Detection of elevated pulmonary capillary wedge pressure in elderly patients with various cardiac disorders by the Valsalva manoeuvre

Abstract

In the present study, we assessed whether elevated (> or =15 mmHg) PCWP (pulmonary capillary wedge pressure) can be detected using the blood pressure response to the Valsalva manoeuvre in a group of elderly patients with various cardiac disorders, including atrial fibrillation and valvular heart disease, and healthy elderly controls. The Valsalva manoeuvre was performed in 93 patients (71+/-4 years) and 28 healthy controls (70+/-4 years) undergoing right-sided cardiac catheterization. Blood pressure was measured non-invasively with Finapres. PPR (pulse pressure ratio), the ratio of minimum pulse pressure during phase 2 and maximum pulse pressure during phase 1 of the Valsalva manoeuvre, was correlated with PCWP (r=0.63, P<0.001). The area under the receiver operator characteristic curve of PPR with elevated PCWP was 0.85 (P<0.001). For PPR=0.62, sensitivity for elevated PCWP was 80%, specificity was 79%, positive predictive value was 76% and negative predictive value was 83%. Correlation of PPR with PCWP and the ability of PPR to detect elevated PCWP was present in atrial fibrillation, heart failure and valvular heart disease. In conclusion, PPR is a sensitive and specific instrument to diagnose elevated PCWP non-invasively in a large group of elderly patients with various cardiac disorders. This makes the Valsalva manoeuvre a useful non-invasive tool for diagnosing heart failure, applicable in elderly patients with common cardiac disorders, such as atrial fibrillation and valvular heart disease.

Finger photoplethysmography during the Valsalva maneuver reflects left ventricular filling pressure

“…However, other studies PAR (9,17,23,33) using the Finapres or the Vericor have shown close correlation between cardiac filling pressure and just PAR, which would be much easier to derive from a bedside photoplethysmography signal than combining multiple variables. Some studies (3,9,23,38) have used a higher expiratory effort, as high as 40 mmHg, and one study (33) used a longer expiratory effort duration of 15 s. The expiratory effort needs to be consistent, because PAR is lower when expiratory effort is higher (10,21,32). We chose parameters that patients with heart and/or lung disease would be more likely to achieve (23).…”

“…Two disadvantages of performing a bedside Valsalva maneuver with only a sphygmomanometer are that the expiratory effort is not measured and standardized and that a continuous blood pressure signal is not recorded. These drawbacks may limit accuracy because expiratory effort affects blood pressure response (21,23) and because calculation of pulse amplitude ratio, a continuous variable, requires a continuous signal. These considerations may contribute to a lack of widespread clinical use of the technique.…”

Continuous and noninvasive recording of cardiovascular parameters with the Finapres finger cuff enhances undergraduate student understanding of physiology

“…The Finapres system sometimes produced different measurements of BP compared with an ambulatory Omron blood pressure cuff. The manufacturer (Finapres Medical Systems) and findings from other authors (1,4,14) indicated that the Finapres is suitable in situations where changes in BP are more important than absolute values. To obtain accurate absolute values for recordings of BP and CO, the Finapres equipment must be calibrated at each use (14).…”

“…The use of echocardiography required the employment of a qualified echocardiographer, a luxury that many university teaching laboratories do not have. Such novel approaches for the teaching of cardiovascular physiology are rare.The Finapres finger cuff is a recording system that provides continuous and concurrent calculations of CO, BP, SV, TPR, and HR (1,13,14). It is traditionally used in research settings.…”

“…The Finapres finger cuff is a recording system that provides continuous and concurrent calculations of CO, BP, SV, TPR, and HR (1,13,14). It is traditionally used in research settings.…”