title: The mitral L wave: a marker of advanced diastolic dysfunction in patients with atrial fibrillation.
abstract: 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).
  
  
  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<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.
authors.affiliation: Department of Cardiology and Internal Medicine, Tane General Hospital, Osaka, Japan.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Nakai
authors.forename: Masaaki
authors.initials: M
authors.lastname: Takeuchi
authors.forename: Tomoko
authors.initials: T
authors.lastname: Nishikage
authors.forename: Toshiki
authors.initials: T
authors.lastname: Nagakura
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Otani
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000503:physiopathology*; D015415:Biomarkers; D001783:Blood Flow Velocity; D003971:Diastole; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology*; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D015415:Biomarkers