The importance of blood pressure response to Valsalva maneuver in patients with puhnonary hypertension

Abstract

Objective To use a simple bedside technique to verify the pathophysiological mechanism of pulmonary hypertension （PH） in different races. Method The Valsalva maneuver （VM） was performed in patients referred to a specialty PH clinic. The blood pressure response of patients to VM was in different fashions. The blood pressure （BP） was measured by using cuff and stethoscope. When the cuff was inflated to 15 mmHg above the systolic pressure, sound could be heard by auscultation during VM and when the cuff was deflated the sound disappeared over 3 heart beats which was considered as abnormal BP response, and less than 3 heart beats defined as normal BP response. The right heart catheterization in patients with PH as a part of the standard evaluation. Results This study included 84 patients with a mean age of （63 ± 16） years. Those with abnormal BP response to VM had higher pulmonary artery wedge pressure （PAWP） [（22.5±6.6） vs. （11.9±4.3） mmHg, P 〈0.0001] and lower pulmonary vascular resistance [（5.8 ± 4.0） vs. （8.1 ± 4.6 ） WU, P = 0.01]. Blood pressure response to VM did not correlate with mean pulmonary artery （PA） pressure [（46.2 ± 9.9） vs. （43.4 ±10.4） mmHg, P =0.20] or cardiac index （both 2.4 ± 0.6 L/min/m^2）. The abnormal BP response to VM had high sensitivity （89.4%）, specificity （86.1%） and accuracy （86.9%） for determining PAWP〉 15 mmHg.Conclusions BP response to Valsalva maneuver provides important information about left heart filling pressures in patients with PH. Key words: Pulmonary hypertension; Hemodynamics; Valsalva maneuver