Potentials and limitations of the Valsalva maneuver as a method of differentiating between normal and pseudonormal left ventricular filling patterns

Pseudonormalization of the left ventricular (LV) filling pattern complicate s the Doppler echocardiographic assessment of LV diastolic function in pati ents with heart failure. The Valsalva maneuver is recommended as a method o f differentiating between normal and pseudonormal LV filling patterns. Howe ver, neither a standardized Valsalva maneuver nor a healthy control populat ion has been studied so far. Therefore, we studied changes in mitral flow v elocities in response to a standardized Valsalva maneuver in 55 heart failu re patients with LV systolic dysfunction and 35 control subjects. The study subjects were instructed to elevate their intrathoracic airway pressure to 40 mm Hg for 10 seconds. Doppler mitral flow velocities were recorded at r est and during the Valsalva maneuver. All study subjects had comparable dec reases in early mitral flow velocity, but mitral flow velocity at atrial co ntraction increased rather than decreased in patients with a restrictive LV filling pattern. This markedly abnormal response might be useful in detect ing elevated filling pressures and pseudonormal filling patterns. Furthermo re, in all but 2 patients and all control subjects with an E/A ratio betwee n 1 and 2, inversion of the E/A ratio occurred. This proves that, in contra st to previous beliefs, inversion of the E/A ratio does not differentiate b etween normal and pseudonormal LV filling patterns. (C) 1999 by Excerpta Me dica, Inc.