Rh. Schwengel et al., ABNORMAL VALSALVA BLOOD-PRESSURE RESPONSE IN DILATED CARDIOMYOPATHY -ASSOCIATION WITH PSEUDONORMALIZATION OF ECHOCARDIOGRAPHIC DOPPLER TRANSMITRAL FILLING VELOCITY PATTERN, The American heart journal, 126(5), 1993, pp. 1182-1186
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.