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

Noninvasive Evaluation of Pulmonary Capillary Wedge Pressure by BP Response to the Valsalva ManeuverPulmonary capillary wedge pressure (PCWP) is an important indicator of the hemodynamic severity of congestive heart failure (CHF) and is related to prognosis in these patients. In addition, PCWP is a useful tool for the guidance of therapy in patients with CHF. Its measurement, however, requires right heart catheterization, a method that is inconvenient for patients and is associated with some morbidity and even mortality. Thus, this method has its limitations for the routine screening of CHF or for repeated measurements as a guide to ambulatory therapy. Attempts at noninvasive approaches to estimate the PCWP are scarce, and clinical and radiographic signs are quite insensitive methods for the detection of an elevated PCWP in patients with CHF.
The arterial pressure during the Valsalva maneuver (VM) is abnormal in patients with CHF, with the contour of the strain phase of the arterial pressure response to the VM having a square-wave re-sponse.” Anecdotal experience presumed an semi-quantitative estimation of the left ventricular systolic function by the arterial pressure response to the VM. Furthermore, the BP response to the VM may have a direct correlation to the PCWP in patients with CHF. However, confirmation of this finding is still lacking, and no data are yet available on the correlation between changes in the BP response to the VM and changes in the PCWP after modification of long-term drug therapy. Levitra Click Here Thus, the aim of this study was to compare the BP response to the VM with the invasively measured PCWP in a prospective, blinded study in patients undergoing right heart catheterization. Additionally, assessment was repeated in those patients undergoing right heart catheterization after modification of therapy.