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Significance and prognostic impact of v wave on pulmonary artery pressure in patients with heart failure: beyond the wedge pressure

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Abstract

Background

A v wave on pulmonary artery wedge (PAW) pressure sometimes augments and appears on pulmonary artery (PA) pressure wave in patients with heart failure (HF). However, the significance of PA v wave in HF remains to be elucidated.

Methods

We retrospectively analyzed pressure waveforms in 61 HF patients (left ventricular ejection fraction 35 ± 15%). On the PAW and PA pressure waveforms, mean pressure as well as peak and amplitude of v waves (ampPAWv and ampPAv, respectively) were measured. Occurrence of worsening HF and cardiac death was recorded for 2 years after the catheterization.

Results

The ampPAWv did not correlate with ampPAv. When the patients were divided into 4 groups: I (high-ampPAWv/high-ampPAv), II (high-ampPAWv/low-ampPAv), III (low-ampPAWv/high-ampPAv), and IV (low-ampPAWv/low-ampPAv), the prevalence of group III was low (I: 13, II: 17, III: 4, IV: 27). Mean pressures of PAW and PA were similarly elevated in groups I and II. Cardiac index was lowest (I: 2.0 ± 0.4, II: 2.8 ± 0.6, III: 2.2 ± 0.2, IV: 2.4 ± 0.6 L/min/m2, ANOVA P < 0.01, P < 0.01 for I vs II) and tricuspid annular plane systolic excursion / systolic PA pressure was impaired (I: 0.27 ± 0.07, II: 0.48 ± 0.22, III: 0.59 ± 0.35, IV: 0.68 ± 0.35 mm/mmHg, ANOVA P < 0.01) in group I. During the follow-up, 13 events were observed. Kaplan–Meier analysis showed that patients in group I were at highest risk of cardiac events.

Conclusions

PA v was observed mainly in patients with augmented PAW v wave and decreased cardiac index, suggesting an advanced stage of HF. Moreover, augmented PAv was associated with worse outcome in HF patients.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan

    Hiroyuki Iwano, Kiwamu Kamiya, Toshiyuki Nagai, Shingo Tsujinaga, Miwa Sarashina, Suguru Ishizaka, Yasuyuki Chiba & Toshihisa Anzai

  2. Division of Clinical Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan

    Shinobu Yokoyama, Masahiro Nakabachi & Hisao Nishino

  3. Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan

    Michito Murayama

  4. Faculty of Health Sciences, Hokkaido University, Sapporo, Japan

    Kazunori Okada & Sanae Kaga

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  1. Hiroyuki Iwano
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  2. Shinobu Yokoyama
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Correspondence to Hiroyuki Iwano.

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380_2020_1580_MOESM1_ESM.jpg

Supplemental Figure Kaplan-Meier curve analysis of event free survival of patients with significant PA v wave and those without. Abbreviations are the same as Figure 5. (JPG 59 kb)

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Iwano, H., Yokoyama, S., Kamiya, K. et al. Significance and prognostic impact of v wave on pulmonary artery pressure in patients with heart failure: beyond the wedge pressure. Heart Vessels 35, 1079–1086 (2020). https://doi.org/10.1007/s00380-020-01580-6

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  • DOI: https://doi.org/10.1007/s00380-020-01580-6

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