Two-Slope Mitral Inflow Ascending Arm in Patients with Heart Failure and Preserved Ejection Fraction, Individuals With Risk Factors, and Healthy Controls – A Novel Phenomenon

Objective: To calculate the frequency of 1- and 2-slope E wave ascending arm (EWAA) in 3 study groups: healthy controls (HC), subjects with risk factors for developing heart failure with preserved ejection fraction (HFPEF-RF), and patients with HFPEF.

Methods: Retrospective analysis of EWAAs. Investigators were blind to the association between subject`s clinical group and subject`s echocardiographic examination when measuring slopes.

Results: In the HC, HFPEF-RF, and HFPEF groups there were: 57 and 166, 60 and 161, and 66 and 199 subjects and E waves, respectively. The prevalence of a 2-slope EWAA in the HC, HFPEF-RF, and HFPEF groups was: 38%, 39%, and 46%, respectively (p<0.22). Value of the early slope when 2-slope EWAA was detected was 34-50% greater than that when a single slope EWAA was detected, in each of the groups (p<0.001).

Conclusion: This study shows that a 2-slope EWAA phenomenon is common in the 3 study groups. Further research is required to reveal the mechanism underlying the 2-slope EWAA phenomenon.

Significance: The 2-slope EWAA phenomenon represents a change in the sum of the physical forces driving blood from left atrium to left ventricle at early diastole. If 2-slope EWAA is related to a physiologic effort to augment early diastole, certain medications may impair this phenomenon.