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Figure 2 (Upper left) Mitral left ventricular (LV) inflow; (upper right) pulmonary venous flow; (lower left) tissue Doppler velocities at lateral side of mitral annulus; (lower right) tricuspid regurgitation (TR) jet by continuous wave (CW) Doppler. Mitral inflow is pseudonormal (E/A ratio of 1), and systolic/diastolic (S/D) velocity (and time velocity integral) ratio >1 in the pulmonary veins. However, atrial reversal (Ar) velocity in pulmonary venous flow is increased both in amplitude and duration, indicating increased LV end diastolic pressure. The early diastolic (Ea) velocity is reduced and Ea/ late diastolic (Aa) velocity ratio is <1, indicating abnormal LV relaxation. The E/Ea ratio is increased to 12.5, indicating increased LV pre-A pressure. Peak TR velocity = 2.8 m/s, indicating an RV and pulmonary artery (PA) systolic pressure of at least 31 mm Hg.