Left ventricular (LV) filling patterns in 26 elderly (mean age 81 years) patients with severe aortic stenosis (AS) were evaluated using pulsed-wave Doppler echocardiography. Parameters of LV filling, including the ratio of the peak atrial velocity to the peak early diastolic velocity (A/E ratio) and the percent contribution of active atrial filling to total LV filling (%A), of these patients with AS (group I) were compared with 2 groups presumed to have abnormal LV filling: elderly patients (group II) and hypertensives with increased LV mass (group III), as well as with normal volunteers (group IV). The patients with AS had a broad range of LV inflow velocity patterns (A/E = 0.91 +/- 0.56, range 0.20 to 1.91; %A = 34.3 +/- 16.4, range 3.0 to 65), as compared with the consistently low A/E ratio (0.48 +/- 0.13) and %A (25 +/- 7) in the normal volunteers and the high A/E ratio and %A in the elderly (A/E = 1.48 +/- 0.28, %A = 49 +/- 11) and hypertensive (A/E = 1.41 +/- 0.32, %A = 49 +/- 8) groups. When comparing the data obtained by Doppler with hemodynamics at catheterization, the patients with AS and a high A/E ratio (A/E ratio greater than 1, n = 11) had lower LV mid-diastolic pressures (7 vs 18 mm Hg, p less than 0.001), lower pulmonary artery systolic pressures (33 vs 49 mm Hg, p less than 0.05) and less symptomatic heart failure than those patients with AS and a low A/E ratio (A/E less than 1). The aortic valve area was similar in these 2 subgroups (0.40 vs 0.37 cm2).(ABSTRACT TRUNCATED AT 250 WORDS)