{"id":18323,"date":"2017-10-21T20:50:06","date_gmt":"2017-10-21T15:20:06","guid":{"rendered":"https:\/\/cardiophile.org\/?p=18323"},"modified":"2017-10-21T20:50:06","modified_gmt":"2017-10-21T15:20:06","slug":"triphasic-left-ventricular-filling-pattern","status":"publish","type":"post","link":"https:\/\/johnsonfrancis.org\/professional\/triphasic-left-ventricular-filling-pattern\/","title":{"rendered":"Triphasic left ventricular filling pattern"},"content":{"rendered":"<h2><span style=\"color: #008000;\">Triphasic left ventricular filling pattern<\/span><\/h2>\n<p><iframe loading=\"lazy\" width=\"560\" height=\"315\" src=\"https:\/\/www.youtube.com\/embed\/VQQVKaxjipA\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture\" allowfullscreen=\"\"><\/iframe><\/p>\n<figure id=\"attachment_41204\" aria-describedby=\"caption-attachment-41204\" style=\"width: 645px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" class=\"size-full wp-image-41204\" src=\"https:\/\/johnsonfrancis.org\/professional\/wp-content\/uploads\/2017\/10\/Triphasic-mitral-flow.jpg\" alt=\"Triphasic mitral flow\" width=\"645\" height=\"328\"><figcaption id=\"caption-attachment-41204\" class=\"wp-caption-text\">Triphasic mitral flow<\/figcaption><\/figure>\n<p style=\"text-align: center;\"><strong><span style=\"color: #0000ff;\"><em>Triphasic left ventricular filling pattern (Representative image)<\/em><\/span><\/strong><\/p>\n<p>Normal left ventricular filling pattern is biphasic with an early diastolic E wave which occurs soon after the opening of the mitral valve and a late diastolic A wave during atrial systole. Normally E wave is taller than A wave, but A wave can be taller in situations of left ventricular diastolic dysfunction (E\/A reversal). A triphasic left ventricular filling pattern with an additional mid diastolic wave, called <em>T wave<\/em> <sup>1<\/sup> by some authors and <em>L wave<\/em> <sup>2<\/sup>&nbsp;by others, can occur in situations of left ventricular diastolic dysfunction, especially in hypertrophic cardiomyopathy. A corresponding <em>L&#8217; wave<\/em><sup>3,4<\/sup>&nbsp;or <em>T&#8217; wave<\/em><sup>1<\/sup> in tissue Doppler has also been described. Same pattern has been documented in color M-Mode with additional T wave. The name <em>T wave was probably derived as short form for a third wave<\/em>, though it occurs between the first and second diastolic waves. Third wave has also been documented in pulmonary venous Doppler in which the T wave is between the early diastolic D wave and AR wave of atrial reversal. AR wave is negative while D and T waves of pulmonary venous Doppler are positive waves.<sup>1&nbsp;<\/sup>Triphasic pattern of mitral inflow and mitral annular tissue Doppler has also been reported in a hypertensive emergency.<sup>5&nbsp;<\/sup>L wave has also been reported in M-Mode echocardiogram along with a mitral inflow L wave.<sup>6<\/sup> L wave indicates mid diastolic flow from pulmonary veins into the left atrium and further into the left ventricle.<sup>7&nbsp;<\/sup>In those with left ventricular diastolic dysfunction, an L wave indicates high risk of risk hospitalization for heart failure as it connotes high left ventricular filling pressures.<sup>8<\/sup> It is associated with clinical heart failure in case of left ventricular systolic dysfunction.<sup>9<\/sup><\/p>\n<p><span style=\"color: #008000;\"><strong>Mechanism of triphasic left ventricular filling pattern<\/strong><\/span><\/p>\n<p>Triphasic left ventricular filling pattern has been considered to be a mixed pattern of restrictive filling and impaired relaxation. The third longitudinal movement of the mitral annulus on tissue Doppler is thought to be due to extra myocardial relaxation with a suction force.<sup>1 <\/sup>This suction force due to the delayed relaxation causes the mid diastolic flow which is manifest as the T wave or L wave. There is also a view that the third mid diastolic wave indicates advanced left ventricular diastolic dysfunction as is often present in hypertrophic cardiomyopathy.<sup>3 <\/sup>This was suggested by&nbsp;an association of L&#8217; with higher E\/E&#8217; ratio, larger left atrium and higher proBNP levels.<\/p>\n<p><span style=\"color: #0000ff;\"><strong>References<\/strong><\/span><\/p>\n<ol>\n<li>Araujo AQ, Arteaga E, Salemi VMC, Mady C. Triphasic left ventricular filling in hypertrophic cardiomyopathy. Heart 2005;91(4):538.<\/li>\n<li>Coppini R, Ho CY, Ashley E, Day S, Ferrantini C, Girolami F, Tomberli B, Bardi S, Torricelli F, Cecchi F, Mugelli A, Poggesi C, Tardiff J, Olivotto I.&nbsp;Clinical Phenotype and Outcome of Hypertrophic Cardiomyopathy Associated With Thin-Filament Gene Mutations. Am Coll Cardiol. 2014;64(24):2589-2600.<\/li>\n<li>Ha JW, Ahn JA, Moon JY, Suh HS, Kang SM, Rim SJ, Jang Y, Chung N, Shim WH, Cho SY.&nbsp;Triphasic mitral inflow velocity with mid-diastolic flow: the presence of mid-diastolic mitral annular velocity indicates advanced diastolic dysfunction.&nbsp;Eur J Echocardiogr. 2006 Jan;7(1):16-21.<\/li>\n<li>Debl K, Djavidani B, Buchner S, Poschenrieder F, Feuerbach S, Riegger G, Luchner A.&nbsp;Triphasic mitral inflow pattern and regional triphasic mitral annulus velocity in hypertrophic cardiomyopathy.&nbsp;J Am Soc Echocardiogr. 2008 Apr;21(4):407.e5-6.<\/li>\n<li>Schiano Lomoriello V, Esposito R, Marzano A, Raia R, Galderisi M.&nbsp;Triphasic diastolic pattern and delayed timing of myocardial relaxation identify dynamic changes of left ventricular filling pressure.&nbsp;Minerva Cardioangiol. 2008 Jun;56(3):371-5.<\/li>\n<li>Kumar V, Jose J, Jose VJ.&nbsp;L wave in echo Doppler.&nbsp;Indian Heart J. 2014 May-Jun;66(3):392-3.<\/li>\n<li>&nbsp;Keren G, Meisner JS, Sherez J, Yellin EL, Laniado S. Interrelationship of mid-diastolic mitral valve motion, pulmonary venous flow, and transmitral flow. Circulation. 1986;74:36-44.<\/li>\n<li>Lam CS, Han L, Ha JW, Oh JK, Ling LH. The mitral L wave: a marker of pseudonormal filling and predictor of heart failure in patients with left ventricular hypertrophy. J Am Soc Echocardiogr. 2005;18:336-341.<\/li>\n<li>Ha JW, Oh JK, Redfield MM, Ujino K, Seward JB, Tajik AJ. Triphasic mitral inflow velocity with middiastolic filling: clinical implications and associated echocardiographic findings. <span class=\"ref-journal\">J Am Soc Echocardiogr. <\/span>2004;<span class=\"ref-vol\">17<\/span>:428-431.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>In triphasic left ventricular filling pattern, described in hypertrophic cardiomyopathy, an additional mid diastolic wave which is called T wave or L wave is seen. A corresponding L&#8217; wave can be noted on tissue Doppler echocardiography. <\/p>\n","protected":false},"author":1,"featured_media":22286,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","footnotes":""},"categories":[8],"tags":[],"class_list":["post-18323","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-echocardiogram-library"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Triphasic left ventricular filling pattern - All About Cardiovascular System and Disorders<\/title>\n<meta name=\"description\" content=\"A triphasic left ventricular filling pattern with an additional mid diastolic wave, called T wave by some authors and L wave by others, can occur in situations of left ventricular diastolic dysfunction, especially in hypertrophic cardiomyopathy.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/johnsonfrancis.org\/professional\/triphasic-left-ventricular-filling-pattern\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Triphasic left ventricular filling pattern - 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