Fig. 1. Schematic drawing illustrating different mitral flow velocity patterns (MFVPs). (Top ) A normal MFVP with the simulaneous left atrial (LA; solid line)–left ventricular (LV; dashed line) pressure gradients. The positive transmitral pressure gradients (LA pressure > LV pressure) result in a forward mitral flow. Two distinct forward flows can be distinguished; the E wave, which represents the early filling of the ventricle, and the A wave, which represents the atrial contraction component of LV filling. Negative pressure gradients (LV pressure > LA pressure) decelerate flow after peak E- and A-wave velocities. The magnitude of the pressure gradients determines the peak flow velocities and the subsequent rate of relaxation. (Bottom ) MFVP during different stages of impaired LV filling. In most cases, the initial diastolic filling abnormality is impaired relaxation. Slowing of relaxation delays mitral valve opening. As a consequence of the lower LA–LV pressure gradient, peak E-wave velocity is decreased and deceleration time is increased. The contribution of the atrial contraction in diastolic function increases, resulting in a higher A-wave velocity and a decrease in E/A ratio. Progression of diastolic dysfunction is associated with an alteration of LV compliance. In the presence a mild to moderate decrease in LV compliance and increase in LA pressure, peak E-wave velocity will increase with shortening of the deceleration time. This results in a normalization of the MFVP. This evolution of the MFVP (when diastolic dysfunction progresses from isolated relaxation abnormalities to a restrictive filling pattern) is called pseudonormalization. When diastolic dysfunction progresses further to a stage where compliance is severly affected and LA pressure markedly increased, peak E-wave velocity will continue to increase with further shortening of deceleration time.