The effect of the Valsalva maneuver on echocardiographic dimensions in man.

Abstract

SUMMARY Physiologic changes in the circulatory system caused by performing the Valsalva maneuver are blunted or absent in patients with congestive heart failure. Previously there has been no noninvasive method for examining cardiac chamber size during this maneuver. M-mode echocardiography was used to evaluate possible changes in cardiac chamber dimensions in 12 normal subjects (group I) and 15 patients with cardiovascular disease (group II). In group I, the left ventricular end-diastolic dimension decreased 11.2% (±1.5%) and the end-systolic dimension 9.5% (±1.32%), with a fall in stroke volume of 29%. The left atrial (LA) dimension decreased 30%.THE VALSALVA MANEUVER, raising intrathoracic pressure against a closed glottis ("forced expiration"),1 and the Mueller maneuver, reducing intrathoracic pressure behind a closed glottis ("forced inspiration"),2 have been used in the investigation of cardiovascular hemodynamics and autonomic nervous system function.2 4 Both produce marked hemodynamic changes, resulting in widespread alterations in the central and peripheral circulation. Disease states alter these responses.5 The echocardiogram permits the noninvasive determination of an internal dimension of the left atrium, aorta, and left ventricle. We investigated the echocardiogram during the Valsalva and Mueller maneuvers in normal volunteers and in patients with heart disease to determine the change in cardiac chamber size that such maneuvers might produce and the correlation of this change with abnormalities of cardiovascular function. MethodsTwenty men and seven women were studied. Group I was composed of 12 normal subjects (age range 21 to 58 years, mean = 32) who had no history of cardiovascular or other disease. These subjects were chosen from a group of 24 volunteers because they had satisfactory ventricular and atrial echograms throughout the Valsalva maneuver. Group II consisted of 15 patients (19 to 65 years, mean = 47) admitted to Vanderbilt University Hospital for cardiac evaluation and included patients with ischemic heart disease, aortic stenosis, mitral regurgitation, mitral stenosis and one with severe hypertension. These patients (excepting the hypertensive patient) underwent cardiac catheterization within one week of the study described below. Their The Valsalva and Mueller maneuvers were calibrated using a standard mouthpiece connected in parallel to a graduated manometer and a Statham transducer. The manometer displayed the positive or negative pressure generated by the patient and was placed in view of the patient so that he could maintain the desired pressure. The pressure generated was recorded on the echocardiogram (via a pulse amplifier) or the time during which it was maintained was marked by a separate observer using a marker channel on the strip chart recorder. All subjects were thoroughly instructed and practiced each maneuver several times. Movement and tension of the thoracic and abdominal musculature were observed to ensure valid performance.Left atrial diameter was measured as an...

Alterations in the responses of the sympathetic nervous system and renin in borderline hypertension.

“…The Valsalva maneuver was carried out with 40 mm Hg of positive intrathoracic pressure generated for a period of 20 seconds as previously described. 18 The parameter assessed was the percent reduction in left atrial diameter associated with the strain phase of the Valsalva maneuver.…”

“…This was achieved by concomitant measurement of the urinary excretion of their metabolites, normetanephrine and metanephrine, with a newly developed stable isotope ratio method employing mass spectrometry. 18 In addition to assessment of the adrenergic and renin responses to these stimuli, we also characterized study subjects in terms of plasma volume, venous reflex response, and echocardiographic left atrial size change during the Valsalva maneuver.…”

Altered effect of the Valsalva maneuver on left ventricular volume in patients with cardiomyopathy.

“…2' 3' 5 This effect may be augmented by a decreased effective afterload resulting from the increase in intrathoracic pressure.`8 (2) The left ventricular end-diastolic volume may be maintained in such patients during the strain and thus the stroke volume is unchanged. [9][10] 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.…”

Real-time phase-contrast flow MRI of the ascending aorta and superior vena cava as a function of intrathoracic pressure (Valsalva manoeuvre)

“…All these findings are consistent with a plethora of data obtained by echocardiography over several decades. 1,4,[26][27][28][29][30][31][32][33] While real-time MRI studies of cardiac function and flow offer general advantages over ECG-synchronized cine MRI techniques, which include free breathing, beat-to-beat analyses and dynamic access to physiological interventions, the NLINV method adds adequate temporal and spatial resolution as demonstrated in previous work. [16][17][18][19][20][21][22] On the other hand, a potential limitation of the proposed method, which currently hampers its widespread availability, is the high computational demand of NLINV reconstructions.…”