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).


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.
Nakai
Hiromi
H
Department of Cardiology and Internal Medicine, Tane General Hospital, Osaka, Japan.
Takeuchi
Masaaki
M
Nishikage
Tomoko
T
Nagakura
Toshiki
T
Otani
Shinichiro
S
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
D015415:Biomarkers