0
Clinical Investigations: CARDIOLOGY |

Noninvasive Evaluation of Pulmonary Capillary Wedge Pressure by BP Response to the Valsalva Maneuver*

Daniel Weilenmann, MD; Hans Rickli, MD; Ferenc Follath, MD; Wolfgang Kiowski, MD; Hans Peter Brunner-La Rocca, MD
Author and Funding Information

*From the Division of Cardiology (Drs. Weilenmann, Rickli, Kiowski, and Brunner-La Rocca) and the Department of Internal Medicine (Dr. Follath), University Hospital, Zurich, Switzerland.

Correspondence to: Daniel Weilenmann MD, Division of Cardiology, University Hospital, Petersgraben 4, CH-4031 Basel, Switzerland; e-mail: dweilenmann@uhbs.ch



Chest. 2002;122(1):140-145. doi:10.1378/chest.122.1.140
Text Size: A A A
Published online

Study objectives: To determine the BP response to the Valsalva maneuver (VM) at baseline and after changes in therapy and to compare this response to the invasively measured pulmonary capillary wedge pressure (PCWP).

Design: Comparison of the BP response to the VM with invasively measured PCWP. In a subset of patients, direct PCWP and pulse amplitude ratio (PAR) measurements were repeated (mean ± SD) 3.2 ± 4.5 months later after adjusting the therapy.

Setting: Tertiary-care center.

Patients: Forty-two stable patients (8 women; mean age, 58 ± 13 years) undergoing right heart catheterization who were in sinus rhythm.

Measurements: PAR calculated between the end and the beginning of the VM using the last two beats and the first three beats of the straining phase and simultaneous measurement of PCWP.

Results: There was a highly significant correlation between the invasively measured PCWP (range, 2 to 32 mm Hg) and the PAR (range, 0.28 to 1.15; R2 = 0.75; p < 0.001). In addition, changes of PCWP during follow-up (−16 to 13 mm Hg) were well-correlated (R2 = 0.93; p < 0.001; n = 11) with changes in PAR (−0.44 to 0.47). The administration of medication (eg, β-blockers, amiodarone, angiotensin-converting enzyme inhibitor, and digoxin) did not influence the results.

Conclusions: PCWP and changes during therapy can be estimated noninvasively by measuring the PAR during the VM with acceptable accuracy in stable patients with cardiac conditions. Thus, this method may be a useful tool in detecting an elevated PCWP and hemodynamic response to therapy.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543