Abnormal Mitral Valve Motion in Patients with Elevated Left Ventricular Diastolic Pressures

Konecke, Lee L.; Feigenbaum, Harvey; Chang, Sonia; Corya, Betty C.; Fischer, Johannes

doi:10.1161/01.cir.47.5.989

Cited by 107 publications

(18 citation statements)

References 15 publications

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“…low cardiac out put, rather than an elevated LV end-diastolic pressure, as suggested earlier by Konecke et al [29], The latter mea sured the mitral DE slope (but not DE interval) in a series of hemodynamically studied patients; LV end-diastolic pressure was normal in patients with DE slopes exceeding 25 cm/s, but 14 mm or more in patients with DE slopes less than 25 cm/s. Feigenbaum [28] also in cluded an example of decreased DE slope in a patient with pulmonary hypertension.…”

Section: Diastole Systolesupporting

confidence: 58%

Suppression of Early Mitral Valve Opening in Cor pulmonale

D'cruz¹,

Danopulos²,

Gupta³

1988

Am J Noninvas Cardiol

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We describe a new échocardiographie abnormality, prolongation of the mitral DE interval, in 17/22 patients with cor pulmonale. The mitral DE interval was 0.067 ± 0.008 s (mean ± SD) in 50 age-matched controls, and 0.114 ± 0.021 s in the 22 cor pulmonale patients. ECG evidence of right ventricular hypertrophy was present in only 11/22 patients. Six patients with the most severe cor pulmonale had the longest DE intervals, with complete or near complete suppression of early diastolic mitral valve opening in 4. Of these 6 patients, 4 died within 3 months, but none of the other 16 died in this period. The pathogenesis of this échocardiographie abnormality is uncertain, but abnormal ventricular interdependence resulting in leftward (posterior) septal shift may be a key factor. Close attention to the DE phase of mitral motion may provide useful diagnostic and prognostic information in patients with suspected cor pulmonale.

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Section: Diastole Systolesupporting

confidence: 58%

Suppression of Early Mitral Valve Opening in Cor pulmonale

D'cruz¹,

Danopulos²,

Gupta³

1988

Am J Noninvas Cardiol

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“…The 'B-bump' represents an abrupt motion of the ante rior mitral leaflet towards the septum in late diastole and is seen on an M-mode echocardiogram as a discrete deflection between the A and C points [21][22][23], Although its pathophysiology has not been well clarified, the 'Bbump' has been documented as a fairly reliable finding of an elevated LVEDP in the absence of mitral stenosis [21][22][23], especially in patients with low left ventricular ejec tion fractions [24]. In the present study, transmitral early and late pulsed Doppler flow velocity signals were utilized to measure early diastolic filling (E), and late diastolic (atrial, A) contribution to left ventricular filling [1-8, 14, 15, 17-20].…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have demonstrated a cor relation between substantially elevated left ventricular end-diastolic pressure (LVEDP) and the presence of a 'Bbump' (deflection of the A-C closure slope) on the ante rior mitral valve leaflet on the M-mode echocardiogram [21][22][23][24], The present study was performed to investigate whether an elevation of LVEDP, signified by the presence of a 'B-bump' on the anterior mitral leaflet, influences left atrial contribution to left ventricular filling in patients with dilated cardiomyopathy (DCM). l There may be more than one indication.…”

Section: Introductionmentioning

confidence: 99%

Doppler Evidence for Reduced Atrial Contribution to Left Ventricular Filling in Patients with a Dilated Cardiomyopathy and a 'B-Bump' on the Mitral Valve Echocardiogram

Shandling¹,

Myrianthefs²,

Gardin³

et al. 1993

Am J Noninvas Cardiol

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The hemodynamic contribution of left atrial contraction to left ventricular filling in dilated cardiomyopathy (DCM) remains controversial. The degree of filling of the left ventricle may influence this contribution. Previous studies have demonstrated a correlation between an elevated left ventricular enddiastolic pressure (LVEDP) and the presence of a ‘B-bump’ (a deflection on the A-C closure slope) on the anterior mitral valve leaflet on the M-mode echocardiogram. To assess whether the presence of a ‘B-bump’ reflecting an elevated LVEDP is associated with differences in left atrial contribution to left ventricular filling, we measured pulsed-wave Doppler mitral flow velocity recordings obtained from 48 DCM patients, with (n = 16) and without (n = 32) a ‘B-bump’. There were no statistically significant differences between the two groups with regard to age, heart rate, body surface area, electrocardiographic PR interval, left ventricular end-diastolic dimenson, left ventricular percent fractional shortening, left atrial size, or distance of penetration of the mitral regurgitant signal into left atrium. The mean ratio of mitral peak-signal velocity in late-to-early diastole, PFVA/PFVE (0.58 ± 0.24 in those with ‘B-bump’ versus 0.96 ± 0.55 in those without a ‘B-bump’, p < 0.005, and the mean ratio of time-velocity integral in late-to-early diastole 0.39 ± 0.14 vs. 0.65 ± 0.34, p < 0.002) were both found significantly decreased in the ‘B-bump’ group. Since the mitral time-velocity integral is proportional to stroke volume, and the A/E integral ratio approximates a volume ratio of transmitral flow, it is concluded that in the group of patients with DCM and a ‘B-bump’ of the anterior mitral leaflet, corresponding to an elevated LVEDP, the relative left atrial volume contribution to left ventricular filling and stroke volume is reduced.

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“…First, concomitant diastolic and moderate-to-severe systolic dysfunction (LVEF <0.35) has been shown in patients to result in an increased LV end-diastolic pressure (LVEDP). 10 In those patients who have an elevated left atrial pressure, a longer time would then be required for the ventricle to generate a pressure greater than that in the atrium and would thereby affect mitral valve closure. Investigators who conducted prior invasive and hemodynamic studies have reported a qualitatively prolonged transmitral flow and delayed closure of the mitral valve in patients with an elevated LVEDP, evidenced with use of M-mode echocardiography.…”

Section: A B C D Ementioning

confidence: 99%

Slope of the Anterior Mitral Valve Leaflet: A New Measurement of Left Ventricular Unloading for Left Ventricular Assist Devices and Systolic Dysfunction

Martinez¹,

Bradley²,

Novak³

et al. 2014

Texas Heart Institute Journal

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Left ventricular assist device (LVAD)-T herapy with an implanted continuous-flow left ventricular assist device (CF-LVAD) has improved survival rates and quality of life in patients with endstage heart failure by increasing cardiac output and decreasing left ventricular (LV) preload.1-3 In non-LVAD-supported patients with heart failure, multiple transthoracic echocardiographic (TTE) methods exist for evaluating LV filling pressures, including chamber dimensions, mitral valve inflow Doppler measurements, pulmonary venous Doppler measurements, and tissue Doppler velocities. [4][5][6] In patients with nonphysiologic unloading of the LV by a CF-LVAD, acquisition and interpretation of the Doppler and echocardiographic images required for many of these accepted methods might be challenging. Even in circumstances in which accurate Doppler evaluation is possible, some studies in CF-LVAD patients have revealed that, although E/e′ ratio decreases after LVAD implantation, it correlates poorly with invasive measurements of pulmonary capillary wedge pressure (PCWP). 7,8 Other guidelines are therefore needed to supplement current knowledge toward evaluating LV unloading and clinical status in CF-LVAD-supported patients.The mitral valve is a fast-moving structure, the motion of which is best detected with the superior temporal resolution of M-mode echocardiography in the parasternal views. 9 In the presence of elevated filling pressures, the anterior mitral leaflet tracing in M-mode displays gradual closure after the peak of the A-wave in cardiac diastole, as compared with brisk closure in patients with normal filling pressures. 9 In extreme cases, this closure process slows to the point where there is a recognizable "B-bump" after atrial contraction, which for more than 40 years has been known to correlate with significantly elevated LV end-diastolic pressure (LVEDP)-greater than 20 mmHg. 10Until now, the slope of the anterior mitral leaflet (SLAM) in end-diastole has never

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Abnormal Mitral Valve Motion in Patients with Elevated Left Ventricular Diastolic Pressures

Abstract: SUMMARY

Cited by 107 publications

References 15 publications

Suppression of Early Mitral Valve Opening in Cor pulmonale

Suppression of Early Mitral Valve Opening in Cor pulmonale

Doppler Evidence for Reduced Atrial Contribution to Left Ventricular Filling in Patients with a Dilated Cardiomyopathy and a 'B-Bump' on the Mitral Valve Echocardiogram

Slope of the Anterior Mitral Valve Leaflet: A New Measurement of Left Ventricular Unloading for Left Ventricular Assist Devices and Systolic Dysfunction

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