Zema M J, Restivo B, Sos T, Sniderman K W, Kline S
Br Heart J. 1980 Nov;44(5):560-9. doi: 10.1136/hrt.44.5.560.
Thirty-seven patients were evaluated before cardiac catheterisation by bedside physical examination, including Valsalva manoeuvre, to assess the value of the sphygmomanometrically determined arterial pressure responses during the Valsalva manoeuvre and to compare its sensitivity, specificity, and predictive accuracy in the detection of left ventricular dysfunction with that of the commonly used diagnostic signs including the chest x-ray. Patients not on beta-blockade treatment could be separated into three distinct arterial pressure responses detectable at the bedside which corresponded well to three statistically different groups with regard to left ventricular ejection fraction (0.29 +/0 0.11, 0.48 +/0 0.15, 0.69 +/0 0.11) and left ventricular end-diastolic pressure (38 +/- 5 mmHg, 24 +/- 10 mmHg, 14 +/- 5 mmHg) at subsequent cardiac catheterisation. In patients not on beta-blockade it was shown for the first time that (1) the height of the systolic arterial pressure overshoot was directly related to left ventricular ejection fraction and inversely related to left ventricular end-diastolic pressure, and that (2) the bedside sphygmomanometrically determined arterial pressure response during Valsalva manoeuvre provided a semiquantitative estimate of left ventricular function and was unsurpassed in its ability to do so by any of the standard diagnostic signs including the chest x-ray film.
37名患者在进行心导管检查前接受了床边体格检查，包括瓦尔萨尔瓦动作，以评估通过血压计测定的瓦尔萨尔瓦动作期间动脉压反应的价值，并将其在检测左心室功能障碍方面的敏感性、特异性和预测准确性与包括胸部X光在内的常用诊断体征进行比较。未接受β受体阻滞剂治疗的患者可分为三种不同的床边可检测到的动脉压反应，这与随后心导管检查时左心室射血分数（0.29±0.11、0.48±0.15、0.69±0.11）和左心室舒张末期压力（38±5 mmHg、24±10 mmHg、14±5 mmHg）的三个统计学上不同的组很好地对应。在未接受β受体阻滞剂治疗的患者中，首次表明：（1）收缩期动脉压过冲的高度与左心室射血分数直接相关，与左心室舒张末期压力呈负相关；（2）床边通过血压计测定的瓦尔萨尔瓦动作期间的动脉压反应提供了左心室功能的半定量估计，并且在这方面其能力优于包括胸部X光片在内的任何标准诊断体征。
