Interaction between long axis incoordination and left ventricular filling. Long isovolumic relaxation time and isolated A wave would support a diagnosis of diastolic disease in the patient above. Prolonged isovolumic relaxation time is associated with increased tension in the left ventricle due to continued inward movement of the lateral long axis after the aortic valve has closed (A2), due in part to reduced long axis amplitude during systole and in part to delayed activation (patient has LBBB on ECG). LBBB results in a delay in the onset, and therefore a delay in the offset, of long axis amplitude.