What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Dilated cardiomyopathy (n=26). Intervention: Mueller manoeuvre vs. Healthy individuals. Primary outcome: Mitral-to-aortic velocity-time integral (VTI) ratio (p=<0.001).

What does this research mean for the field?

In patients with dilated cardiomyopathy, a reduction of intrathoracic pressure during the Mueller manoeuvre increases the mitral-to-aortic velocity-time integral ratio, suggesting the induction of functional mitral regurgitation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the mechanisms behind reduced left ventricular forward stroke volume during the Mueller manoeuvre by analyzing left ventricular inflow and outflow hemodynamics in dilated cardiomyopathy.

September 1, 2026Clinical Physiology and Functional ImagingOpen Access

Mueller manoeuvre increases the mitral‐to‐aortic velocity–time integral ratio, a mitral regurgitant index, in patients with dilated cardiomyopathy

Q: What are the key findings of this study?

The Mueller manoeuvre increased the mitral-to-aortic VTI ratio in patients with dilated cardiomyopathy compared to a decrease in healthy controls (interaction P<0.001).

Q: What does this research mean for the field?

In patients with dilated cardiomyopathy, a reduction of intrathoracic pressure during the Mueller manoeuvre increases the mitral-to-aortic velocity-time integral ratio, suggesting the induction of functional mitral regurgitation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the mechanisms behind reduced left ventricular forward stroke volume during the Mueller manoeuvre by analyzing left ventricular inflow and outflow hemodynamics in dilated cardiomyopathy.

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Key result

Mueller manoeuvre increases mitral-to-aortic VTI ratio in dilated cardiomyopathy but decreases it in healthy controls.

P<0.001
n=26

Why the study?

Intrathoracic pressure reduction during the Mueller manoeuvre decreases LV forward stroke volume in systolic heart failure, but the underlying mechanisms were not determined.

Does the Mueller manoeuvre alter left ventricular inflow and outflow dynamics in patients with dilated cardiomyopathy compared to healthy individuals?

Population

13 DCM patients with LVEF <40% without mitral regurgitation and 13 healthy individuals

Comparison

Mueller manoeuvre vs quiet respiration

Design

Physiological mechanistic study

Authors

JVJuha VirolainenHelsinki University Hospital MVMarkku VentiläUniversity of Helsinki MKMarkku KupariCardiac Imaging

Discussion

Member takes

Implication

Raises possibility of functional mitral regurgitation from negative intrathoracic pressure in DCM; leaves open clinical relevance and need for validation.

Key Points

To evaluate the mechanisms behind reduced left ventricular forward stroke volume during the Mueller manoeuvre by analyzing left ventricular inflow and outflow hemodynamics in dilated cardiomyopathy.
Enrolled 13 patients with dilated cardiomyopathy (ejection fraction <40%, mean age 44 years) and 13 healthy control participants (mean age 42 years).
Participants performed the Mueller manoeuvre targeting −30 mmHg intrathoracic pressure for >10 seconds.
Doppler echocardiography measured systolic aortic and diastolic mitral flow velocity–time integrals (VTI) during quiet respiration and the manoeuvre.
Patients with dilated cardiomyopathy had a significantly greater decrease in aortic VTI during the manoeuvre compared to controls (−4.2 ± 0.3 cm vs. −1.6 ± 0.5 cm; p < 0.001).
The mitral-to-aortic VTI ratio increased from 0.78 ± 0.04 to 1.03 ± 0.08 in dilated cardiomyopathy (p = 0.006) but decreased from 0.70 ± 0.03 to 0.61 ± 0.03 in controls (p = 0.025; group × manoeuvre interaction F = 16.8, p < 0.001).

Study Design

Type

Cross-Sectional (n=26)

Structured PICO

Does the Mueller manoeuvre alter left ventricular inflow and outflow dynamics in patients with dilated cardiomyopathy compared to healthy individuals?

Population

26 subjects (13 with dilated cardiomyopathy and LVEF <40%, 13 healthy controls) undergoing the Mueller manoeuvre to assess left ventricular flow dynamics.

Exposure

Mueller manoeuvre (MM) with a target of -30 mmHg pressure for >10 s

Comparator

Quiet respiration

Outcome

Changes in left ventricular inflow and outflow dynamics, specifically aortic and mitral flow velocity-time integrals (VTI) and the mitral-to-aortic VTI ratiosurrogate

Main Result

p-value: p=<0.001

A reduction of intrathoracic pressure during the Mueller manoeuvre increases the mitral-to-aortic VTI ratio in patients with dilated cardiomyopathy, suggesting the appearance of functional mitral regurgitation.

Cite This Study

Virolainen et al. (2026) conducted a cross-sectional in Dilated cardiomyopathy (n=26). Mueller manoeuvre vs. Healthy individuals was evaluated on Mitral-to-aortic velocity-time integral (VTI) ratio (p=<0.001). The Mueller manoeuvre increased the mitral-to-aortic VTI ratio in patients with dilated cardiomyopathy compared to a decrease in healthy controls (interaction P<0.001).

synapsesocial.com/papers/6a969a7f535111e2d4ce8ce8 https://doi.org/10.1111/cpf.70090

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Implication

Raises possibility of functional mitral regurgitation from negative intrathoracic pressure in DCM; leaves open clinical relevance and need for validation.

Mueller manoeuvre increases the mitral‐to‐aortic velocity–time integral ratio, a mitral regurgitant index, in patients with dilated cardiomyopathy

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Mueller manoeuvre increases the mitral‐to‐aortic velocity–time integral ratio, a mitral regurgitant index, in patients with dilated cardiomyopathy

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Also Consider