Abstract 15279: The Response to Valsalva Maneuver Predicts Left Ventricular Filling Pressures in Patients With Heart Failure, Pulmonary Hypertension, and Cardiac Transplant Recipients
Introduction: The blood pressure response to Valsalva maneuver (VM) can reliably assess volume status and filling pressures (FPs) in heart failure patients with reduced ejection fraction (HFrEF). However, it is unclear if blood pressure response to VM can be used to assess FPs in patients with heart failure with preserved ejection fraction (HFpEF), heart transplant (HT) recipients, and pulmonary arterial hypertension (PAH). In these groups, accurate assessment of FPs may help to determine appropriate therapy.
Hypothesis: Our hypothesis is that the response to VM will predict FPs in patients with HFpEF, HT, and PAH with comparable efficacy as in patients with HFrEF.
Methods: We prospectively enrolled 79 patients who had right heart catheterization (RHC), over a period of one year. Patients performed the VM by forceful expiration to achieve a pressure of 40mmHg for 15s. RHC data and the response to VM which was recorded using finger photoplethysmography were correlated. Pulse pressure ratio (PPR) was defined as the ratio of lowest pulse pressure during strain phase to pulse pressure at baseline. Heart rate ratio (HRR) was defined as the ratio of heart rate during phase 4 to heart rate during strain (phase2).
Results: Among 79 patients (57 ±15 yrs, females 33%, NYHA Class III-IV 51%), 34 had HFrEF, 12 HFpEF, 12 had PAH, and 21 had HT. PPR correlated significantly to pulmonary capillary wedge pressure (PCWP) in the entire cohort (r=0.73, p<0.000) and in subgroups (Fig 1A). A PPR of 0.62 had a sensitivity of 78%, and specificity of 93% in predicting PCWP>15 mmHg (Fig 1B). In HFpEF alone, a significant correlation between HRR and right atrial pressure (r= -0.76, p=0.005) and a non-significant trend with PCWP (r=-0.58, p=0.06) was noted. In heart failure patients, there were 6 deaths in PPR ≥0.6 compared to no deaths in PPR<0.6 (p=0.02).
Conclusions: The response to VM is a simple bedside tool for non-invasive estimation of filling pressures in patients with heart failure, HT, and PAH.
Author Disclosures: J. Kandala: None. F. Rischard: None. M.J. Friedman: None. F.I. Marcus: None.
- © 2016 by American Heart Association, Inc.