A V-wave amplitude >13 mm Hg predicts pulmonary hypertension with 70% sensitivity and correlates positively with mean pulmonary artery pressure despite PAWP <15 mm Hg.
Does left atrial V-wave amplitude correlate with the presence of pulmonary hypertension in patients with normal pulmonary artery wedge pressure?
A high left atrial V-wave amplitude is strongly associated with pulmonary hypertension even when mean pulmonary artery wedge pressure is normal, suggesting it may act as a pathophysiological trigger.
Abstract Background Postcapillary pulmonary hypertension occurs when left atrial (LA) pressure is elevated due to various causes. The V-wave is a distinct pressure pattern that converts continuous into a pulsatile reverse LA flow during ventricular systole. This phenomenon is typically seen in conditions such as mitral regurgitation and restrictive cardiomyopathy. Purpose To determine whether the V-wave could act as a trigger for pulmonary hypertension. Methods To investigate this, 662 patients scheduled for preoperative coronary angiography underwent simultaneous right heart catheterization to record pulmonary artery wedge pressure (PAWP) to and investigate V-wave characteristics. For this purpose and to avoid confounding factors, only patients with a PAWP lower than 15 mmHg were included. Results Among the patients, 213 had heart failure with reduced ejection fraction (HFrEF), while 71 had normal cardiac function. Additionally, 48 patients had significant mitral regurgitation, 320 had aortic valve disease (50 with aortic regurgitation and 270 with aortic stenosis), 6 had mitral stenosis, and 4 had restrictive cardiomyopathy. The average PAWP was 9.0 ± 3.6 mm Hg. In patients with normal pulmonary pressure, defined as a mean pulmonary artery pressure (mPAP) of 20 mm Hg or less, the V-wave amplitude averaged 10.3 ± 3.9 mm Hg. However, in patients with pulmonary hypertension, where mPAP exceeded 20 mm Hg, the V-wave amplitude was significantly higher, averaging 15.1 ± 4.0 mm Hg (p = 10.8 × 10⁻²⁹). A positive linear correlation was observed between mPAP and V wave amplitude while PAWP was loweh than 15 mm Hg (Figure 1). From the ROC curve analysis, the study identified optimal cutoffs for predicting pulmonary hypertension. A V-wave amplitude greater than 13 mm Hg had a sensitivity of 70% (AUC = 0.81, p0,01), A V-wave to PAPW ratio of 4.5 or more had a sensitivity of 69% (AUC = 0,61, p 0,02), while a V-wave to PAPW gradient higher than 3 mm Hg had a sensitivity of 70% (AUC = 0.59, p=0,04). Conclusio: The presence of a high V-wave can transform continuous LA pressure and pulmonary blood flow into a pulsatile pattern, which may contribute to pulmonary hypertension. This effect is particularly significant in patients with normal wedge pressure, suggesting that the V wave may play a key role in worsening pre and post-tpulmonary hypertension in specific cardiac conditions.
Bauer et al. (2025) studied this question. A V-wave amplitude >13 mm Hg predicts pulmonary hypertension with 70% sensitivity and correlates positively with mean pulmonary artery pressure despite PAWP <15 mm Hg.