Figure 12.

Pulsed wave Doppler interrogation of the mitral valve at the level of the leaflet tips. Panel A demonstrates grade I diastolic dysfunction with “E-A reversal”. This finding is commonly seen in patients over the age of 65, or those with underlying left-sided heart disease. In addition, this pattern is commonly seen in PAH, highlighting how decreased RV function and increased RV size increase ventricular interdependence and impair early LV diastolic filling. Importantly, grade I diastolic dysfunction typically denotes normal resting left atrial pressure. Panel B demonstrates grade II diastolic dysfunction or a “pseudonormal” filling pattern (E>A). This is associated with moderate left atrial hypertension. Panel C demonstrates Grade III or restrictive mitral inflow (E>>A with a short deceleration time). This is seen in patients with markedly elevated left heart filling pressures. Pattern A is common in PAH; patterns B and C are rare in PAH and common in PVH.