Clinical and Echocardiographic Correlation of the Mitral L-Wave: An Observational Study

Abstract

Background: The mitral L-wave is a mid-diastolic transmitral Doppler flow signal that is often underrecognized in routine echocardiography despite its diagnostic and prognostic importance. This observational study evaluated the clinical and echocardiographic correlates of the mitral L-wave among patients attending a tertiary care general medicine department. Methods: Fifty-three patients with an echocardiographically confirmed mitral L-wave were studied over 6 months (April 2024–September 2024) at the Department of General Medicine, L.N. Medical College and J.K. Hospital, Bhopal. Clinical presentation, comorbidity profile, and the response of the L-wave to the Valsalva maneuver were recorded and analyzed descriptively. Results: A mitral L-wave was frequently observed in patients with coronary artery disease and chronic kidney disease (50.9% each), and hypertension and type 2 diabetes mellitus (49.1% each), consistent with elevated left ventricular filling pressures. Dyspnea on exertion (62.2%) was the most common presenting symptom, and females constituted a slightly higher proportion (52.8%) of the cohort. Eight patients (15.1%) showed a preload-dependent change in L-wave amplitude during the Valsalva maneuver. Conclusion: The mitral L-wave is a reproducible, load-sensitive Doppler finding associated with diastolic burden that may assist in the early detection and management of heart failure with preserved ejection fraction.