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, we studied the effect of the Valsalva maneuver (40 cm H20 for 15 sec) on left ventricular volume in 12 normal subjects with a mean left ventricular ejection fraction of 0.65 ± 0.07 (± SD) and in eight 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 two-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 < .001) and in patients it decreased from 13 ± 2.2 to 10 ± 2.9 cm2 (p < .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 fourchamber (96 ± 21 to 68 ± 18 ml, p < .01) and two-chamber views (97 + 15 to 56 20 ml, p < .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 + 13to40 ± 11 ml,p< .01 and63 ± 9to33 ± 16ml,p< .01),butinthepatientstherewasnochange in stroke volume in either view during the Valsalva maneuver (45 ± 21 to 45 ± 23 and 49 + 12 to 49 + 17 ml). We conclude that 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. 10, 1984; accepted Nov. 8, 1984. Presented in part at the 56th Annual Scientific Sessions of the American Heart Association. To test these possibilities we studied the effect of a standardized Valsalva maneuver on right ventricular end-diastolic cross-sectional area, left ventricular enddiastolic volume, and left ventricular stroke volume determined by two-dimensional echocardiography in normal volunteers and patients with nonischemic cardiomyopathy in whom clinical findings were consistent with congestive heart failure.

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The gross behavior of two comparable groups of normal Ss including men, women, and children was measured continuously over a 2-wk. interval by noise and activity recordings. The second group differed from the first in that no clocks or other mechanical means of recording time were available. Both groups were under relatively identical conditions of isolated confinement in a simulated fallout shelter. Normal cues as to passage of time were not available due to the construction characteristics of the experimental chamber. Thermal and ventilation conditions were maintained at optimal levels. Both measures revealed highly positive correlations between the mean circadian patterns of the two groups. Noise and activity were also highly correlated within groups. Longitudinal comparisons of daily means revealed slightly decreasing noise trends after the fourth day of confinement. Such a trend was not generally apparent in either of the longitudinal activity plots.