{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T08:07:42Z","timestamp":1769155662837,"version":"3.49.0"},"reference-count":20,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T00:00:00Z","timestamp":1757635200000},"content-version":"unspecified","delay-in-days":73,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2025,8,19]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Stiff left atrium (LA) is important in the pathophysiology and progression of heart failure with preserved ejection fraction. Non-invasive techniques used to measure stiff LA have significant limitations. Prominent V waves seen during right heart catheterisation (RHC) have been linked to a stiff LA; however, there are no studies exploring the prevalence of this in patients with pulmonary hypertension (PH). We present the first study assessing stiff LA using invasive techniques in patients with PH using V wave measurements on RHC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>50 patients with PH (66.9\u00b114.5 years, 30% male) and 18 controls were studied. Patients with left ventricular (LV) dysfunction, moderate or greater mitral regurgitation or atrial fibrillation were excluded. Echocardiographic (LA area, E\/E' average, LV hypertrophy) and RHC (peak\/mean pulmonary artery pressures, mean pulmonary capillary wedge pressure (mPCWP), V wave) parameters were collected. Prominent V wave was defined as \u226510\u2009mm Hg above mPCWP. Prevalence of prominent V waves and its correlations between echocardiographic and RHC parameters were determined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Six (12%) patients with PH had prominent V waves, while none of the control patients did (12% vs 0%, respectively, p=0.18). Prominent V waves were only seen in patients with postcapillary PH (28.6% vs 0%; p=0.003) and were strongly associated with echocardiographic parameters\u2014LA size and E\/E' ratio.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Prominent V waves, a marker of stiff LA, can be easily and readily assessed by RHC and are common with postcapillary PH. Larger studies are needed to elucidate its clinical implications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2025-003399","type":"journal-article","created":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T04:40:24Z","timestamp":1757652024000},"page":"e003399","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Prominent V waves in right heart catheterisation as a marker of left atrial stiffness in pulmonary hypertension"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5346-2258","authenticated-orcid":false,"given":"Jayant Vignesh","family":"Ravindran","sequence":"first","affiliation":[{"name":"Department of Cardiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia"},{"name":"University of Sydney, Glebe, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tommy","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"Naoum","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia"},{"name":"University of Sydney, Glebe, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Yiannikas","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia"},{"name":"University of Sydney, Glebe, New South Wales, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,9,11]]},"reference":[{"key":"2026010701110084000_12.2.e003399.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2021.10.010"},{"key":"2026010701110084000_12.2.e003399.2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.114.001667"},{"key":"2026010701110084000_12.2.e003399.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2022.11.002"},{"key":"2026010701110084000_12.2.e003399.4","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.085761"},{"key":"2026010701110084000_12.2.e003399.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.11.051"},{"key":"2026010701110084000_12.2.e003399.6","doi-asserted-by":"crossref","DOI":"10.1093\/eurheartj\/ehw597","article-title":"Pulmonary hypertension in heart failure with preserved ejection fraction: a plea for proper phenotyping and further research\u2020","volume":"38","author":"Hoeper","year":"2016","journal-title":"Eur Heart J"},{"key":"2026010701110084000_12.2.e003399.7","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1001\/jamainternmed.2015.0924","article-title":"A contemporary appraisal of the heart failure epidemic in Olmsted County","volume":"175","author":"Gerber","year":"2000","journal-title":"JAMA Intern Med"},{"key":"2026010701110084000_12.2.e003399.8","doi-asserted-by":"crossref","first-page":"102537","DOI":"10.1016\/j.cpcardiol.2024.102537","article-title":"Prevalence and impact of pulmonary hypertension on acute decompensated heart failure with preserved ejection fraction hospitalizations: A five-year retrospective analysis","volume":"49","author":"Wahadneh","year":"2024","journal-title":"Curr Probl Cardiol"},{"key":"2026010701110084000_12.2.e003399.9","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1016\/j.hlc.2016.05.125","article-title":"Pulmonary Hypertension due to Radiofrequency Catheter Ablation (RFCA) for Atrial Fibrillation: The Lungs, the Atrium or the Ventricle?","volume":"25","author":"Verma","year":"2016","journal-title":"Heart Lung Circ"},{"key":"2026010701110084000_12.2.e003399.10","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1093\/ehjci\/jeab221","article-title":"Left atrial evaluation by cardiovascular magnetic resonance: sensitive and unique biomarkers","volume":"23","author":"Peters","year":"2021","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2026010701110084000_12.2.e003399.11","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1002\/ejhf.1464","article-title":"Left atrial strain and compliance in the diagnostic evaluation of heart failure with preserved ejection fraction","volume":"21","author":"Reddy","year":"2019","journal-title":"Eur J Heart Fail"},{"key":"2026010701110084000_12.2.e003399.12","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1097\/HCO.0000000000000537","article-title":"Left atrial strain: measurement and clinical application","volume":"33","author":"Buggey","year":"2018","journal-title":"Curr Opin Cardiol"},{"key":"2026010701110084000_12.2.e003399.13","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1016\/j.jcmg.2022.10.011","article-title":"Left Atrial Strain for Assessment of Left Ventricular Diastolic Function: Focus on Populations With Normal LVEF","volume":"16","author":"Nagueh","year":"2023","journal-title":"JACC Cardiovasc Imaging"},{"key":"2026010701110084000_12.2.e003399.14","doi-asserted-by":"publisher","DOI":"10.1002\/clc.4960061104"},{"key":"2026010701110084000_12.2.e003399.15","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1159\/000493007","article-title":"The Accuracy of a Large V Wave in the Pulmonary Capillary Wedge Pressure Waveform for Diagnosing Current Mitral Regurgitation","volume":"141","author":"Hayashi","year":"2018","journal-title":"Cardiology"},{"key":"2026010701110084000_12.2.e003399.16","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(82)90415-5"},{"key":"2026010701110084000_12.2.e003399.17","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.2020"},{"key":"2026010701110084000_12.2.e003399.18","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2009.189118"},{"key":"2026010701110084000_12.2.e003399.19","doi-asserted-by":"crossref","first-page":"1839","DOI":"10.1016\/j.hrthm.2013.09.010","article-title":"Symptomatic pulmonary hypertension with giant left atrial v waves after surgical maze procedures: evaluation by comprehensive hemodynamic catheterization","volume":"10","author":"Welch","year":"2013","journal-title":"Heart Rhythm"},{"key":"2026010701110084000_12.2.e003399.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.01.059"}],"container-title":["Open 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