Grade I diastolic dysfunction and elevated left ventricular end‐diastolic pressure: Mitral Doppler inflow, pulmonary vein atrial reversal, and the M‐mode mitral B‐bump

Grade I diastolic dysfunction ( DD ) is generally associated with a normal mean left atrial pressure ( LAP ) and normal left ventricular end‐diastolic pressure ( LVEDP ). The first hemodynamic alteration seen in DD , however, is the development of an elevated LVEDP with a persistent normal LAP . This is manifested by echocardiography as a continued mitral pulsed wave ( PW ) E/A <0.8 (Grade I DD ), but with evidence of an elevated LVEDP . Such findings include alterations in PV flow, mitral PW inflow response to Valsalva maneuver, and also the presence of a B‐bump on the mitral M‐mode tracing. When assessing diastolic function, it may be clinically helpful to assess for this early hemodynamic manifestation of DD .