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

Background The prominent mid-diastolic filling wave (mitral L wave) indicates advanced diastolic dysfunction in patients in sinus rhythm. The aim of the present study was to determine the clinical implications of the mitral L wave in patients with atrial fibrillation (AF). Methods and Results Ninety...

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Published in:Circulation Journal 2007, Vol.71(8), pp.1244-1249
Main Authors: Nakai, Hiromi, Takeuchi, Masaaki, Nishikage, Tomoko, Nagakura, Toshiki, Otani, Shinichiro
Format: Article
Language:English
Subjects:
Age Factors
Aged
Aged, 80 and over
Atrial fibrillation
Atrial Fibrillation - physiopathology
Biomarkers
Blood Flow Velocity
Diastole
Diastolic function
Female
Heart Rate
Humans
Male
Middle Aged
Mitral L wave
Mitral Valve - physiopathology
Prevalence
Risk Factors
Sex Factors
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cited_by cdi_FETCH-LOGICAL-c479t-2f4a5410fdfc45aa3ba663005d063eb6bb562af8b7a550826c3be376e4716c0e3
cites cdi_FETCH-LOGICAL-c479t-2f4a5410fdfc45aa3ba663005d063eb6bb562af8b7a550826c3be376e4716c0e3
container_end_page 1249
container_issue 8
container_start_page 1244
container_title Circulation Journal
container_volume 71
creator Nakai, Hiromi
Takeuchi, Masaaki
Nishikage, Tomoko
Nagakura, Toshiki
Otani, Shinichiro
description Background The prominent mid-diastolic filling wave (mitral L wave) indicates advanced diastolic dysfunction in patients in sinus rhythm. The aim of the present study was to determine the clinical implications of the mitral L wave in patients with atrial fibrillation (AF). Methods and Results Ninety-nine consecutive non-valvular chronic persistent AF patients were enrolled. The mitral L wave was defined as a distinct mid-diastolic flow velocity following the E wave with a peak velocity >20 cm/s. The prevalence of the L wave in AF patients (34/99, 34%) was significantly higher than that observed in patients in sinus rhythm during the same study period (23/946, 2.4%, p
doi_str_mv 10.1253/circj.71.1244
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The aim of the present study was to determine the clinical implications of the mitral L wave in patients with atrial fibrillation (AF). Methods and Results Ninety-nine consecutive non-valvular chronic persistent AF patients were enrolled. The mitral L wave was defined as a distinct mid-diastolic flow velocity following the E wave with a peak velocity &gt;20 cm/s. The prevalence of the L wave in AF patients (34/99, 34%) was significantly higher than that observed in patients in sinus rhythm during the same study period (23/946, 2.4%, p&lt;0.001). Patients with AF and L wave were older, more frequently female and had a slower heart rate, shorter isovolumic relaxation times, larger E wave velocities and lower early diastolic mitral annulus velocity (E') resulting in the higher E/E' compared to those without L waves. The left atrial volume index was significantly larger in patients with an L wave. The Valsalva maneuver decreased, and leg elevation increased, the amplitude of the L wave in the subset of patients who received these procedures. Conclusions The appearance of the mitral L wave in AF is relatively common, and its presence indicates advanced diastolic dysfunction, including elevated filling pressures and distended noncompliant LA. 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The aim of the present study was to determine the clinical implications of the mitral L wave in patients with atrial fibrillation (AF). Methods and Results Ninety-nine consecutive non-valvular chronic persistent AF patients were enrolled. The mitral L wave was defined as a distinct mid-diastolic flow velocity following the E wave with a peak velocity &gt;20 cm/s. The prevalence of the L wave in AF patients (34/99, 34%) was significantly higher than that observed in patients in sinus rhythm during the same study period (23/946, 2.4%, p&lt;0.001). Patients with AF and L wave were older, more frequently female and had a slower heart rate, shorter isovolumic relaxation times, larger E wave velocities and lower early diastolic mitral annulus velocity (E') resulting in the higher E/E' compared to those without L waves. The left atrial volume index was significantly larger in patients with an L wave. The Valsalva maneuver decreased, and leg elevation increased, the amplitude of the L wave in the subset of patients who received these procedures. Conclusions The appearance of the mitral L wave in AF is relatively common, and its presence indicates advanced diastolic dysfunction, including elevated filling pressures and distended noncompliant LA. 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The aim of the present study was to determine the clinical implications of the mitral L wave in patients with atrial fibrillation (AF). Methods and Results Ninety-nine consecutive non-valvular chronic persistent AF patients were enrolled. The mitral L wave was defined as a distinct mid-diastolic flow velocity following the E wave with a peak velocity &gt;20 cm/s. The prevalence of the L wave in AF patients (34/99, 34%) was significantly higher than that observed in patients in sinus rhythm during the same study period (23/946, 2.4%, p&lt;0.001). Patients with AF and L wave were older, more frequently female and had a slower heart rate, shorter isovolumic relaxation times, larger E wave velocities and lower early diastolic mitral annulus velocity (E') resulting in the higher E/E' compared to those without L waves. The left atrial volume index was significantly larger in patients with an L wave. The Valsalva maneuver decreased, and leg elevation increased, the amplitude of the L wave in the subset of patients who received these procedures. Conclusions The appearance of the mitral L wave in AF is relatively common, and its presence indicates advanced diastolic dysfunction, including elevated filling pressures and distended noncompliant LA. (Circ J 2007; 71: 1244 - 1249)</abstract><cop>Japan</cop><pub>The Japanese Circulation Society</pub><pmid>17652889</pmid><doi>10.1253/circj.71.1244</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record>
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source Freely Accessible Journals
subjects Age Factors
Aged
Aged, 80 and over
Atrial fibrillation
Atrial Fibrillation - physiopathology
Biomarkers
Blood Flow Velocity
Diastole
Diastolic function
Female
Heart Rate
Humans
Male
Middle Aged
Mitral L wave
Mitral Valve - physiopathology
Prevalence
Risk Factors
Sex Factors
title The Mitral L Wave: A Marker of Advanced Diastolic Dysfunction in Patients With Atrial Fibrillation
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