[Prognostic value of Valsalva maneuver-induced change in Doppler-detected ventricular filling in patients with systolic dysfunction].

INTRODUCTION AND OBJECTIVES In patients with systolic dysfunction, different ventricular filling patterns are associated with different prognoses. The load changes resulting from nitroprusside infusion or long-term therapy for heart failure induce alterations in filling pattern that have been shown to serve as outcome markers. Our aim was to investigate the prognostic value of the Doppler-detected change in pseudonormal or restrictive left ventricular filling pattern induced by the Valsalva maneuver in patients with systolic dysfunction. MATERIAL AND METHOD The study included 36 patients in sinus rhythm with a depressed ejection fraction and an E/A ratio greater than 1. Filling velocities were recorded before and after 3 Valsalva maneuvers. RESULTS The E/A ratio remained greater than 1 in 12 patients (group A); in 24 patients (group B), it fell below 1, indicating an abnormal relaxation pattern (i.e., a reversible pattern). During a mean follow-up period of 18 months, 8 patients died: 6 in group A (50%) and 2 in group B (8.3%; P=.005). Moreover, 12 patients either died or suffered severe heart failure: 8 in group A (67%) and 4 in group B (17%; P=.003). A reversible filling pattern was associated with lower risks of death (hazard ratio [HR]=0.06; 95% confidence interval [CI], 0.01-0.48) and of hospitalization or death (HR=0.11; 95% CI, 0.03-0.43). CONCLUSIONS Change of a pseudonormal or restrictive left ventricular filling pattern into an abnormal relaxation pattern after the Valsalva maneuver in patients with systolic dysfunction predicts a lower risk of death or severe heart failure.