ABNORMAL VALSALVA BLOOD-PRESSURE RESPONSE IN DILATED CARDIOMYOPATHY -ASSOCIATION WITH PSEUDONORMALIZATION OF ECHOCARDIOGRAPHIC DOPPLER TRANSMITRAL FILLING VELOCITY PATTERN

In patients with dilated cardiomyopathies, the presence of an abnormal blood pressure response to the Valsalva maneuver has been shown to co rrelate well with increased left-sided filling pressures. The presence of a ''pseudonormalized'' early peak to late peak velocity (E/A) rati o on echocardiographic Doppler transmitral filling pattern has also be en correlated with increased left ventricular end-diastolic pressures in these patients. Since both abnormal blood pressure response to the Valsalva maneuver and a ''pseudonormalized'' Doppler transmitral E/A r atio probably represent elevated left ventricular filling pressure, we postulated that there would be a positive correlation between the two in a group of patients with dilated cardiomyopathy and abnormal systo lic function. Twenty-five consecutive male patients with New York Hear t Association (NYHA) class II to IV heart failure and dilated cardiomy opathy were included. Patients with abnormal blood pressure responses to Valsalva had significantly larger peak early (E) velocities, smalle r peak late (A) velocities, and larger E/A ratios compared with patien ts with normal responses. E/A ratio <1.0 was present in eight (100%) o f the eight patients with a normal blood pressure response to the Vals alva maneuver and E/A ratio >1.0 was present in 12 (71%) of 17 patient s with an abnormal response (p < 0.01). This correlation supports the hypotheses of the physiologic mechanisms of these phenomena and also p rovides two noninvasive methods of evaluating left-sided filling press ures useful in the diagnosis and treatment of congestive heart failure caused by dilated cardiomyopathy.