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Elucidating the B bump on the mitral valve M-mode echogram in patients with severe left ventricular systolic

Aloir Queiroz Araujo1, Alaor Queiroz Araujo

  • 1Cardiology Division, Echocardiography Department, University Hospital, Federal University of Espirito Santo, David Teixeira 155, ap. 101, Vitoria ES 29065-320, Brazil. aloirqueiroz@cardiol.br

International Journal of Cardiology
|May 26, 2004
PubMed

Insights

The mitral valve B bump, a sign of high left ventricular end-diastolic pressure (LVEDP), is caused by prolonged left atrial pressure during late diastole, not by ventricular inflow.

Area of Science:

  • Cardiology
  • Echocardiography
  • Cardiac Physiology

Background:

  • The mitral valve B bump on M-mode echograms indicates elevated left ventricular end-diastolic pressure (LVEDP).
  • The precise pathophysiological mechanism underlying the B bump remains incompletely understood.

Purpose of the Study:

  • To elucidate the hemodynamic mechanisms of the mitral valve B bump in late diastole.
  • To investigate the relationship between left atrial (LA) and left ventricular (LV) pressures and flow dynamics.

Main Methods:

  • Doppler echocardiography was used to analyze diastolic events in the LA and LV of 10 patients with severe dilated LV dysfunction.
  • Left ventricular end-diastolic pressure (LVEDP) was assessed by measuring the difference in durations of the atrial reverse (AR) wave in pulmonary venous flow (PVF) and the atrial (A) wave in mitral flow (MF).
  • Correlations between ECG P wave to B bump end (P-B) and P wave to AR wave end (P-AR) were analyzed, alongside mitral diastolic regurgitation (DR).

Main Results:

  • All patients exhibited restrictive diastolic filling patterns.
  • A strong linear correlation was found between P-B and P-AR (r=0.94, p<0.001).
  • Mitral diastolic regurgitation was present in only five patients, and no LV inflow occurred during the B bump phenomenon.

Conclusions:

  • The mitral B bump is a late diastolic event characterized by semi-open mitral leaflets without effective LV inflow.
  • Elevated left atrial pressure, prolonging the AR wave beyond the A wave, generates the B bump by acting on the mitral leaflets.
  • Diastolic regurgitation is associated with LVEDP exceeding LA pressure but is not causally linked to the B bump.
Abstract

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