The impact of large v-waves of pulmonary artery wedge pressure in patients with wild-type transthyretin amyloid cardiomyopathy

Abstract

Background: An enlarged v-wave amplitude and a large v-wave in the pulmonary artery wedge pressure (PAWP) suggest impaired left atrial (LA) reservoir function. This study investigated the clinical importance of enlargement of v-wave amplitude in patients with wild-type transthyretin amyloid cardiomyopathy (ATTRwt-CM).

Methods and results: We retrospectively analysed patients with ATTRwt-CM (n = 204) and hypertrophic cardiomyopathy (HCM) (n = 78). The v-wave amplitude of PAWP was higher in the ATTRwt-CM group than in the HCM group (5.6 ± 4.73 mm Hg vs. 3.0 ± 2.50 mm Hg; p < 0.001). We also assessed prognostic impact of v-waves in patients with ATTRwt-CM. Large v-waves were defined as amplitude ≥10 mm Hg. We assigned the patients to groups with (n = 48) and without (n = 156) large v-wave. LA peak longitudinal strain (LS) and LS rate (LSR) were significantly decreased in the group with large v-waves. Large v-waves were also a determinant of all-cause death (log-rank, p = 0.033) and rehospitalization for heart failure (HF) events (log-rank, p = 0.001). The four forced inclusion models significantly associated a large v-wave with increased HF rehospitalization risk in multivariable Cox analysis.

Conclusions: The v-wave amplitude of enlarged PAWP in ATTRwt-CM correlated with declining LA peak LS and LSR and higher risk of all-cause death and HF rehospitalization. Therefore, assessing PAWP waveforms might help to diagnose ATTRwt-CM, and predict LA dysfunction and a poor prognosis.

Keywords: Heart failure; Left atrial reservoir function; Left atrial stiffness; Transthyretin amyloid cardiomyopathy; v-Wave.