Zema M J
Angiology. 1985 Feb;36(2):96-104. doi: 10.1177/000331978503600205.
One hundred survivors of first myocardial infarction were studied prior to hospital discharge by 24 hour ambulatory electrocardiography as well as radionuclide ventriculography. The bedside Valsalva maneuver, with simple sphygmomanometric determination of arterial pressure response, was performed 6 weeks post infarction and patients were followed for a mean of 22 months. The arterial pressure response pattern provided a semiquantitative estimate of resting left ventricular systolic function when related to the radionuclide ejection fraction (SIN, 0.56 +/- 0.13; ABO, 0.43 +/- 0.18; SQW, 0.16 +/- 0.06) (P less than 0.02). Abnormal Valsalva responses (ABO and SQW) were found more commonly in patients with diminished left ventricular systolic function and high grade ventricular arrhythmias. The SQW response pattern was highly predictive of future sudden cardiac death. The bedside Valsalva maneuver, performed 2-4 weeks after hospital discharge, upon the ambulatory patient is a simple, safe, inexpensive and uniformly applicable method which may serve as the basis for a strategy with which to approach the post-infarction patient regarding risk stratification and further clinical management.
100例首次心肌梗死幸存者在出院前接受了24小时动态心电图及放射性核素心室造影检查。在心肌梗死后6周进行了床边瓦尔萨尔瓦动作，并通过简单的血压计测定动脉压反应，对患者进行了平均22个月的随访。当与放射性核素射血分数相关时，动脉压反应模式提供了静息左心室收缩功能的半定量估计（SIN，0.56±0.13；ABO，0.43±0.18；SQW，0.16±0.06）（P<0.02）。异常的瓦尔萨尔瓦反应（ABO和SQW）在左心室收缩功能减退和高级别室性心律失常患者中更常见。SQW反应模式对未来心源性猝死具有高度预测性。对门诊患者在出院后2-4周进行床边瓦尔萨尔瓦动作，是一种简单、安全、廉价且普遍适用的方法，可作为对心肌梗死后患者进行风险分层和进一步临床管理策略的基础。
