Left Ventricular Rapid Filling Wave

Definition and Physiological Significance

The left ventricular rapid filling wave (RFW) is a hemodynamic phenomenon that occurs during early diastole, representing the pressure rise in the left ventricle as blood rapidly enters from the left atrium following mitral valve opening, according to the European Society of Cardiology 1
The rapid filling wave appears on left ventricular pressure recordings as a distinct pressure rise that occurs after the left ventricular minimal pressure and before the pre-A pressure, as described by the European Society of Cardiology 1
This phase is primarily driven by the pressure gradient between the left atrium and left ventricle, which develops during ventricular relaxation, as reported by the European Society of Cardiology 2

The rapid filling wave is influenced by multiple factors, including left ventricular relaxation (lusitropy) and left ventricular compliance (stiffness), as stated by the American Heart Association 3
Left atrial pressure and mitral valve function also influence the rapid filling wave, according to the European Society of Cardiology 1 and 2

The rapid filling phase corresponds to the E-wave on mitral inflow Doppler, and key parameters that reflect this phase include mitral E velocity, E-wave deceleration time (DT), and tissue Doppler e' velocity, as described by the European Society of Cardiology 2
The E/e' ratio helps distinguish between normal and elevated filling pressures by correcting for the effect of relaxation on the E wave, as reported by the European Society of Cardiology 2

Alterations in the rapid filling wave can indicate diastolic dysfunction, as stated by the American Heart Association 3
In more advanced diastolic dysfunction, the rapid filling wave may appear enhanced due to increased left atrial pressure despite impaired relaxation, according to the European Society of Cardiology 2

The rapid filling wave should be interpreted in context with other diastolic parameters, including left atrial size and tricuspid regurgitation velocity, as reported by the American Heart Association 3
The presence of L wave (mid-diastolic flow) is also an important consideration, according to the European Society of Cardiology 2

Heart rate and rhythm abnormalities can significantly affect the rapid filling wave assessment, as stated by the European Society of Cardiology 4
Age-related changes in diastolic function must be considered when interpreting rapid filling parameters, according to the European Society of Cardiology 2