Vol. 85, Issue 3, 817-823, September 1998
Pulse pressure response to the strain of the Valsalva maneuver
in humans with preserved systolic function
Jean-Louis
Hébert1,
Catherine
Coirault2,
Karen
Zamani1,
Guy
Fontaine3,
Yves
Lecarpentier1, and
Denis
Chemla1
1 Service de Physiologie
Cardio-Respiratoire, Centre Hospitalier Universitaire de
Bicêtre-Assistance Publique-Hôpitaux de Paris, 94 275 Le
Kremlin-Bicêtre Cédex;
2 Institut National de la
Santé et de la Recherche Médicale U451-Loa-Ensta-Ecole
Polytechnique, 91 125 Palaiseau Cédex; and
3 Hôpital Jean-Rostand, 94 200 Ivry-sur-Seine Cédex, France
 |
ABSTRACT |
Arterial pulse
pressure response during the strain phase of the Valsalva maneuver has
been proposed as a clinical tool for the diagnosis of left heart
failure, whereas responses of subjects with preserved systolic function
have been poorly documented. We studied the relationship between the
aortic pulse amplitude ratio (i.e., minimum/maximum pulse pressure)
during the strain phase of the Valsalva maneuver and cardiac
hemodynamics at baseline in 20 adults (42 ± 14 yr) undergoing
routine right and left heart catheterization. They were normal subjects
(n = 5) and patients with
various forms of cardiac diseases
(n = 15), and all had a left
ventricular ejection fraction 
40%. High-fidelity pressures were
recorded in the right atrium and the left ventricle at baseline and at
the aortic root throughout the Valsalva maneuver. Aortic pulse
amplitude ratio 1) did not correlate
with baseline left ventricular end-diastolic pressure, cardiac index
(thermodilution), or left ventricular ejection fraction
(cineangiography) and 2) was
positively related to total arterial compliance (area method) (r = 0.59) and to basal mean right
atrial pressure (r = 0.57) (each
P < 0.01). Aortic pulse pressure
responses to the strain were not related to heart rate responses during
the maneuver. In subjects with preserved systolic function, the aortic
pulse amplitude ratio during the strain phase of the Valsalva maneuver relates to baseline total arterial compliance and right heart filling
pressures but not to left ventricular function.
central venous pressure; arterial compliance; heart period; hemodynamics; baroreceptor reflex; systolic function
| |
INTRODUCTION |
THE ARTERIAL PRESSURE CONTOUR during the strain phase
of the Valsalva maneuver relates to cardiac status. Arterial pressure decreases during the strain phase of the maneuver in healthy subjects but not in patients with increased pulmonary capillary wedge pressure (2, 10, 23). Given that a wide range of arterial pressure responses is
currently observed from typically normal to abnormal responses, the
aortic pulse amplitude ratio (i.e., minimum/maximum pulse pressure) has
been used to quantify the amount of arterial pressure decrease (2,
23). In patients with various degrees of heart impairment,
the pulse amplitude ratio relates to pulmonary capillary wedge pressure
(2, 23, 29). Some authors have suggested that the pulse amplitude ratio
may improve the assessment of cardiac status (29, 33) and may furnish a
noninvasive scale of myocardial dysfunction (3, 23). Others raised
doubts about this, given that an abnormal response is observed in
diseases in which the left ventricular (LV) function is preserved (15).
Arterial pressure response during the strain phase of the Valsalva
maneuver might reflect either LV function (3, 23), or right-sided
pressures (15), or both (2, 10, 29), and it seems of physiological
interest to clarify this issue. In this respect, we feel that two
points remain poorly documented: 1) until now, the respective roles of LV and right-sided pressures in
arterial response during the maneuver have not been studied with use of
high-fidelity pressure catheters; and
2) given that arterial compliance is
known to influence the aortic pressure-flow relationship (8, 21, 26,
27), compliance may also play a role in aortic pressure response during
the maneuver, but no study has so far tested this hypothesis.
The aim of our study was to document simultaneous high-fidelity, left-
and right-sided hemodynamics during the Valsalva maneuver in patients
with preserved systolic function. We studied the influences of baseline
right- and left-sided pressures and arterial compliance on the pulse
amplitude ratio during the maneuver. Given that the Valsalva maneuver
is usually used to assess autonomic function (6, 7), we also studied
the interplay between aortic pressure responses and heart rate
responses during the maneuver.
| |
METHODS |
Patients
Twenty patients (15 men and 5 women; mean age 42 ± 14 yr) were
enrolled in our prospective study, after giving their informed consent.
The investigation was approved by the Comité Consultatif de
Protection des Personnes dans la Recherche Biomédicale de Bicêtre. For inclusion in the study,
1) patients had to be referred to
our laboratory for diagnostic right and left heart catheterization for
the investigation of chest pain, heart failure, or other cardiovascular disorders; and 2) their LV ejection
fraction (cineangiography) had to be 40%. Patients with aortic,
mitral, or tricuspid valvular regurgitation were excluded from the
study, as were patients with contraindications to the Valsalva maneuver
(aortic stenosis, recent myocardial infarction, glaucoma, retinopathy).
The final diagnoses were as follows: normal subjects
(n = 5), idiopathic dilated
cardiomyopathy (n = 3), systemic
hypertension (n = 2), atrial septal
defect (n = 1), hypertrophic
cardiomyopathy (n = 1), coronary
artery disease (n = 1), mitral
stenosis (n = 1), and arrhythmogenic
right ventricular dysplasia (n = 6).
Nine patients were not receiving vasoactive drugs. The other patients
were taking angiotensin-converting enzyme inhibitors
(n = 2), 
-adrenergic blocking
agents (n = 3), calcium-channels blockers (n = 6), diuretics
(n = 3), amiodarone (n= 1), flecainide (n = 3), 
-adrenergic blocking agent
(n = 1), or nitrates
(n = 1).
Catheterization Technique
Patients were studied according to our routine protocol
(4, 5, 13). They were unsedated and were investigated at least 12 h
after the previous intake of usual treatment. Right and left heart
catheterizations were performed by using the Seldinger technique from
the femoral vein and artery, as previously described (4, 13). The 5-Fr
right heart and 6-Fr left heart pressure-measuring catheters were
equipped with two high-fidelity transducers, one at the tip and the
other 10 cm from the tip (Cordis/Sentron, Roden, The Netherlands) (14).
Catheters were advanced so as to obtain simultaneous right atrial and
ventricular and LV and aortic root pressure recordings. This enabled us
to record right atrial and LV pressures immediately before the Valsalva
maneuver. In three patients with peripheral arterial disease of the
lower limbs, we used the percutaneous brachial artery approach (22).
Pressure data were recorded on a personal computer with customized
software (sampling rate 500 Hz). Mean pressure in the right atrium was calculated by dividing the area under the curve by the heart period.
Protocol and Calculations
Valsalva maneuver.
Pressure data were obtained at baseline after a 10-min
equilibration period. Thereafter, the calibrated Valsalva maneuver was
performed at a pressure of 40 mmHg for 15 s (13). In healthy subjects,
four phases are classically observed (12, 16). In phase I (onset of
strain), there is a transient rise in aortic pressure. In phase II
(continuous straining), a biphasic response is generally observed,
consisting of a reduction in systolic aortic pressure (phase IIa),
followed by a secondary rise in systolic aortic pressure, after ~5 s,
to resting values (phase IIb). In phase III (release of the strain),
aortic pressure suddenly drops. In phase IV (pressure overshoot),
systolic and pulse aortic pressures overshoot above resting values,
thus leading to heart period increases via baroreceptor reflex
stimulation.
A typical abnormal response is generally observed in patients with
congestive heart failure and increased pulmonary capillary wedge
pressure (10). In these patients the pulse pressure remains virtually
unchanged, whereas both systolic and diastolic aortic pressure levels
are shifted upward. On the release of the maneuver, the aortic blood
pressure immediately returns toward normal (12, 15, 33). Overall, this
leads to the typical "square-wave" blood pressure response
(3).
Aortic pulse amplitude ratio.
In clinical practice a wide range of arterial pressure responses are
observed, from a typically normal response to a square-wave response,
and the aortic pulse amplitude ratio has been used to quantify arterial
pressure decrease (2). We therefore calculated the aortic pulse
amplitude ratio, i.e., the ratio of the lowest aortic pulse pressure
during active straining (phase II) to the greatest aortic pulse
pressure at onset of the strain (phase I; Ref. 2; Fig.
1). Pulse pressure was calculated as
systolic pressure minus diastolic pressure.
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Fig. 1.
Typical normal response of aortic pulse pressure to
Valsalva maneuver during calibrated strain. In this patient, 63 consecutive beats ( ) were studied. High-fidelity aortic pressure
recordings were obtained at aortic root level. Pulse pressure was
calculated as systolic pressure minus diastolic pressure. In healthy
subjects, 4 phases are classically observed: phase I (onset of strain),
phase II (continuous straining), phase III (release of the strain), and
phase IV (pressure overshoot). In phase II, a biphasic response is
generally observed, consisting of reduction in systolic aortic pressure
(phase IIa), followed by secondary rise in systolic aortic pressure
(phase IIb). Pulse amplitude ratio was defined as ratio of lowest
aortic pulse pressure during phase II (*) to greatest aortic pulse
pressure during phase I (**). Pulse amplitude ratio = 0.23.
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Heart period responses and Valsalva ratio.
The beat-to-beat heart period was calculated throughout the maneuver.
It is generally agreed that sympathetic stimulation during the strain
is reflected by reflex tachycardia (phases IIa and IIb) and
vasoconstriction, as reflected by diastolic aortic pressure increases
during phase IIb (16). Baroreceptor reflex stimulation of the
parasympathetic drive during phase IV was quantified by calculating the
so-called Valsalva ratio, as previously recommended (7). The Valsalva
ratio is defined (6) as the largest R-R interval during the poststrain
phase IV divided by the shortest R-R interval during the strain (phase
II). According to Ewing et al. (7) a Valsalva ratio >1.21 is
considered normal. Heart period responses and the Valsalva ratio were
studied in 17 patients. In three patients, heart period responses and
the Valsalva ratio could not be studied because of ventricular
premature beats during phase IV (n = 2) or ventricular pacing (n = 1).
Cardiac output and total arterial compliance.
After pressure recordings had been completed, thermodilution cardiac
output was measured in triplicate, and two consecutive monoplane LV
cineangiographies and coronary angiograms were performed. Baseline
total arterial compliance was estimated by using the area method (21),
with compliance estimated as follows
where
K is an area coefficient calculated as
the area under the pressure curve throughout the cardiac cycle divided
by the area under the pressure curve throughout the diastolic period. Total arterial compliance indirectly reflects the viscoelastic properties of large arteries (21).
Statistics
Results are expressed as means ± SD. Pressure data at baseline were
averaged out over 10 consecutive cycles. Correlations were tested by
using the least squares method. Throughout phases I, IIa, and IIb, both
the heart period and pressure data were compared by using Student's
paired t-test, after analysis of
variance. The P values take into
account the Bonferroni correction. Comparisons among patients with LV
end-diastolic pressure 
12 mmHg (n = 10) and LV end-diastolic pressure >12 mmHg
(n = 10) were performed by using the
unpaired Student's t-test. A
P value <0.05 was considered statistically significant.
| |
RESULTS |
Standard hemodynamics at baseline are presented in Table
1.
Aortic Pulse Pressure and Pulse Amplitude Ratio
During the Valsalva maneuver, maximum (phase I) aortic pulse pressure
ranged from 20 to 112 mmHg (mean ± SD = 58 ± 24 mmHg), and
minimum (phase II) aortic pulse pressure ranged from 12 to 31 mmHg (22 ± 5 mmHg). This resulted in an aortic pulse amplitude ratio
(minimum/maximum aortic pulse pressure) ranging from 0.19 to 0.85 (0.45 ± 0.19).
There was a negative relationship between maximum (phase I) aortic
pulse pressure at the onset of strain and total arterial compliance
(r = 
0.76,
P < 0.01). Conversely, the maximum
aortic pulse pressure did not correlate with LV end-diastolic pressure or with mean right atrial pressure. There was no relationship between
minimum (phase II) aortic pulse pressure during strain and LV
end-diastolic pressure, mean right atrial pressure, or total arterial
compliance.
There was no relationship between the aortic pulse amplitude ratio and
the baseline value of LV end-diastolic pressure
(r = 0.33; Fig.
2A),
cardiac index (r = 0.05), and LV ejection fraction
(r = 0.31). The pulse amplitude
ratio was similar in patients with baseline LV end-diastolic pressure
12 mmHg (n = 10) and in patients
with LV end-diastolic pressure >12 mmHg
(n = 10) (0.48 ± 019 and 0.42 ± 0.19, respectively; P = not
significant; Fig.
3A).
There was a positive linear relationship between the aortic pulse
amplitude ratio and mean right atrial pressure
(r = 0.58, P < 0.01; Fig.
2B). The pulse amplitude ratio was
higher in patients with baseline mean right atrial pressure >6 mmHg
(n = 10) than in patients with mean
right atrial pressure 6 mmHg (n = 10) (0.54 ± 0.15 and 0.35 ± 0.19, respectively;
P < 0.05; Fig.
3B).
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Fig. 2.
A: pulse amplitude ratio during strain
phase of Valsalva maneuver as a function of baseline left ventricular
(LV) end-diastolic pressure (n = 20 subjects). r = 0.33;
P = not significant (NS).
B: pulse amplitude ratio
during strain phase of Valsalva maneuver as a function of baseline mean
right atrial pressure (n = 20).
r = 0.58;
P < 0.01.
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Fig. 3.
A: pulse amplitude ratio during strain
phase of Valsalva maneuver in subjects with baseline LV end-diastolic
pressure (LVEDP) 12 mmHg (n = 10)
and in subjects with baseline LVEDP >12 mmHg
(n = 10).
B: pulse amplitude ratio during strain
phase of Valsalva maneuver in subjects with baseline mean right atrial
pressure (MRAP) 6 mmHg (n = 10) and
in subjects with baseline MRAP >6 mmHg
(n = 10). Filled circles and error
bars, means ±SD. Open circles, individual data
points.
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There was a positive linear relationship between the aortic pulse
amplitude ratio and total arterial compliance
(r = 0.59, P < 0.01; Fig.
4). The pulse amplitude ratio was higher in
patients with baseline compliance >1.67 ml/mmHg
(n = 10) than in patients with
compliance <1.67 ml/mmHg (n = 10)
(0.62 ± 0.22 and 0.40 ± 0.18, respectively;
P < 0.05). When the influence of
arterial compliance was taken into account, the aortic pulse amplitude ratio and mean right atrial pressure were still related (partial correlation coefficient = 0.51, P < 0.01).
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Fig. 4.
Pulse amplitude ratio during strain phase of Valsalva maneuver as a
function of baseline total arterial compliance
(n = 20 subjects).
r = 0.59;
P < 0.01.
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Heart Period Responses and Valsalva Ratio
We also tested the potential link between aortic pressure responses and
heart period responses. There was a biphasic change in aortic pressures
during the strain (Fig.
5A). As
expected, systolic and diastolic pressures fell significantly from
phase I to phase IIa (each P < 0.01), whereas systolic and diastolic pressures increased significantly
during phase IIb (each P < 0.01). Figure 5A shows that pulse
pressure significantly decreased from phase I to phase IIa
(P < 0.01), whereas it remained
unchanged during phase IIb. The heart period decreased throughout the
strain of the Valsalva maneuver (P < 0.001; Fig. 5B).
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Fig. 5.
A: systolic (open circles), diastolic
(open squares), and pulse (filled circles) pressures during strain of
the Valsalva maneuver. All pressures decreased significantly from phase
I to phase IIa (each P < 0.01).
During phase IIb, systolic and diastolic pressures increased
significantly (each P < 0.01),
whereas pulse pressure was unchanged.
B: heart period responses during
strain of Valsalva maneuver. Heart period (open circles) fell
throughout strain of Valsalva maneuver
(P < 0.001). Values are means ± SD; n = 17 subjects.
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The Valsalva ratio ranged from 1.09 to 2.33 (1.56 ± 0.34). The
Valsalva ratio was deemed normal (i.e., >1.21) in 76% of the subjects. There was no relationship between the Valsalva ratio and the
pulse amplitude ratio (Fig. 6).
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Fig. 6.
Lack of relationship between Valsalva ratio and pulse amplitude ratio
(n = 17 subjects).
r = 0.02;
P = NS.
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| |
DISCUSSION |
To the best of our knowledge, our study is the first to have been
performed with the use of simultaneous left- and right-sided high-fidelity pressure catheters in humans during the Valsalva maneuver. We studied normal subjects and patients with various forms of
cardiac diseases, all of whom had preserved LV systolic function. The
aortic pressure response to the strain of the Valsalva maneuver was
related to right ventricular filling pressure and total arterial
compliance but not to LV end-diastolic pressure. Thus, in populations
similar to ours, the pressure responses during the Valsalva maneuver
would not help to detect increased LV end-diastolic pressure. From a
physiological point of view, our results are consistent with a major
role of arterial compliance and central venous pressure in the pressure
responses to this respiratory maneuver.
The pulse amplitude ratio (i.e., minimum/maximum pulse pressure)
furnishes a precise scale quantifying the amount of arterial pressure
decrease during the strain phase of the Valsalva maneuver (2, 23). The
aortic pulse amplitude ratio did not correlate with baseline LV
ejection fraction or cardiac index, and this is consistent with
previous studies (2, 29). Given that LV filling pressure is an
important indicator of cardiac function, its indirect determination
(i.e., without LV catheterization) is of major interest to clinicians.
It has been suggested that the pulse amplitude ratio may relate to LV
filling pressure in cardiac patients (2, 23, 29) and furnish a scale of
myocardial dysfunction (3, 23). In our study, this did not hold true in
subjects with LV ejection fraction 40% and LV end-diastolic pressure
<25 mmHg. In this population, graded aortic pulse pressure responses
to the strain during the Valsalva maneuver were observed, without the
square-wave phenomenon. Other researchers have reported that unchanged
pulse amplitude during the strain of the Valsalva maneuver results
primarily from elevation of right ventricular filling pressures (15),
and our results are consistent with this hypothesis. In studies of
patients with mitral stenosis, Judson et al. (15) have reported that
the square-wave response does not directly correlate with the severity
of the obstuction at the valvular orifice but rather with the degree of
failure of the right ventricle. In normal subjects, a square-wave
response is induced when large volumes of blood are rapidly infused;
aortic pressure response normalizes after either sustained venous
pooling or venesection (15).
Our results are also fairly consistent with the curves of vascular
function, as defined by Guyton et al. (11). Systemic venous return is
driven by the pressure difference between mean systemic filling
pressure and mean right atrial pressure. Venous return is affected by
peripheral factors (blood volume in the large and compliant venous
reservoir, skeletal muscle contraction) and central factors
(intrathoracic pressures, right ventricular function, right atrial mean
pressure) (11, 19, 28, 31). In normal subjects, the venous reservoir is
slightly repleted, and mean right atrial pressure is low. Large
intrathoracic veins tend to collapse during normal inspiration, and
venous return is impeded during the end-inspiratory phase. During the
strain of the Valsalva maneuver, this phenomenon is enhanced and
sustained, thus leading to venous blockage, responsible for the
physiological decrease of aortic pulse pressure (25). Driving pressure
in the venous vessels is reduced either in cases where there is a significant repletion of the venous system or as a consequence of any
factor leading to an elevation of the filling pressures of the right
heart. Large systemic veins at their intrathoracic entry point remain
fully open during the strain (1, 9), leading to a merely preserved flow
through the pulmonary system, the left ventricle (17, 20), and the
aorta. With the exception of patients with significant intracardiac
shuntings, the role of the pulmonary blood volume as a reservoir
remains moderate (11).
No correlation was found between the pulse amplitude ratio and mean
right atrial pressure in a previous study (2). This could be due to the
use of fluid-filled catheters coupled to classic transducers, because
mean right atrial pressure obtained from this recording system is
somewhat imprecise. Although Schmidt and Shah (29) have found that
patients with abnormal arterial response have a significantly higher
mean right atrial pressure than do patients with normal response, they
conclude that increased LV filling pressure plays a primary role in
arterial response (determined by using cuff sphygmomanometer and
auscultation). Similarly, McIntyre et al. (23) stated that the pulse
amplitude ratio (digital photoplethysmography) mainly relates to
pulmonary capillary wedge pressure, although patients they observed
presented a positive relationship between mean right atrial pressure
and the aortic pulse amplitude ratio. From a physiological point of view, however, these results (23, 29) must be considered with caution
given the following: 1) from aorta
to peripheral arteries, there is a well-known pulse wave amplification,
the magnitude of which varies from subject to subject;
2) digital photoplethysmography leads to an unpredictable pressure bias relative to aortic root pressure (18); and 3) all invasive
pressures were fluid-filled recorded.
Our results indicate that pulse amplitude ratio also related to
baseline total arterial compliance. Total arterial compliance is known
to influence the aortic pressure-flow relationship (8, 21, 26, 27).
From a theoretical point of view, one could predict a poor relationship
between stroke volume and aortic pulse pressure in subjects with high
arterial compliance and a stronger relationship between stroke volume
and aortic pulse pressure as compliance decreases (26). This may well
explain the positive relationship between compliance and the pulse
amplitude ratio in our study. Further studies are needed to pinpoint
the role of arterial compliance in hemodynamic responses to the
Valsalva maneuver in patients with depressed systolic function.
In an attempt to explain the lack of relationship between the pulse
amplitude ratio and LV end-diastolic pressure, some distinctive features of our study need to be specified. First, to the best of our
knowledge, our study is the first to have been performed with the use
of simultaneous left- and right-sided high-fidelity pressure catheters.
This is especially valuable, given that significant increases in blood
volume and/or venous resistance result in minute increases in
right atrial pressure because of the high compliance of the venous
system (11). A previous study has used the left high-fidelity pressure
catheter, but it focused on aortic wave reflection during the maneuver
(24). Second, we focused on subjects with preserved systolic function.
Their LV end-diastolic pressure was moderately elevated (<25 mmHg),
and this could have revealed the prominent influence of right
ventricular filling pressure and total arterial compliance on the pulse
amplitude ratio. Third, it is widely agreed that LV end-diastolic
pressure strongly depends on the compliance of the ventricular
myocardium, and it is therefore a less satisfactory index of LV preload
than is LV volume; conversely, given the high compliance of the atrial
myocardium, right atrial pressure reflects right ventricular preload.
This could explain the relationship between pulse amplitude ratio and
right atrial pressure but not LV end-diastolic pressure. Finally,
arterial data were obtained at the aortic root level, thus minimizing
the influence of pressure wave amplification on the pathophysiological analysis of the maneuver. This is especially valuable if one considers the relationship observed between total arterial compliance and pulse
amplitude ratio in our study.
We also studied the potential interplay between aortic pressure
responses and heart rate responses during the Valsalva maneuver. The
Valsalva maneuver is usually used to assess autonomic function (6, 7).
Indeed, this respiratory effort leads to sympathetic stimulation during
phase II and parasympathetic stimulation via baroreceptor reflex
stimulation during phase IV. The question thus arises as to how
autonomic status influences aortic pulse pressure responses in the
Valsalva maneuver. During phase II, both the continuous decreases in
the heart period and the secondary rise in diastolic pressure (phase
IIb) point to acute sympathetic stimulation. Importantly, aortic pulse
pressure remained unchanged during phase IIb, and this is consistent
with our hypothesis that pulse pressure decrease during the strain is
mainly of mechanical origin (i.e., reduced systemic venous
return). As far as the release of the strain is concerned
(phase IV), there was no relationship between the pulse amplitude ratio
and the Valsalva ratio. It is important to note that 76% of the
patients had a normal Valsalva ratio (>1.21), meaning that our
results do not apply to dysautonomic patients, who must be studied
specifically.
The implications of our study need to be discussed. First, it has been
suggested that blood pressure responses to the strain of the Valsalva
maneuver could help to predict increased LV filling pressure (23). Our
study indicates that this does not hold true at the aortic root level
in patients with an LV ejection fraction 40% and that the results of
the maneuver should be interpreted cautiously in populations similar to
ours. Second, our results show the importance of arterial compliance in
the interpretation of the hemodynamic effects of the Valsalva maneuver.
It remains to be documented whether compliance also has a prominent
role in the blood pressure responses during other respiratory
maneuvers.
The limitations of our study need to be discussed. The design of the
study (simultaneous high-fidelity pressure recordings) prevented the
inclusion of a greater number of subjects. However, the fact that we
could observe a statistically significant relationship between aortic
pulse pressure ratio and both right atrial pressure and total arterial
compliance in 20 subjects should be interpreted as a strength of the
study. Furthermore, given that both normal subjects and patients (e.g.,
hypertensive patients) were included, a huge range of baseline aortic
pressures was observed (the pulse pressure ranging from 20 to 112 mmHg;
58 ± 24 mmHg), and this tended to reinforce the clinical relevance
of our study. Finally, we wish to emphasize the fact that some
scattering in the relationships observed suggests that factors other
than right atrial pressure and total arterial compliance may be
involved in the aortic pressure response to the strain of the Valsalva
maneuver, and further studies are needed to confirm this.
In conclusion, aortic pulse pressure response to the strain phase of
the calibrated Valsalva maneuver appeared to be related to total
arterial compliance and right heart filling pressure in subjects with
preserved LV systolic function.
| |
ACKNOWLEDGEMENTS |
The authors acknowledge John Kenneth Hylton for invaluable
assistance in the preparation of the manuscript. They also thank Pierre
Paris from Bicêtre Hospital for helpful support, Martine Corti
and Hans Kerkhoven for scientific assistance, and Georges Buscaillet
and Liliane Larsonneur for excellent technical assistance.
| |
FOOTNOTES |
Address for reprint requests: J.-L. Hébert, Service de
Physiologie Cardio-Respiratoire, Centre Hospitalier Universitaire de
Bicêtre, 94 275 Le Kremlin-Bicêtre Cédex, France
(E-mail: chemla{at}enstay.ensta.fr).
Received 29 July 1997; accepted in final form 4 May 1998.
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Abstract
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