HEART-RATE CHANGES DURING THE VALSALVA MANEUVER IN PATIENTS WITH ISOLATED AORTIC-INSUFFICIENCY

To determine the possible relationship between left ventricular dilata tion and heart rate changes provoked by the Valsalva maneuver (Valsalv a ratio), we studied 9 patients with isolated chronic aortic insuffici ency. Left ventricular systolic function was assessed by two-dimension al echocardiography and cardiac catheterization. All patients were asy mptomatic (functional class I of the New York Heart Association). The left ventricular internal diameters and volumes were significantly inc reased in all patients. The asymptomatic patients had either normal or slightly depressed ejection fraction (EF>0.40). The Valsalva ratio of these asymptomatic patients showed no significant correlation with th e left ventricular volumes or with the left ventricular ejection fract ion. In other words, parasympathetic heart rate control, as expressed by the Valsalva ratio, was normal in the asymptomatic patients with Le ft ventricular dilatation and preserved left ventricular ejection frac tion. Therefore, left ventricular dilatation may not be the major mech anism responsible for the abnormal parasympathetic heart rate control of patients with acquired heart disease.