title: Elucidating the B bump on the mitral valve M-mode echogram in patients with severe left ventricular systolic dysfunction.
abstract: BACKGROUND
  The B bump on mitral valve M-mode echogram is predictive of significant elevation of left ventricular end-diastolic pressure (LVEDP). However, its pathophysiologic mechanism remains unclear.
  
  
  METHODS
  We investigated, by means of Doppler echocardiography, the hemodynamic events that take place at late diastole in left atrium (LA) and left ventricle (LV). The study group consisted of 10 consecutive and strictly selected patients with severe dilated LV dysfunction. The noninvasive validated index used for definition of high LVEDP was the difference between the durations of atrial reverse (AR) wave in pulmonary venous flow (PVF) and atrial (A) wave in mitral flow (MF). Peak velocities of PVF and MF were measured. The time interval from ECG P wave to the end of B bump (P-B) and from P wave to the end of AR (P-AR) were measured and correlated. Mitral diastolic regurgitation (DR) was searched with M-mode color Doppler.
  
  
  RESULTS
  All patients presented with restrictive diastolic signs on MF and PVF. The mean value of AR time minus A time was 61+/-12 ms. There was a strong linear correlation between P-B and P-AR (r=0.94, p<0.001). Only five patients had DR. No patient had LV inflow during B bump.
  
  
  CONCLUSIONS
  (1) Mitral B bump is essentially a late diastolic phenomenon in which the leaflets keep a semi-open position without LV inflow effectiveness. (2) The resultant LA pressure which prolongates the duration of AR wave beyond A wave, analogously work over mitral leaflets, pushing them toward LV generating the bump. (3) DR is caused by LVEDP higher than LA pressure and coexists with B bump without a cause-effect relationship.
authors.affiliation: Cardiology Division, Echocardiography Department, University Hospital, Federal University of Espirito Santo, David Teixeira 155, ap. 101, Vitoria ES 29065-320, Brazil. aloirqueiroz@cardiol.br
authors.forename: Aloir Queiroz
authors.initials: AQ
authors.lastname: Araujo
authors.forename: Alaor Queiroz
authors.initials: AQ
authors.lastname: Araujo
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil; D003971:Diastole / Q000502:physiology; D004452:Echocardiography; D018618:Echocardiography, Doppler, Color; D005260:Female; D006801:Humans; D007089:Image Enhancement; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000503:physiopathology; D012720:Severity of Illness Index; D013223:Statistics as Topic; D013318:Stroke Volume / Q000502:physiology; D013599:Systole / Q000502:physiology; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*