CAN THE EXTENT OF CHANGE OF THE LEFT-VENTRICULAR DOPPLER INFLOW PATTERN DURING THE VALSALVA MANEUVER PREDICT AN ELEVATED LEFT-VENTRICULAR END-DIASTOLIC PRESSURE
Hp. Brunnerlarocca et al., CAN THE EXTENT OF CHANGE OF THE LEFT-VENTRICULAR DOPPLER INFLOW PATTERN DURING THE VALSALVA MANEUVER PREDICT AN ELEVATED LEFT-VENTRICULAR END-DIASTOLIC PRESSURE, Echocardiography, 15(3), 1998, pp. 211-218
Background: The objective of this study was to determine whether analy
sis of changes in the transmitral filling pattern during the Valsalva
maneuver improves the diagnostic accuracy to noninvasively detect an e
levated left ventricular end-diastolic pressure (LVEDP). Methods: We p
rospectively compared the diagnostic accuracy of the mitral flow veloc
ity indexes at baseline with those obtained during the Valsalva maneuv
er to detect an elevated LVEDP in 50 patients with coronary artery dis
ease. Results: Moderate correlations were found between LVEDP (mean, 1
1.8 +/- 6.2 mmHg) and deceleration time (r=0.49), isovolumetric relaxa
tion time (r=0.52), and the E/A ratio (r=0.48). There was a strong cor
relation (r=0.73) between LVEDP and the percentile decrease in the E/A
ratio during the Valsalva maneuver. Discriminant analysis showed that
a decrease in E/A ratio during the Valsalva maneuver by greater than
or equal to 40% detected an elevated LVEDP with a sensitivity of 77% a
nd a specificity of 94%, resulting in a diagnostic accuracy of 88%. In
11 patients, the constellation of pseudonormalization (normal E/A rat
io and elevated LVEDP) was present. This could be identified in 73% wi
th a diagnostic accuracy of 87%. Conclusions: For a comprehensive asse
ssment of diastolic dysfunction by Doppler echocardiography, combined
analysis of the E/A ratio at baseline and during the Valsalva maneuver
should be performed routinely as an easy method of increasing diagnos
tic accuracy and uncovering pseudonormalization.