Acute L waves in heart failure

L waves are an unusual finding in the analysis of mitral valve pulsed-wave Doppler. This wave is recorded as flow between the left atrium and left ventricle during diastole, due to elevated left ventricular (LV) filling pressures.1, 2, 3 In this situation, triphasic mitral filling can be observed, with the presence of mid-diastolic L waves.

We present the case of a 71-year-old female with preserved LV ejection fraction (LVEF) and moderate ventricular hypertrophy secondary to hypertensive cardiomyopathy, according to a cardiac magnetic resonance study performed the year before. The patient had an episode of acute pulmonary edema during an admission for malaria, with complications of fever, acute kidney disease and hypertensive crisis. During the initial assessment, a transthoracic echocardiogram was performed, which showed high LV filling pressure (E/E′ ratio 23), systolic pulmonary pressure of 60 mmHg estimated by tricuspid regurgitation Doppler, and L waves on mitral pulsed-wave Doppler (Figure 1). Laboratory tests showed NT-proBNP of 1962 pg/ml.

CITA DEL ARTÍCULO  Rev Port Cardiol. 2023 Nov 2:S0870-2551(23)00462-6.  doi: 10.1016/j.repc.2023.06.010