ALTERED EFFECT OF THE VALSALVA MANEUVER ON LEFT-VENTRICULAR VOLUME IN PATIENTS WITH CARDIOMYOPATHY
ALTERED EFFECT OF THE VALSALVA MANEUVER ON LEFT-VENTRICULAR VOLUME IN PATIENTS WITH CARDIOMYOPATHY
复制标题
DOI：
10.1161/01.cir.71.2.227
复制
发表时间：
1985-01-01
期刊：
影响因子：
37.8
通讯作者：
CRAWFORD, MH
中科院分区：
文献类型：
--
作者：
LITTLE, WC;BARR, WK;CRAWFORD, MH
The failure of the blood pressure to fall during the late strain phase of the Valsalva maneuver in patients with heart failure may result from the left ventricle operating on a flat portion of its function curve or from maintenance of left ventricular volume despite decreased systemic venous return. To test these possibilities, the effect of the Valsalva maneuver were studied (40 cm H2O for 15 s) on left ventricular volume in 12 normal subjects with a mean left ventricular ejection fraction of 0.65 .+-. 0.07 (.+-. SD) and in 8 patients with nonischemic cardiomyopathy, evidence of pulmonary congestion, and a mean left ventricular ejection fraction of 0.23 .+-. 0.09. Left ventricular volume and right ventricular area were determined by apical 2-dimensional echocardiography. In both groups the right ventricular end-diastolic area decreased during the late strain phase of the Valsalva maneuver. In normal subjects it decreased from 9.3 .+-. 1.5 to 5.6 .+-. 1.6 cm2 (P < 0.001) and in patients it decreased from 13 .+-. 2.2 to 10 .+-. 2.9 cm2 (P < 0.001). In normal subjects, left ventricular end-diastolic volume decreased from the control level during the Valsalva maneuver, and this was apparent in both the 4-chamber (96 .+-. 21 to 68 .+-. 18 ml, P < 0.01) and 2-chamber views (97 .+-. 15 to 56 .+-. 20 ml, P < 0.01). In the patients, left ventricular end-diastolic volume was not significantly different from control in either view (199 .+-. 70 to 195 .+-. 78 and 214 .+-. 77 to 218 .+-. 86 ml, respectively). In normal subjects, a decrease in stroke volume from control during the Valsalva maneuver was evident in both views (61 .+-. 13 to 40 .+-. 11 ml, P < 0.01 and 63 .+-. 9 to 33 .+-. 16 ml, P < 0.01), but in the patients there was no change in stroke volume in either view during the Valsalva maneuver (45 .+-. 21 to 45 .+-. 23 and 49 .+-. 12 to 49 .+-. 17 ml). In patients with pulmonary congestion and reduced left ventricular ejection fraction, left ventricular stroke volume does not fall during the strain phase of the Valsalva maneuver because left ventricular end-diastolic volume is maintained.
