# Prominente V-golven verhogen rechterventrikelbelasting bij HFpEF — Implicaties voor de hemodynamische beoordeling *geplaatst 2026-10-18 · Algemeen · Circulation · doi 10.1161/CIRCULATIONAHA.126.081799 · https://hartvaat.nl/2026/10/11/prominente-v-golven-verhogen-rechterventrikelbelasting-bij-hfpef-implicaties-voo/* In een retrospectieve cohortstudie onder 1069 patiënten met HFpEF die een invasieve oefentest ondergingen, bleek dat prominente V-golven (PAWP V-golf ≥10 mmHg boven het gemiddelde PAWP) de pulmonale systolische druk aanzienlijk verhogen (54 versus 38 mmHg) en het risico op hartfalenhospitalisatie of overlijden verdubbelen (HR 2,09). Na correctie voor de V-golf daalde de prevalentie van gecombineerde pre- en postcapillaire pulmonale hypertensie van 60,2% naar 29,3%. Deze bevindingen tonen aan dat het negeren van de V-golf tijdens invasieve beoordeling de ernst van pulmonale vaatziekte overschat en dat V-golven een onafhankelijke drijver zijn van rechterhartfalen bij HFpEF, onafhankelijk van de longvaten. ## English: Prominent V Waves Augment Right Ventricular Afterload Independent of the Lung Vessels in Heart Failure: Implications for Clinical Assessment of Pulmonary Vascular Disease. In a retrospective cohort study of 1,069 patients with HFpEF undergoing invasive exercise hemodynamics, prominent V waves (PAWP V wave ≥10 mmHg above mean PAWP) were associated with markedly higher PA systolic pressure (54 vs 38 mmHg) and a doubled risk of heart failure hospitalization or death (HR 2.09). Correcting for the V wave reduced the prevalence of combined pre- and postcapillary pulmonary hypertension from 60.2% to 29.3%, indicating that uncorrected V waves artificially inflate estimates of pulmonary vascular disease. These findings highlight that prominent V waves independently augment right ventricular afterload and contribute to right heart failure in HFpEF, underscoring the need for V-wave correction during invasive hemodynamic assessment. ## Abstract (original, from the publication) BACKGROUND: Left atrial (LA) stiffening augments the LA V wave, pressurizing the pulmonary artery (PA) out of proportion to left ventricular end-diastolic pressure. We characterized the pathophysiologic, diagnostic, and clinical implications of LA stiffening, as defined by prominent V waves, in heart failure with preserved ejection fraction. METHODS: In this retrospective cohort study, patients with heart failure with preserved ejection fraction and less than moderate mitral regurgitation at rest underwent invasive hemodynamic exercise testing. Patients with heightened operant LA stiffening were defined by the PA wedge pressure (PAWP) V wave exceeding mean PAWP by ≥10 mm Hg. A previously used formula for V wave-corrected PAWP was validated against the PAWP waveform pressure-time-area to explore impact of the V wave on transpulmonary pressure gradients. Clinical, echocardiographic, hemodynamic, and outcome data were compared for patients with and without prominent V waves. RESULTS: Compared with patients without prominent V waves (n=844, 79%), those with prominent V waves (n=225, 21%) were older and more likely to be women, with more severe LA myopathy, evidenced by greater LA volume index (42.2±15.0 versus 32.5±13.0 mL/m2, P<0.001), lower LA reservoir strain (16.4±7.5% versus 23.2±8.3%, P<0.001), more atrial fibrillation (61.3% versus 22.9%, P<0.001), and increased operant LA reservoir stiffness (0.59±0.25 versus 0.23±0.24 mm Hg/mL, P<0.001). Patients with prominent V waves had markedly higher PA systolic pressure than those without (54±16 versus 38±12 mm Hg, P<0.001) despite no difference in end-diastolic PAWP-PA pressure gradient (3±5 versus 3±4 mm Hg, P=0.950). Incorporating the V wave into PAWP improved correlation between directly measured PAWP pressure-time integral compared with mid-A wave PAWP (R2=0.96 versus R2=0.86, P<0.001 for comparison). In patients with prominent V waves, the prevalence of combined pre- and postcapillary pulmonary hypertension decreased from 60.2% to 29.3% after V wave correction for the transpulmonary pressure gradients. Despite similar corrected pulmonary vascular resistances in patients with and without prominent V waves, apparent PA compliance was much lower in patients with prominent V waves (3.03±1.56 versus 4.90±2.27 mL/mm Hg, P<0.001), augmenting right ventricular afterload, and these changes were coupled with more severe right ventricular dysfunction, tricuspid regurgitation, blunted cardiopulmonary exercise reserve, and increased risk of hospitalization for heart failure or death in patients with versus without prominent V waves (adjusted hazard ratio, 2.09 [95% CI, 1.53-2.86]; P<0.001). CONCLUSIONS: More than 1 in 5 patients with heart failure with preserved ejection fraction display prominent V waves in excess of end-diastolic PAWP. This augments right ventricular afterload due to backward transmission of the V wave, contributing to right heart failure that is independent of the pulmonary vasculature. Failure to account for the V wave during hemodynamic assessment overestimates the severity of pulmonary vascular disease present. Auteurs: Thanat Chaikijurajai, Yogesh N V Reddy, Tomonari Harada, Jwan A Naser, Sho Kazui, Naoyuki Akashi, Takahiro Okuno, Fahime Ghanbari, Barry A Borlaug --- Bron: Circulation, https://doi.org/10.1161/CIRCULATIONAHA.126.081799. Bijgewerkt 2026-10-12T00:56:58Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.