Kito Kento, Kataoka Akihisa, Okamoto Maki, Nakada Satoshi, Shirakura Kazuyo, Kobayashi Hanako, Chikuda Ikumi, Nishikawa Junichi, Iseki Yosei, Katayama Taiga, Kawashima Hideyuki, Sajima Takeyuki, Yamamoto Hirosada, Watanabe Yusuke, Yokoyama Naoyuki, Kozuma Ken
Division of Cardiology, Department of Internal Medicine, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan.
Department of Clinical Laboratory, Teikyo University Hospital, Tokyo, Japan.
Eur Heart J Imaging Methods Pract. 2025 Jun 3;3(1):qyaf071. doi: 10.1093/ehjimp/qyaf071. eCollection 2025 Jan.
Left ventricular outflow tract (LVOT) obstruction is a key feature of hypertrophic obstructive cardiomyopathy (HOCM), whereas patent foramen ovale (PFO) obstruction is associated with cryptogenic stroke and other conditions. The Valsalva manoeuvre (VM) is a standard technique for diagnosing these conditions; however, its inconsistent execution can limit diagnostic accuracy. We aimed to evaluate the party balloon inflation manoeuvre (PBIM) as an alternative to VM for diagnosing HOCM and PFO by comparing their haemodynamic effects.
In this single-centre pilot study, we conducted and experiments. The pressure characteristics of the two balloon sizes were measured in the experiment. In the study, we assessed haemodynamic changes in 25 healthy volunteers using transthoracic echocardiography. The endpoints included the left ventricular diastolic dimension (LVDd) for HOCM and the right ventricular inflow velocity-time integral (RV inflow-VTI) for PFO. PBIM significantly reduced LVDd compared with VM, indicating greater LVOT obstruction provocation ( < 0.01). The RV inflow-VTI was also significantly higher with PBIM, suggesting increased venous return and enhanced right-to-left shunting ( < 0.01). The heart rate and perceived exertion scores were higher with the PBIM, reflecting a greater physiological load.
PBIM is a simple, effective, and reliable alternative to VM for diagnosing HOCM and PFO, offering clear visual feedback and improved diagnostic performance. Further research in patient populations is required to confirm these findings. UMIN000054423.(https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&recptno=R000062098&type=summary&language=J).
左心室流出道（LVOT）梗阻是肥厚型梗阻性心肌病（HOCM）的关键特征，而卵圆孔未闭（PFO）梗阻与不明原因的卒中及其他疾病相关。瓦尔萨尔瓦动作（VM）是诊断这些疾病的标准技术；然而，其执行不一致会限制诊断准确性。我们旨在通过比较其血流动力学效应，评估派对气球充气动作（PBIM）作为VM的替代方法用于诊断HOCM和PFO。
在这项单中心前瞻性研究中，我们进行了实验1和实验2。在实验1中测量了两种气球尺寸的压力特征。在实验2中，我们使用经胸超声心动图评估了25名健康志愿者的血流动力学变化。终点指标包括用于诊断HOCM的左心室舒张末期内径（LVDd）和用于诊断PFO的右心室流入速度时间积分（RV流入-VTI）。与VM相比，PBIM显著降低了LVDd，表明对LVOT梗阻的激发作用更强（P<0.01）。PBIM时RV流入-VTI也显著更高，提示静脉回流增加和右向左分流增强（P<0.01）。PBIM时心率和主观用力评分更高，反映出更大的生理负荷。
PBIM是一种用于诊断HOCM和PFO的简单、有效且可靠的VM替代方法，提供清晰的视觉反馈并提高诊断性能。需要在患者群体中进行进一步研究以证实这些发现。UMIN000054423.（https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&recptno=R000062098&type=summary&language=J）
