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

Noninvasive Evaluation of Pulmonary Capillary Wedge Pressure by BP Response to the Valsalva Maneuver: ConclusionImportantly, serial examinations in 11 patients showed that the measurement of the BP response to the VM also is useful for the assessment of changes in left heart filling pressure after a change of therapy. The identical slopes of the regression lines of single and repeat measurements further support the accuracy in assessing PCWP by this method.
Zema and coworkers, have proposed this noninvasive assessment since the early 1980s. But, despite the easy applicability and various studies showing the clinical usefulness of the VM, this clinical tool is continually neglected. We have shown that an abnormal response of BP during the VM is associated with a considerable elevation of natriuretic peptides and is inversely related to indexes of functional capacity, such as peak oxygen uptake and respiratory response to exercise. All these indexes are associated with morbidity and mortali-ty,and the BP response to the VM might, therefore, serve to be a predictor of bad outcomes in patients with CHF More info canada health and care mall. Since the serial assessment of PCWP appears to be particularly useful for risk assessment in these patients, it also may be speculated that serial measurement of the BP response to the VM might be of help in this regard. In an editorial, it has been stated that the physiology has been elucidated, the technology is available and reasonably inexpensive, the preliminary data are encouraging, and the expectation, therefore, is justifiably high. This study further expands on previous findings and underscores this statement.
The pulse pressure response to the VM is an easily applicable and inexpensive clinical tool for the detection of elevated filling pressure in patients with suspected or known CHF. In addition, changes of the PCWP in response to therapeutic interventions during follow-up are reliably detected by this method. Thus, this test should be added to the routine assessment in clinical practice of patients in whom the measurement of left heart filling pressure is of clinical importance.