Objectives: To investigate the relationship
of the BP response to the Valsalva maneuver (VM) to parameters of
congestive heart failure (CHF) other than hemodynamic measures.
Design: Comparison of neurohormones (atrial natriuretic
peptide [ANP], brain natriuretic peptide [BNP], norepinephrine[
NE]), parameters of spiroergometry, and clinical parameters with BP
response to the VM.
Setting: Tertiary care
Patients: Forty-five patients with stable CHF
(ejection fraction, 28 ± 7%).
Pulse amplitude ratio (PAR) calculated between the end and the
beginning of the VM using the last two and the first three beats of the
straining phase. Failure of the systolic BP to fall below the resting
level during the VM.
Results: Patients in the New York
Heart Association class III (n = 15) had a higher PAR than
those in class II (0.82 ± 0.21 vs 0.63 ± 0.20; p < 0.01).
There was a close correlation between PAR and ANP (r = 0.76) and BNP
(r = 0.62), whereas other parameters were less well correlated
(eg, for peak V̇o2,
r = −0.35; p < 0.05). Patients with failure of the systolic BP to
fall below the resting level (n = 24) had higher neurohormones
(mean ANP, 246 ± 158 vs 84 ± 43 pg/mL; mean BNP,
282 ± 289 vs 81 ± 85 pg/mL; p < 0.001; mean NE, 3.9 ± 1.7
vs 3.4 ± 1.5 nmol/L; nanosecond), lower exercise capacity
(19.8 ± 5.2 vs 23.0 ± 3.7 mL/kg/min; p < 0.05), and their
quality of life (Minnesota questionnaire) was more compromised
(31 ± 19 vs 18 ± 15; p < 0.05).
The BP response to the VM is related to a broad range of clinical and
neurohumoral parameters of CHF. Whether or not it is also related to
prognosis remains to be determined. Nevertheless, this easily
applicable test should be part of the assessment of patients with