Heart failure patients (pts) with the restrictive transmitral flow pattern by Doppler echo have been demonstrated to have increased functional impairment and higher mortality. However, the role of left atrial transport in contributing to LV dysfunction in such patients is unknown. Therefore, we analyzed the relation of transmittal flow (TMF) patterns and pulmonary venous flow (PVF) velocities in 51 heart failure pts (29 men, 22 women; age 61 +/- 9 yrs) with an ejection fraction (EF) < 40%. Transthoracic echo and pulsed Doppler were performed from the apical 4-chamber view at the mitral annulus level for TMF, and at the orifice of the right upper pulmonary vein using color flow guidance for PVF. Measurements: TMF early (E) and late (A) velocities; PVF systolic (S), diastolic (D), atrial reversal (Ar) velocities (cm/s); left atrial size (LA, cm) and heart rate (HR). 13 pts of the study population had right heart catheter measurements of the pulmonary wedge pressure (PWP). Pts were assigned to two groups according to TMF: a restrictive (21 pts) with E/A =< 2 and A =< 35, and a nonrestrictive (30 pts) with E/A < 2 or A > 35. Results (mean +/- SD):There was no relationship between PWP and Ar (r = 0.003, p = NS). However, an elevated PWP was associated a decreased S (r = -0.70, P < 0.01) and an increased D (r = 0.76, p < 0.01). Thus, the Doppler echo findings in heart failure pts with a restrictive transmitral flow pattern suggest that both reduced LA compliance (i.e. decreased systolic atrial filling and high PWP) and reduced LA contraction (i.e. decreased forward and backward flow during atrial systole) contribute to abnormal left atrial transport function.