PULSE PRESSURE RESPONSE TO THE STRAIN OF THE VALSALVA MANEUVER IN HUMANS WITH PRESERVED SYSTOLIC FUNCTION

Arterial pulse pressure response during the strain phase of the Valsal va maneuver has been proposed as a clinical tool for the diagnosis of left heart failure, whereas responses of subjects with preserved systo lic function have been poorly documented. We studied the relationship between the aortic pulse amplitude ratio (i.e., minimum/maximum pulse pressure) during the strain phase of the Valsalva maneuver and cardiac hemodynamics at baseline in 20 adults (42 +/- 14 yr) undergoing routi ne right and left heart catheterization. They were normal subjects (n = 5) and patients with various forms of cardiac diseases (n = 15), and all had a left ventricular ejection fraction greater than or equal to 40%. High-fidelity pressures were recorded in the right atrium and th e left ventricle at baseline and at the aortic root throughout the Val salva maneuver. Aortic pulse amplitude ratio 1) did not correlate with baseline left ventricular end-diastolic pressure, cardiac index (ther modilution), or left ventricular ejection fraction (cineangiography) a nd 2) was positively related to total arterial compliance (area method ) (r = 0.59) and to basal mean right atrial pressure (r = 0.57) teach P < 0.01). Aortic pulse pressure responses to the strain were not rela ted to heart rate responses during the maneuver. In subjects with pres erved systolic function, the aortic pulse amplitude ratio during the s train phase of the Valsalva maneuver relates to baseline total arteria l compliance and right heart filling pressures but not to left ventric ular function.