Valsalva maneuver to predict dynamic intraventricular obstruction during dobutamine stress echocardiography in patients with hypertension

Abstract

We were to evaluate the effect of Valsalva maneuver with comparison to preload reduction by nitroglycerin (NTG) to predict intraventricular obstruction (IVO) during dobutamine stress echocardiography (DSE) in patients with hypertension. A total of 38 hypertensive patients (mean age 66.0±9.9 years; 32% male) were prospectively enrolled. The patients with positive exercise electrocardiography, transmural infarction, significant valvular heart disease, atrial fibrillation, beta-blocker therapy, and induced ischemia during DSE were excluded. The development of an IVO during DSE was defined as a late-peaking intraventricular pressure gradient (IVPG) >30 mmHg. The patients were divided into 2 groups, without IVO (n=11, non-IVO) and with IVO (n=27). IVO group had smaller left ventricular (LV) cavity and LV end-diastolic volume, and more increased interventricular septum thickness and higher basal septal thickness than non-IVO group. At rest, after Valsalva maneuver, during peak dose of dobutamine, and after NTG, IVPG was higher in IVO-group. To predict IVO during DSE, IVPG ≥5 mmHg after Valsalva maneuver had a sensitivity of 70.4% and specificity of 90.9%. and IVPG ≥4.5 mmHg after NTG had a sensitivity of 33.3% and specificity of 90.9%. Simple and safe Valsalva maneuver plays an effective role to predict dynamic IVO in patients with hypertension who might be good candidate for beta-blocker therapy and is even more sensitive than preload reduction by NTG.