Hébert J L, Coirault C, Zamani K, Fontaine G, Lecarpentier Y, Chemla D
Service de Physiologie Cardio-Respiratoire, Centre Hospitalier Universitaire de Bicêtre-Assistance Publique-Hôpitaux de Paris, 94 275 Le Kremlin-Bicêtre Cédex, France.
J Appl Physiol (1985). 1998 Sep;85(3):817-23. doi: 10.1152/jappl.1998.85.3.817.
Arterial pulse pressure response during the strain phase of the Valsalva maneuver has been proposed as a clinical tool for the diagnosis of left heart failure, whereas responses of subjects with preserved systolic function have been poorly documented. We studied the relationship between the aortic pulse amplitude ratio (i.e., minimum/maximum pulse pressure) during the strain phase of the Valsalva maneuver and cardiac hemodynamics at baseline in 20 adults (42 +/- 14 yr) undergoing routine right and left heart catheterization. They were normal subjects (n = 5) and patients with various forms of cardiac diseases (n = 15), and all had a left ventricular ejection fraction >/=40%. High-fidelity pressures were recorded in the right atrium and the left ventricle at baseline and at the aortic root throughout the Valsalva maneuver. Aortic pulse amplitude ratio 1) did not correlate with baseline left ventricular end-diastolic pressure, cardiac index (thermodilution), or left ventricular ejection fraction (cineangiography) and 2) was positively related to total arterial compliance (area method) (r = 0.59) and to basal mean right atrial pressure (r = 0.57) (each P < 0.01). Aortic pulse pressure responses to the strain were not related to heart rate responses during the maneuver. In subjects with preserved systolic function, the aortic pulse amplitude ratio during the strain phase of the Valsalva maneuver relates to baseline total arterial compliance and right heart filling pressures but not to left ventricular function.
瓦尔萨尔瓦动作用力阶段的动脉脉压反应已被提议作为诊断左心衰竭的一种临床工具，然而，收缩功能保留的受试者的反应记录较少。我们研究了20名接受常规左右心导管检查的成年人（42±14岁）在瓦尔萨尔瓦动作用力阶段的主动脉脉搏振幅比（即最小/最大脉压）与基线时心脏血流动力学之间的关系。他们是正常受试者（n = 5）和患有各种形式心脏病的患者（n = 15），所有患者的左心室射血分数均≥40%。在整个瓦尔萨尔瓦动作过程中，在基线时以及主动脉根部记录右心房和左心室的高保真压力。主动脉脉搏振幅比1）与基线左心室舒张末期压力、心脏指数（热稀释法）或左心室射血分数（心血管造影）无关，2）与总动脉顺应性（面积法）呈正相关（r = 0.59），与基础平均右心房压力呈正相关（r = 0.57）（均P < 0.01）。瓦尔萨尔瓦动作用力时主动脉脉压反应与该动作过程中的心率反应无关。在收缩功能保留的受试者中，瓦尔萨尔瓦动作用力阶段的主动脉脉搏振幅比与基线时的总动脉顺应性和右心充盈压有关，但与左心室功能无关。
