床边瓦尔萨尔瓦动作时血压反应的可靠性及其与 NT-pBNP 水平的关系。
Reliability of the blood pressure response during performance of bedside Valsalva maneuver and association with NT-pBNP levels.
机构信息
Department of Geriatrics, Kliniken Essen Mitte, Essen, Germany.
Department of Geriatrics, Helios Klinikum Schwelm, Schwelm, Germany.
出版信息
Z Gerontol Geriatr. 2021 Jul;54(4):371-376. doi: 10.1007/s00391-021-01849-z. Epub 2021 Feb 3.
BACKGROUND
Heart failure (HF) is common in older people. The diagnosis of HF, however, is difficult in older subjects, especially in settings without direct access to further diagnostics. The type of blood pressure response during the performance of a Valsalva maneuver has been suggested as an easily applicable bedside test to detect HF; however, the reliability of this maneuver and the association with HF is unknown in geriatric patients.
METHODS
This study included 89 patients admitted for geriatric rehabilitation. Systolic blood pressure was taken while the patient performed a Valsalva maneuver. The systolic blood pressure response was classified as sinusoidal (type A), absent overshoot (type B) or square pattern (type C). To test interrater reliability systolic blood pressure response was evaluated independently by two investigators. The procedure was repeated after 1h to estimate test-retest reliability. Both investigators were blinded to the results of the other. Interrater reliability and test-retest reliability were calculated using Cohen's kappa. Blood samples for N‑terminal pro brain natriuretic peptide (NT-pBNP) were obtained on the morning the Valsalva maneuver was performed.
RESULTS
Blood pressure response was sinusoidal in 37 (42%), showed an absent overshoot in 17 (19%) and had a square wave pattern in 34 (38%) patients. Cohen's kappa was 0.911 (95% CI 0.837-0.985) for interrater reliability and 0.929 (95% CI 0. 0.862-0.996) for test-retest reliability. The interrater and test-retest agreement were 94% and 96%, respectively. The mean NT-pBNP plasma levels and the interquartile ranges (IQR) in subjects with types A, B and C blood pressure response pattern were 213 (153-324) pg/ml, 805 (622-1332) pg/ml and 3964 (2595-5906) pg/ml, respectively (p < 0.001).
CONCLUSION
The blood pressure response during a Valsalva maneuver shows an excellent reliability in older subjects. The type of response is associated with the NT-pBNP plasma level.
背景
心力衰竭（HF）在老年人中很常见。然而，在没有直接进行进一步诊断的情况下，老年人的 HF 诊断较为困难。在进行瓦尔萨尔瓦动作时的血压反应类型被认为是一种易于应用的床边测试，可以检测 HF；然而，这种动作的可靠性以及与 HF 的关联在老年患者中尚不清楚。
方法
本研究纳入了 89 名因老年康复而入院的患者。在患者进行瓦尔萨尔瓦动作时测量收缩压。收缩压反应分为正弦型（A 型）、无超射（B 型）或方波型（C 型）。为了测试观察者间可靠性，收缩压反应由两名观察者独立评估。在 1 小时后重复该程序以估计测试-再测试可靠性。两名观察者均对彼此的结果不知情。观察者间可靠性和测试-再测试可靠性使用 Cohen's kappa 进行计算。在进行瓦尔萨尔瓦动作的当天早上，采集 N-末端脑利钠肽前体（NT-pBNP）的血样。
结果
血压反应为正弦型的患者有 37 例（42%），无超射的患者有 17 例（19%），方波型的患者有 34 例（38%）。观察者间可靠性的 Cohen's kappa 为 0.911（95%CI 0.837-0.985），测试-再测试可靠性的 Cohen's kappa 为 0.929（95%CI 0.862-0.996）。观察者间和测试-再测试的一致性分别为 94%和 96%。在 A、B 和 C 型血压反应模式的患者中，平均 NT-pBNP 血浆水平及其四分位间距（IQR）分别为 213（153-324）pg/ml、805（622-1332）pg/ml 和 3964（2595-5906）pg/ml（p<0.001）。
结论
在老年患者中，瓦尔萨尔瓦动作期间的血压反应具有极好的可靠性。反应类型与 NT-pBNP 血浆水平相关。
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