E-wave generated intraventricular diastolic vortex to L-wave relation: Model-based prediction with in vivo validation

Erina Ghosh, Shelton D. Caruthers, Sándor J. Kovács

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


The Doppler echocardiographic E-wave is generated when the left ventricle's suction pump attribute initiates transmitral flow. In some subjects E-waves are accompanied by L-waves, the occurrence of which has been correlated with diastolic dysfunction. The mechanisms for L-wave generation have not been fully elucidated. We propose that the recirculating diastolic intraventricular vortex ring generates Lwaves and based on this mechanism, we predict the presence of L-waves in the right ventricle (RV). We imaged intraventricular flow using Doppler echocardiography and phase-contrast magnetic resonance imaging (PC-MRI) in 10 healthy volunteers. L-waves were recorded in all subjects, with highest velocities measured typically 2 cm below the annulus. Fifty-five percent of cardiac cycles (189 of 345) had L-waves. Color M-mode images eliminated mid-diastolic transmitral flow as the cause of the observed L-waves. Three-dimensional intraventricular flow patterns were imaged via PC-MRI and independently validated our hypothesis. Additionally as predicted, L-waves were observed in the RV, by both echocardiography and PC-MRI. The re-entry of the E-wave-generated vortex ring flow through a suitably located echo sample volume can be imaged as the L-wave. These waves are a general feature and a direct consequence of LV and RV diastolic fluid mechanics.

Original languageEnglish
Pages (from-to)316-324
Number of pages9
JournalJournal of Applied Physiology
Issue number3
StatePublished - Aug 1 2014


  • Cardiac magnetic resonance imaging
  • Diastolic function
  • Echocardiography
  • Intraventricular vortex
  • Ventricular suction


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