Effect of the Valsalva manoeuver on diastolic filling indices in patients with essential hypertension

In some hypertensive patients, echocardiographic examination does not revea l any pathologic finding in spite of a documented blood pressure elevation. In our study, we investigated the effect of preload reduction with Valsalv a manoeuver on transmitral flow velocities in hypertensive patients with no rmal mitral flow pattern and compared the results with a healthy control gr oup. Sixty-eight patients without evidence of coronary artery disease or he art failure (28 female, 40 male, age 50 +/-7) were divided in two groups ac cording to their E/A ratio as those with diastolic dysfunction (n=36) and w ithout diastolic dysfunction (DD-: n=32). DD- patients and the control grou p (n=20) performed Valsalva manoeuver and their pulsed-Doppler mitral flow measurements were repeated at the strain phase. During Valsalva manoeuver, E wave velocity decreased in all subjects. In the controls, peak A velocity showed a similar decline and E/A ratio remained over 1.0. However, in 72% of DD- patients A velocity did not change or increased and their EIA ratio fell below 1.0. In 47% of the patients with an E/A ratio reversal after Val salva manoeuver, myocardial perfusion scintigraphy revealed reversible defe cts whereas none of the patients whose E/A ratio remained over 1.0 had perf usion defects. It is concluded that: (1) in hypertensive patients with norm al E/A ratio Valsalva manoeuver should be performed in order to unmask a pr obable false normal finding, (2) an important percent of hypertensive indiv iduals have left ventricular relaxation abnormalities, and (3) diastolic dy sfunction develops together with a decrease in coronary reserve.