Diastolic plateau wave of pulmonary artery pressure in severe congestive heart failure

We describe 3 cases of severe congestive heart failure. The patients exhibited a marked decrease in transmitral flow velocity during atrial contraction and an abnormal diastolic plateau wave of pulmonary artery pressure (PAP). The first patient was a 60-year-old man with acute myocardial infarction and acute renal failure in whom pulmonary capillary wedge pressure (PCWP) was raised to 20 mmHg. Pulsed Doppler echocardiography revealed a marked decrease in transmitral flow velocity during atrial contraction, and the PAP waveform showed a mid to late diastolic plateau wave. Treatment for congestive heart failure reduced PCWP to 10 mmHg and the PAP waveform returned to normal. Doppler examination revealed the normal transmitral flow velocity pattern. The second patient was a 37-year-old woman with subarachnoid hemorrhage and the third patient a 74-year-old man with acute myocardial infarction. In these patients, the PAP waveform also showed a diastolic plateau wave, which was abolished by treatment. We believe that the diastolic plateau wave of PAP indicates left ventricular diastolic dysfunction and marked elevation of left ventricular filling pressure.