TY - JOUR
T1 - Potentials and limitations of the valsalva maneuver as a method of differentiating between normal and pseudonormal left ventricular filling patterns
AU - Wijbenga, Anke A.M.
AU - Mosterd, Arend
AU - Kasprzak, Jarik D.
AU - Ligthart, Jurgen M.R.
AU - Vletter, Wim B.
AU - Balk, Aggie H.M.M.
AU - Roelandt, Jos R.T.C.
PY - 1999/7/1
Y1 - 1999/7/1
N2 - Pseudonormalization of the left ventricular (LV) filling pattern complicates the Doppler echocardiographic assessment of LV diastolic function in patients with heart failure. The Valsalva maneuver is recommended as a method of differentiating between normal and pseudonormal LV filling patterns. However, neither a standardized Valsalva maneuver nor a healthy control population has been studied so far. Therefore, we studied changes in mitral flow velocities in response to a standardized Valsalva maneuver in 55 heart failure patients with LV systolic dysfunction and 35 control subjects. The study subjects were instructed to elevate their intrathoracic airway pressure to 40 mm Hg for 10 seconds. Doppler mitral flow velocities were recorded at rest and during the Valsalva maneuver. All study subjects had comparable decreases in early mitral flow velocity, but mitral flow velocity at atrial contraction increased rather than decreased in patients with a restrictive LV filling pattern. This markedly abnormal response might be useful in detecting elevated filling pressures and pseudonormal filling patterns. Furthermore, in all but 2 patients and all control subjects with an E/A ratio between 1 and 2, inversion of the E/A ratio occurred. This proves that, in contrast to previous beliefs, inversion of the E/A ratio does not differentiate between normal and pseudonormal LV filling patterns.
AB - Pseudonormalization of the left ventricular (LV) filling pattern complicates the Doppler echocardiographic assessment of LV diastolic function in patients with heart failure. The Valsalva maneuver is recommended as a method of differentiating between normal and pseudonormal LV filling patterns. However, neither a standardized Valsalva maneuver nor a healthy control population has been studied so far. Therefore, we studied changes in mitral flow velocities in response to a standardized Valsalva maneuver in 55 heart failure patients with LV systolic dysfunction and 35 control subjects. The study subjects were instructed to elevate their intrathoracic airway pressure to 40 mm Hg for 10 seconds. Doppler mitral flow velocities were recorded at rest and during the Valsalva maneuver. All study subjects had comparable decreases in early mitral flow velocity, but mitral flow velocity at atrial contraction increased rather than decreased in patients with a restrictive LV filling pattern. This markedly abnormal response might be useful in detecting elevated filling pressures and pseudonormal filling patterns. Furthermore, in all but 2 patients and all control subjects with an E/A ratio between 1 and 2, inversion of the E/A ratio occurred. This proves that, in contrast to previous beliefs, inversion of the E/A ratio does not differentiate between normal and pseudonormal LV filling patterns.
UR - http://www.scopus.com/inward/record.url?scp=0032983659&partnerID=8YFLogxK
U2 - 10.1016/S0002-9149(99)00195-2
DO - 10.1016/S0002-9149(99)00195-2
M3 - Article
C2 - 10404855
AN - SCOPUS:0032983659
SN - 0002-9149
VL - 84
SP - 76
EP - 81
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 1
ER -