Left ventricular dysfunction--bedside Valsalva manoeuvre

Abstract

Thirty-seven patients were evaluated before cardiac catheterisation by bedside physical examination, including Valsalva manoeuvre, to assess the value of the sphygmomanometrically determined arterial pressure responses during the Valsalva manoeuvre and to compare its sensitivity, specificity, and predictive accuracy in the detection of left ventricular dysfunction with that of the commonly used diagnostic signs including the chest x-ray. Patients not on beta-blockade treatment could be separated into three distinct arterial pressure responses detectable at the bedside which corresponded well to three statistically different groups with regard to left ventricular ejection fraction (0.29 +/0 0.11, 0.48 +/0 0.15, 0.69 +/0 0.11) and left ventricular end-diastolic pressure (38 +/- 5 mmHg, 24 +/- 10 mmHg, 14 +/- 5 mmHg) at subsequent cardiac catheterisation. In patients not on beta-blockade it was shown for the first time that (1) the height of the systolic arterial pressure overshoot was directly related to left ventricular ejection fraction and inversely related to left ventricular end-diastolic pressure, and that (2) the bedside sphygmomanometrically determined arterial pressure response during Valsalva manoeuvre provided a semiquantitative estimate of left ventricular function and was unsurpassed in its ability to do so by any of the standard diagnostic signs including the chest x-ray film.