Key result
Valsalva maneuver yields ~34% pseudonormal mislabeling in normal subjects, performing worse than NTG.
Why the study?
Does the Valsalva maneuver compared to nitroglycerin administration cause different cardiac hemodynamic changes in subjects with normal cardiac function?
Observational (n=53)
Does the Valsalva maneuver compared to nitroglycerin administration cause different cardiac hemodynamic changes in subjects with normal cardiac function?
The Valsalva maneuver can cause greater changes in myocardial performance than nitroglycerin, leading to the misdiagnosis of normal diastolic function as pseudonormal in up to 34% of healthy subjects.
Differences between Valsalva and NTG responses may affect diastolic grading; leaves open applicability beyond normal hearts.
OBJECTIVES: To identify differences in cardiac hemodynamic changes between the Valsalva maneuver and nitroglycerin (NTG) administration. METHODS: Fifty-three subjects (37 men, 43 ± 12 years) with normal cardiac function [left ventricular ejection fraction ≥55%, early to late mitral inflow velocity ratio (E/A) ≥1, left atrial volume index ≤34 ml/m(2) and early diastolic mitral annulus velocity (E') ≥8 cm/s] were enrolled. Doppler parameters were determined at rest, during the Valsalva maneuver and after NTG administration. RESULTS: Decreased E, A and E/A were observed both during the Valsalva maneuver and after NTG administration (p < 0.0001 for all). However, the reduction in E (ΔEValsalva: -30 ± 16 cm/s vs. ΔENTG: -17 ± 17 cm/s) and E/A (ΔE/AValsalva: -0.37 ± 0.28 vs. ΔE/ANTG: -0.19 ± 0.25) and the prolongation of the deceleration time (DT) of E (ΔDTValsalva: 105 ± 74 ms vs. ΔDTNTG: 83 ± 63 ms) were more prominent during the Valsalva maneuver than with NTG administration (p < 0.0001 for all). Particularly, a greater decrease in E' was observed during the Valsalva maneuver (ΔE'Valsalva: -3 ± 2 cm/s vs. ΔE'NTG: -2 ± 2 cm/s, p < 0.0001). Eighteen subjects (34%) showed ΔE/A ≥0.5 during the Valsalva maneuver; thus, they were mislabeled as 'pseudonormal', while only 3 subjects (6%) showed ΔE/A ≥0.5 after NTG administration. CONCLUSIONS: The Valsalva maneuver not only decreases preload but also affects myocardial performance, thus, its use can result in the mislabeling of normal subjects as pseudonormal.
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Moon et al. (2014) conducted an observational in Normal cardiac function (n=53). Valsalva maneuver vs. Nitroglycerin (NTG) administration was evaluated on Mislabeling as 'pseudonormal' (ΔE/A ≥0.5). The Valsalva maneuver mislabeled 34% of normal subjects as 'pseudonormal' (ΔE/A ≥0.5), compared to only 6% after nitroglycerin administration.
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