Triphasic diastolic transmitral and intraventricular blood flows and their relationship with LV diastolic dysfunction according to echocardiography

An acceleration of blood flow in the diastasis phase with the formation of the so-called L-wave may be found in some patients. The transmitral blood flow is transformed into a triphasic in the presence of L-wave.

Objective: to assess the frequency of L-wave presence and to evaluate the relationship between the presence of L-wave in Doppler imaging of left ventricular blood flow, transmitral blood flow at the level of the mitral valve leaflets, and modern criteria for assessing left ventricular diastolic function.

Material and methods. The study included 105 patients (age 62.21 ± 11.97 (29–91) years, 61 men) with sinus rhythm. From a total of examined patients, 30 were conditionally healthy, 64 patients suffered from coronary heart disease, and 11 suffered from arterial hypertension. Pulsed-wave Doppler ultrasound of transmitral flow was performed in the apical 4-chamber view with the sample volume located at the level of the ends of the mitral valve leaflets, as well as at the level of the basal and middle segments of the left ventricle. The distinct positive wave on the spectrogram during the diastasis phase with a speed exceeding 20 cm/s was considered an additional L-wave, and such blood flow in diastole was considered triphasic.

Results. Triphasic transmitral blood flow was found in 9 patients (8.5%), and triphasic intraventricular blood flow in another 30 patients (28.5%). Patients with triphasic transmitral blood flow were older, with a greater left atrial volume index, and LV diastolic dysfunction was more often detected compared to patients with triphasic intraventricular blood flow (66.7% compared to 23.3%, p = 0.042).

Conclusion. Triphasic transmitral blood flow is revealing significantly less frequently than triphasic intraventricular blood flow (8.5% compared to 28.5%, p < 0.001). Triphasic transmitral blood flow is more often observed in patients with left ventricular diastolic dysfunction.

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