Robertson D, Stevens R M, Friesinger G C, Oates J A
Circulation. 1977 Apr;55(4):596-62. doi: 10.1161/01.cir.55.4.596.
Physiologic changes in the circulatory system caused by performing the Valsalva maneuver are blunted or absent in patients with congestive heart failure. Previously there has been no noninvasive method for examining cardiac chamber size during this maneuver. M-mode echocardiography was used to evaluate possible changes in cardiac chamber dimensions in 12 normal subjects (group I) and 15 patients with cardiovascular disease (group II). In group I, the left ventricular end-diastolic dimension decreased 11.2% (+/- 1.5%) and the end-systolic dimension 9.5% (+/- 1.32%), with a fall in stroke volume of 29%. The left atrial (LA) dimension decreased 30%. In group II, only the response of the LA dimension is reported. There was a diminished response to Valsalva related to the severity of congestive heart failure. Patients in NYHA classes III and IV decreased LA dimension by only 3.8%, significantly less (P less than 0.001) than those in classes I and II who had essentially normal responses. Echocardiographically-determined changes in left atrial size in response to the Valsalva maneuver may provide an objective, noninvasive means of evaluating and following patients with suspected or proven congestive heart failure. Possible mechanisms for the changes observed are discussed.
在充血性心力衰竭患者中，瓦尔萨尔瓦动作引起的循环系统生理变化减弱或消失。此前，尚无用于在此动作期间检查心腔大小的非侵入性方法。使用M型超声心动图评估12名正常受试者（I组）和15名心血管疾病患者（II组）的心腔尺寸可能发生的变化。在I组中，左心室舒张末期内径减小11.2%（±1.5%），收缩末期内径减小9.5%（±1.32%），每搏输出量下降29%。左心房（LA）内径减小30%。在II组中，仅报告了LA内径的反应。与充血性心力衰竭的严重程度相关，对瓦尔萨尔瓦动作的反应减弱。纽约心脏协会（NYHA）III级和IV级患者的LA内径仅减小3.8%，明显低于（P<0.001）I级和II级中反应基本正常的患者。超声心动图测定的左心房大小对瓦尔萨尔瓦动作的反应变化，可能为评估和随访疑似或确诊的充血性心力衰竭患者提供一种客观、非侵入性的方法。本文讨论了观察到的这些变化的可能机制。
