmonary capillary wedge pressure (mPCWP), V wave) parameters were collected. Prominent V wave was defined as ≥10 mm Hg above mPCWP. Prevalence of prominent V waves and its correlations between echocardiographic and RHC parameters were determined.

Results: Six (12%) patients with PH had prominent V waves, while none of the control patients did (12% vs 0%, respectively, p=0.18). Prominent V waves were only seen in patients with postcapillary PH (28.6% vs 0%; p=0.003) and were strongly associated with echocardiographic parameters-LA size and E/E' ratio.

Conclusions: Prominent V waves, a marker of stiff LA, can be easily and readily assessed by RHC and are common with postcapillary PH. Larger studies are needed to elucidate its clinical implications.