Presystolic flow in ascending aorta in a case of left ventricular diastolic dysfunction

A 65 years old hypertensive presented with effort breathlessness. Echocardiography revealed significant concentric remodeling of left ventricle. (relative wall thickness – 0.86) with significantly impaired relaxation (E/A – 0.54 and Ea/Aa – 0.52). Doppler evaluation of flow in ascending aorta revealed a presystolic flow which coincided with P wave of ECG and A wave of mitral flow. This finding suggests increased stiffness of left ventricle resulting in significant increase in left ventricular pressure during left atrial contraction and presystolic flow in aorta. Our case shows that all cases of grade 1 diastolic dysfunction are not alike. Presystolic flow in ascending aorta suggests greater degree of diastolic dysfunction than what is apparent from conventional criteria.