Anatomical, Functional, and Hemodynamic Determinants of Increased Pulmonary Capillary Wedge Pressure V-Wave Amplitude

Introduction: Increased pulmonary capillary wedge pressure (PCWP) V-wave amplitude has been traditionally associated with significant mitral regurgitation (MR). However, increased PCWP V-waves may also occur in patients with elevated left ventricular end-diastolic pressure (LVEDP) or with dilated left atrium (LA). Interactions between MR, increased LVEDP, and LA dilatation in the genesis of increased PCWP V-waves were not well investigated. Material and Methods: It was a single-center cohort study of 153 consecutive hemodynamically stable patients referred for invasive hemodynamic evaluation of dyspnea. Patients with significant valvular disease other than MR, acute coronary syndromes (ACS), hemodynamic instability, pericardial disease, and mechanical ventilation or mechanical LV support were excluded. Results: Study cohort included 41% males, 68.4+/-11.9 years old, 60% were on beta-adrenergic antagonists and 69.3% were on afterload reduction therapy. PCWP V-wave amplitude was significantly increased in patients with moderate or more severe MR (p<0.001), dilated LA (p=0.002), with a trend towards increased V-wave amplitude in elevated >12 mmHg LVEDP (p=0.117). There were no significant differences in age, gender, prevalence of LV dysfunction, other co-morbidities, and/or E/e? ratio according to the MR degree, LA volume, and LVEDP. In patients categorized according to moderate or more severe MR, dilated LA, and increased >12 mmHg LVEDP - the presence of any two of these abnormal parameters was associated with 50-65% prevalence of elevated V-waves and reached 100% when all three were parameters were abnormal (p<0.002). Conclusions: In euvolemic patients undergoing elective invasive hemodynamic evaluation of dyspnea, elevated PCWP V-waves are determined by three major pathophysiological parameters: moderate or more severe MV regurgitation, LA dilatation, and elevated LVEDP. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial NA ### Funding Statement None ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Albany Medical College IRB, Albany, NY I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable NA