Cyclic changes in pulmonary wedge v waves in dilated cardiomyopathy

Right and left cardiac catheterization was performed in a 29-year-oldmale with dilated cardiomyopathy. During the procedure, prominentv waves appeared spontaneously in the pulmonary capillary wedgepressure recording with a simultaneous decrease in left ventricularsystolic pressure. Left ventricular angiography showed moderateto severe mitral regurgitation and an ejection fraction of 22%.The right ventricular endomyocardial biopsy revealed histologicalfindings consistent with dilated cardiomyopathy. Cardiac catheterization was repeated 9 months later, after aperiod of clinical improvement and a reduction in the rightand left ventricular filling pressures was documented. The cyclicswings in the pulmonary capillary wedge pressure and in theleft ventricular systolic pressure were not observed. Left ventriculographyshowed mild mitral regurgitation with an ejection fraction of37%. Right ventricular endomyocardial biopsy documented a reductionin myofibrillar and nuclear hypertrophy. Thus, cyclic changesin pulmonary wedge v waves may be observed in dilated cardiomyopathy.This finding is consistent with cyclic variations in the degreeof mitral regurgitation. Disappearance of this factor seemsto be related to improvement in left ventricular contractility.