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Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
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The mitral L wave: a marker of advanced diastolic dysfunction in patients with atrial fibrillation

Hiromi Nakai1, Masaaki Takeuchi, Tomoko Nishikage

  • 1Department of Cardiology and Internal Medicine, Tane General Hospital, Osaka, Japan.

Circulation Journal : Official Journal of the Japanese Circulation Society
|July 27, 2007
PubMed

Insights

The mitral L wave, a mid-diastolic filling wave, is common in atrial fibrillation (AF) and signals advanced diastolic dysfunction, including elevated filling pressures and left atrial enlargement.

Area of Science:

  • Cardiology
  • Echocardiography
  • Diastology

Background:

  • The mitral L wave signifies advanced diastolic dysfunction in sinus rhythm.
  • Atrial fibrillation (AF) presents unique challenges in diastolic function assessment.

Purpose of the Study:

  • To investigate the clinical implications of the mitral L wave in patients with atrial fibrillation (AF).

Main Methods:

  • Echocardiographic assessment of 99 patients with chronic persistent non-valvular AF.
  • Defined mitral L wave as mid-diastolic flow velocity >20 cm/s.
  • Compared characteristics of patients with and without L waves, and assessed Valsalva/leg elevation effects.

Main Results:

  • Prevalence of mitral L wave in AF was 34% (vs. 2.4% in sinus rhythm, p<0.001).
  • AF patients with L wave were older, more female, with slower heart rate, larger left atrial volume index, and higher E/E' ratio.
  • Valsalva maneuver decreased and leg elevation increased L wave amplitude.

Conclusions:

  • The mitral L wave is relatively common in AF patients.
  • Its presence indicates advanced diastolic dysfunction, elevated filling pressures, and a distended, noncompliant left atrium.
Abstract

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