Do hemodynamic responses to the valsalva maneuver reflect myocardial dysfunction?

In 14 consecutive patients with varying myocardial function, evaluation of the Valsalva maneuver was performed using aortic pulse pressure decay to investigate a possible quantitative relationship between the pattern of response and the degree of myocardial dysfunction. The aortic pulse pressure response during strain correlated with resting left ventricular end-diastolic pressure and pulmonary wedge pressure but not with resting cardiac output, cardiac index and ejection fraction. Similar results were obtained when several indices characterizing the aortic pulse pressure decay during Valsalva were used together to predict resting hemodynamic data by multiple regression analysis. In conclusion, quantitative aortic pulse pressure decay during the strain phase of the Valsalva maneuver correlated only moderately with hemodynamic indices used to identify myocardial dysfunction. These results raise doubts about the use of the Valsalva maneuver for the evaluation of myocardial dysfunction.