J Heart Valve Dis
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Color flow imaging shows that the transmitral flow is initially directed to the left ventricular (LV) apex and then turns around facing the aortic valve. A pulsed wave Doppler sample placed in the LV outflow tract (LVOT) records two peaks of diastolic flow waves, Er and Ar waves, which follow E and A waves of the transmitral flow respectively. The Er and Ar waves represent transmitted E and A flow waves to the LVOT. ⋯ Studies designed to test this hypothesis in a pulsatile LV model showed a linear relationship between the rate of diastolic flow wave propagation inside the LV and its stiffness. These preliminary data suggest that the velocity of A wave transmission inside the LV reflects LV late diastolic stiffness non-invasively. It is expected to be independent of a direct effect of heart rate and of preload.