LIMITATIONS OF THE BLOOD-PRESSURE RESPONSE TO THE VALSALVA MANEUVER AS AN ESTIMATE OF LEFT-VENTRICULAR FUNCTION

Evaluation of the blood pressure response to the Valsalva maneuver has been espoused as a useful clinical indicator of the left ventricular function. We investigated the reliability of the cuff blood pressure r esponse to the Valsalva maneuver and its relationship to left ventricu lar ejection fraction. The blood pressure response to the Valsalva man euver was assessed at the bedside upon 102 patients scheduled to under go echocardiography or left ventricular angiography. This response occ urred in three patterns: normal, abnormal square wave, and absent over shoot. The interrater agreement was calculated. Raters were able to me asure the blood pressure response to the Valsalva maneuver in 69 of 10 2 patients (68%); the results were unobtainable in the remaining 33 pa tients, mainly due to arrhythmias, uncontrolled blood pressure, and pe ripheral vascular disease. The interrater agreement was moderate (68%, kappa = 0.45). A normal response was found predominantly in patients with a left ventricular ejection fraction >40% (negative predictive va lue 92%). The sensitivity of an abnormal response (absent overshoot an d square wave) to detect severe left ventricular dysfunction (ejection fraction <40%) was 88%, and the specificity was 46%. In conlusion, th e blood pressure response to the Valsalva maneuver is not obtainable i n one third of the patients examined. When measured, the interrater ag reement is moderate. A normal blood pressure response to the Valsalva maneuver identifies patients with a normal ejection fraction, An abnor mal blood pressure response to the Valsalva maneuver is moderately sen sitive but not specific in the detection of severe left ventricular dy sfunction.