The Accuracy of a Large V Wave in the Pulmonary Capillary Wedge Pressure Waveform for Diagnosing Current Mitral Regurgitation

Abstract

Background: Large V waves in the pulmonary capillary wedge pressure (PCWP) waveform traditionally indicate severe mitral regurgitation (MR). However, our understanding of MR etiology and hemodynamics has changed in recent decades. Objectives: We aimed to reevaluate the association between large V waves and current MR to determine whether traditional large V wave criteria remain optimal. Method: We reviewed 1,964 right heart catheterizations (RHCs) performed at our institution from 2010 to 2017, and retrospectively selected 126 patients with sinus rhythm who underwent echocardiography within 2 days (0.3 ± 0.5 days) of the RHC. The diagnostic accuracy of 3 traditional criteria for large V waves was assessed, and the optimal cut-off points were determined as those with the maximal Youden indices. Results: Severe MR was observed on echocardiography in 26 (21%) patients, including 15 (58%) with Carpentier classification type II MR and 11 (42%) with type IIIB MR. Large V waves, defined as a difference between the peak V wave and mean PCWP ≥10 mm Hg, had a high specificity of 94% (95% confidence interval: 87–98%), but a low sensitivity of 27% (12–48%) for diagnosing severe MR. The optimal cut-off point for the V wave was 3 mm Hg above the mean PCWP, with a sensitivity of 73% (52–88%) and a specificity of 64% (54–73%). Conclusions: For diagnosing current MR, the cut-off point for a large V wave should be reduced from that previously employed for rheumatic valvular heart disease. This information may be useful in guiding contemporary transcatheter therapies for MR under RHC monitoring.

The Value of Passive Leg Raise During Right Heart Catheterization in Diagnosing Heart Failure With Preserved Ejection Fraction

“…A large V-wave, defined as V-wave minus PCWP ≥10 mmHg, 20,21 corresponds with elevated filling pressures during the passive filling of the left atrium. Although often associated with significant mitral valve pathology, 22 a large V-wave can also be seen in HFpEF, which is then explained by impaired LV distensibility and/or HFpEF-related atrial dysfunction. 20,[23][24][25][26] In the present study, the diagnostic value of the V-wave were evaluated using receiver operating characteristics (ROC) curve analyses.…”