In HFpEF, a prominent V wave can make pulmonary vascular disease look worse than it is

The edition in brief

A retrospective cohort of 1,069 patients with heart failure with preserved ejection fraction who had invasive exercise haemodynamics found 21% had prominent wedge V waves, linked to a stiff, enlarged left atrium and atrial fibrillation. Their pulmonary artery systolic pressure was much higher, but after correcting the wedge pressure for the V wave the share classed as combined pre- and post-capillary pulmonary hypertension fell from 60.2% to 29.3%. The V wave lowered pulmonary artery compliance and was associated with twice the risk of heart failure hospitalisation or death. A single-centre phase 2 trial of 158 patients found oral roxadustat after primary PCI did not reduce infarct size at 30 days. A HELIOS-B analysis found vutrisiran's benefit in transthyretin cardiomyopathy was consistent whether or not patients were also taking tafamidis or heart failure drugs. A pragmatic English trial of 3,543 patients with suspected acute coronary syndrome found the ESC 0/1-hour troponin pathway was non-inferior for safety to a 0/3-hour pathway but did not discharge more patients within four hours, because laboratory turnaround and system delays absorbed the time saved.