Correlates and Prognostic Values of Appearance of L Wave in Heart Failure Patients With Preserved vs. Reduced Ejection Fraction

Abstract

Appearance of L wave is associated with the degree of LV diastolic dysfunction, but there was a difference in LV geometrical correlates of the appearance of L wave between the HFpEF and HFrEF groups. Detection of L wave is suggestive of poor prognosis independent of LVEF in HF.

Serial changes of L wave according to heart rates in a heart failure patient with persistent atrial fibrillation

“…There were 10 bpm difference between the presence and the absence of A wave in the HR of L wave disappearance. These findings are consistent with the previous reports describing that L wave is more likely to be observed in patients with AF and lower HR [3], [4]. In the condition with the presence of A wave, A wave occupied late diastolic phase and shortened the time for L wave existence (Fig.…”

“…L wave is occasionally detected in patients with heart failure and regarded as an indicator of diastolic dysfunction [2], [5]. Some previous researchers have reported that regardless of ejection fraction, L wave is more likely to be observed in heart failure patients with lower HR, higher LV filling pressure and AF, and the presence of L wave is associated with poor prognosis [3], [4], [6]. However, in these reports, L wave was observed not for a certain duration but at a specific point of time, e.g.…”

“…L wave is usually defined as mid-diastolic forward flow velocity of transmitral flow whose velocity is more than 20 cm/sec and has been reported as a marker of diastolic dysfunction and/or elevation of left ventricular (LV) filling pressure, especially in patients with LV hypertrophy [1], [2]. Some previous clinical studies have reported that L wave is more likely to occur in lower heart rate (HR) and atrial fibrillation (AF) [2], [3], [4]. However, L wave is not necessarily observed in patients with those hemodynamic conditions.…”

Mid-Diastolic Events (L Events): A Critical Review

“…Mid-diastolic events (L events). presence as a marker of advanced diastolic dysfunction and increased risk of adverse cardiac events [15][16][17][18]. L events are affected by heart rate (HR), cardiac rhythm, and loading conditions.…”

“…It was called “L” because it follows the K and J pulmonary vein flow phases (corresponding to the S and D waves of pulmonary venous flow Doppler sampling). Although L waves were first reported in healthy individuals, many studies indicate their presence as a marker of advanced diastolic dysfunction and increased risk of adverse cardiac events [ 15 , 16 , 17 , 18 ]. L events are affected by heart rate (HR), cardiac rhythm, and loading conditions.…”