Limitations of the blood pressure response to the Valsalva maneuver as an estimate of left ventricular function

Academic Article

Abstract

  • Evaluation of the blood pressure response to the Valsalva maneuver has been espoused as a useful clinical indicator of the left ventricular function. We investigated the reliability of the cuff blood pressure response to the Valsalva maneuver and its relationship to left ventricular ejection fraction. The blood pressure response to the Valsalva maneuver was assessed at the bedside upon 102 patients scheduled to undergo echocardiography or left ventricular angiography. This response occurred in three patterns: normal, abnormal square wave, and absent overshoot. The interrater agreement was calculated. Raters were able to measure the blood pressure response to the Valsalva maneuver in 69 of 102 patients (68%); the results were unobtainable in the remaining 33 patients, mainly due to arrhythmias, uncontrolled blood pressure, and peripheral vascular disease. The interrater agreement was moderate (68%, kappa = 0.45). A normal response was found predominantly in patients with a left ventricular ejection fraction > 40% (negative predictive value 92%). The sensitivity of an abnormal response (absent overshoot and square wave) to detect severe left ventricular dysfunction (ejection fraction < 40%) was 88%, and the specificity was 46%. In conclusion, the blood pressure response to the Valsalva maneuver is not obtainable in one third of the patients examined. When measured, the interrater agreement is moderate. A normal blood pressure response to the Valsalva maneuver identifies patients with a normal ejection fraction. An abnormal blood pressure response to the Valsalva maneuver is moderately sensitive but not specific in the detection of severe left ventricular dysfunction.
  • Authors

    Digital Object Identifier (doi)

    Author List

  • Prasad NK; Estrada CA; Young MJ; Rosman HS
  • Start Page

  • 95
  • End Page

  • 98
  • Volume

  • 8
  • Issue

  • 2