Abstract
Mid-diastolic events (L events) include three phenomena appreciable on echocardiography occurring during diastasis: mid-diastolic transmitral flow velocity (L wave), mid-diastolic mitral valve motion (L motion), and mid-diastolic mitral annular velocity (L’ wave). L wave is a known marker of advanced diastolic dysfunction in different pathological clinical settings such as left ventricle and atrial remodeling, overloaded states, and cardiomyopathies. Patients with L events have poor outcomes with a higher risk of developing heart failure symptoms and arrhythmic complications, including sudden cardiac death. The exact mechanism underlying the genesis of mid-diastolic events is not fully understood, just as the significance of these events in healthy young people or their presence at the tricuspid valve level. We also report an explicative case of a patient with L events studied using speckle tracking imaging of the left atrium and ventricle at the same reference heartbeat supporting the hypothesis of a post-early diastolic relaxation or a “two-step” ventricular relaxation for L wave genesis. Our paper seeks to extend knowledge about the pathophysiological mechanisms on mid-diastolic events and summarizes the current knowledge.
Highlights
Echocardiography and other diagnostic techniques in the field of cardiovascular diseases have been equipped with new application tools [1–8]
We evaluated a patient with a triphasic transmitral pattern to demonstrate the myocardial mechanics of L events through the use of atrial and ventricular speckle tracking imaging (STI) on the same reference heartbeat (Table 3)
The L wave is by far the most studied mid-diastolic phenomenon. It can define a category of patients at a increased risk of heart failure (HF) and all-cause mortality, when it is combined with altered NP levels
Summary
Echocardiography and other diagnostic techniques in the field of cardiovascular diseases have been equipped with new application tools [1–8]. The study of diastasis and mid-diastolic events initially appeared in the literature in the 1950s [9]. Mid-diastolic transmitral flow velocity (L wave) is the most studied [10–14]. Med. 2021, 10, 5654 presence as a marker of advanced diastolic dysfunction and increased risk of adverse cardiac events [15–18]. L events are affected by heart rate (HR), cardiac rhythm, and loading conditions. This article aimedcarto presence as The a marker advanced diastolic dysfunction and risk of adverse critically review the existing literature on mid-diastolic events This article aimed to critically review the existing literature on mid-diastolic events (especially L waves) in. E’ wave (or e’ wave): early diastolic transmitral flow velocity. ME’ wave (or e’ wave): early diastolic transmitral flow velocity. * In some publications it was defined as basilar–apical mid-diastolic annular velocity > 20 cm/s.
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