Pathophysiology of the aortic regurgitation Doppler signal end-diastolic notching: "A-dip insight".

A 76-year-old man was admitted to the hospital with symptoms of severe decompensated heart failure. Initial echocardiogram showed normal left ventricular (LV) ejection fraction, grade II diastolic dysfunction, and mild-to-moderate aortic regurgitation. The aortic regurgitant Doppler signal exhibited an end-diastolic notching, called an A-dip. After intravenous diuretic therapy and 3 kg weight loss, a new echocardiogram was performed showing a grade I diastolic dysfunction and complete abolishment of the A-dip. Aortic A-dip is a rare finding denoting increased LV filling pressures. Conditions that favor its occurrence are increased LV stiffness, low diastolic blood pressure, and preserved left atrial contractility.