The mitral L wave: A marker of pseudonormal filling and predictor of heart failure in patients with left ventricular hypertrophy

The Mitral L Wave A Marker of Advanced Diastolic Dysfunction in Patients With Atrial Fibrillation

“…The prominent mid-diastolic filling wave, which has been described as a mitral L wave, is rarely encountered in sinus rhythm, but its existence has been reported as indicating advanced diastolic dysfunction with elevated LV filling pressures. [10][11][12][13] We often observed distinct forward flow immediately after the E wave in patients with AF (Fig 1). We hypothesized that this wave might be a marker of advanced diastolic dysfunction in patients with chronic persistent AF.…”

Familial Hypertrophic Cardiomyopathy With Triphasic Transmitral Flow Velocity

“…Moreover, a mid-diastolic wave is observed between the E and A waves in few patients with HCM [3,5,12,13]. Keren et al [14] described that mid-diastolic wave is produced by the re-establishment of a positive transmitral pressure gradient after rapid LV filling in healthy subjects.…”

“…In HCM patients showing marked mid-diastolic waves, the isometric relaxation time and time constant of the LV pressure decay during isovolumic diastole (tau) determined by LV pressure curve is markedly prolonged, and LV pressure following rapid filling gradually decreases [3,5,12]. Therefore, compared to those patients showing a relaxation failure pattern for the TMF velocity, HCM patients with a mid-diastolic wave are characterized by markedly delayed LV relaxation and decreased LV compliance during end-diastole.…”

“…An electrocardiogram (EKG) showed sinus rhythm, and findings of LV hypertrophy accompanied by slight ST depressions in leads V 5,6 were observed. At the age of 49, the degree of LV hypertrophy had increased compared to that at initial examination, and increased ST depression and inverted T waves were observed in leads V 4,5,6 . Furthermore, the patient experienced episodes of syncope, and a Holter electrocardiogram recording confirmed the occurrence of nonsustained ventricular tachycardia.…”

“…With respect to transmitral flow (TMF) velocity patterns in patients with HCM, most patients usually show a relaxation failure pattern [2,3], although some HCM patients with elevated LV end-diastolic pressure show a pseudonormalized pattern [4]. However, it has been reported that a triphasic TMF velocity pattern with a mid-diastolic wave between the early diastolic and atrial systolic waves is observed infrequently in patients with HCM [3,5]. In the present study, we describe five family members with HCM with a similar distribution of LV hypertrophy and LV filling pattern.…”