Clinical implications of antegrade diastolic pulmonary artery flow in adults

•Antegrade diastolic pulmonary artery flow (ADPAF) reflects right ventricular (RV) restriction in adults.•ADPAF was found in 0.07% patients who underwent echocardiography in our hospital.•ADPAF suggests a less favorable prognosis in patients with RV dysfunction. End-diastolic opening of the pulmonary valve and subsequent antegrade diastolic pulmonary artery flow (ADPAF) reflect restrictive right ventricular (RV) physiology in children. However, this has attracted little attention in adults. To clarify the clinical implications of ADPAF in adults. The study population consisted of 23,049 consecutive adult patients who underwent echocardiography in our hospital between 2008 and 2015. ADPAF was found in 17 patients (0.07%). The simultaneous recording of RV and pulmonary artery pressures revealed marked elevation of RV diastolic pressure, which exceeded pulmonary artery pressure at the time of atrial contraction. These results suggested that ADPAF implies RV restriction. Based on the level of tricuspid annular plane systolic excursion (TAPSE), we classified these patients into two groups: reduced RV function (R-RVF) group (12 patients with TAPSE