Normal values of pulmonary capillary wedge pressure and the blood pressure response to the Valsalva manoeuvre in healthy elderly subjects

Remmen, Jaap J.; Aengevaeren, W.R.M.; Verheugt, Freek W. A.; Jansen, René W. M. M.

doi:10.1111/j.1475-097x.2005.00630.x

Cited by 11 publications

(6 citation statements)

References 43 publications

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“…PAR is a continuous variable, best measured using a continuous waveform. PAR has been shown to reflect left heart filling pressure using indwelling pressure transducers [ 15 , 19 ] and noninvasive surrogates of a continuous blood pressure waveform [ 21 – 23 ]. We demonstrated the correlation between PAR and LVEDP using ordinary finger photoplethysmography and an expiratory effort of 20 mmHg, which is a milder effort than is used in other studies and can be achieved by more patients [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

A finger photoplethysmography waveform during the valsalva maneuver detects changes in left heart filling pressure after hemodialysis

et al. 2015

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BackgroundA noninvasive system for determining left ventricular (LV) filling pressure may help to improve personalized fluid removal goals in hemodialysis patients. We previously showed that the change in photoplethysmography (PPG) pulse amplitude measured by finger PPG during a Valsalva maneuver correlates with invasively measured left ventricular end-diastolic pressure (LVEDP). This key PPG change, the ratio of finger PPG pulse amplitude at end-Valsalva to baseline, is known as the Pulse Amplitude Ratio, PAR. The objective of this study was to determine how PAR changes after fluid removal in hemodialysis.MethodsWe tested subjects with end-stage renal disease, before and after hemodialysis. Each subject performed a Valsalva maneuver with an effort of 20 mmHg for 10 s, guided by the device display. Finger PPG was recorded continuously before and during the maneuver. PAR was calculated automatically.ResultsTwenty-seven subjects (21 Males) ages 25–75 years were tested. Access sites were AV-fistulas of the arm predominantly. Weight decreased from 99.7 ± 36.9 kg to 97.0 ± 36.0 kg (p < 0.0003) with an average fluid removal of 3.07 ± 1.08 l. Correspondingly, PAR decreased from 0.74 ± 0.24 to 0.62 ± 0.23 (p = 0.003). The change in PAR was correlated with baseline PAR (r = 0.48, p = 0.01).ConclusionAn index of left heart filling pressure obtained noninvasively using finger photoplethysmography during the Valsalva maneuver is sensitive enough to detect reductions in filling pressure after fluid removal with hemodialysis. Further studies are warranted to determine if this method can be used to guide fluid removal during hemodialysis.

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Section: Discussionmentioning

confidence: 99%

A finger photoplethysmography waveform during the valsalva maneuver detects changes in left heart filling pressure after hemodialysis

et al. 2015

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“…In this procedure, the decrease in BP is due to elevation of intrathoracic and intraabdominal pressure induced by straining. With the increase in intrathoracic pressure, the venous return decreases, causing a reduction in cardiac output and hence a decrease in BP, which in turn leads to baroreflexmediated vasoconstriction (Remmen et al, 2005). The increase in intrathoracic pressure also causes an increase in intracranial pressure (Williams, 1981), leading to a considerably stronger reduction in the cerebral perfusion pressure than indicated by the BP decrease.…”

Section: Methods To Induce Hemodynamic Changesmentioning

confidence: 99%

Cerebral Autoregulation: An Overview of Current Concepts and Methodology with Special Focus on the Elderly

Beek

Claassen

Rikkert

et al. 2008

J Cereb Blood Flow Metab

418

372

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Cerebral autoregulation (CA) refers to the properties of the brain vascular bed to maintain cerebral perfusion despite changes in blood pressure (BP). Whereas classic studies have assessed CA during changes in BP that have a gradual onset, dynamic studies quantify the fast modifications in cerebral blood flow (CBF) in relation to rapid alterations in BP. There is a lack of standardization in the assessment of dynamic CA. This review provides an overview of the methods that have been applied, with special focus on the elderly. We will discuss the relative merits and shortcomings of these methods with regard to the aged population. Furthermore, we summarize the effects of variability in BP on CBF in older people. Of the various dynamic assessments of CA, a single sit-tostand procedure is a feasible and physiologic method in the elderly. The collection of spontaneous beat-to-beat changes in BP and CBF allows estimation of CA using the technique of transfer function analysis. A thorough search of the literature yielded eight studies that have measured dynamic CA in the elderly aged < 75 years. Regardless of the methods used, it was concluded from these studies that CA was preserved in this population.

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“…5) E' and E/E' are influenced by age in healthy subjects [66-68]. Age-related increases in E/E' do not seem to be a consequence of higher LV diastolic pressures since left atrial pressure does not significantly rise in healthy elderly subjects [69,70]. Unexpected high values for E/E' are not uncommon in this setting, and underlying structural heart disease at comprehensive Doppler echocardiography should be taken into consideration before interpreting tissue Doppler echocardiography.…”

Section: Introductionmentioning

confidence: 99%

Current clinical applications of spectral tissue Doppler echocardiography (E/E' ratio) as a noninvasive surrogate for left ventricular diastolic pressures in the diagnosis of heart failure with preserved left ventricular systolic function

Arquès

Roux

Luccioni

2007

Cardiovasc Ultrasound

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Congestive heart failure with preserved left ventricular systolic function has emerged as a growing epidemic medical syndrome in developed countries, which is characterized by high morbidity and mortality rates. Rapid and accurate diagnosis of this condition is essential for optimizing the therapeutic management. The diagnosis of congestive heart failure is challenging in patients presenting without obvious left ventricular systolic dysfunction and additional diagnostic information is most commonly required in this setting. Comprehensive Doppler echocardiography is the single most useful diagnostic test recommended by the ESC and ACC/AHA guidelines for assessing left ventricular ejection fraction and cardiac abnormalities in patients with suspected congestive heart failure, and non-invasively determined basal or exercise-induced pulmonary capillary hypertension is likely to become a hallmark of congestive heart failure in symptomatic patients with preserved left ventricular systolic function. The present review will focus on the current clinical applications of spectral tissue Doppler echocardiography used as a reliable noninvasive surrogate for left ventricular diastolic pressures at rest as well as during exercise in the diagnosis of heart failure with preserved left ventricular systolic function. Chronic congestive heart failure, a disease of exercise, and acute heart failure syndromes are characterized by specific pathophysiologic and diagnostic issues, and these two clinical presentations will be discussed separately.

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Normal values of pulmonary capillary wedge pressure and the blood pressure response to the Valsalva manoeuvre in healthy elderly subjects

Cited by 11 publications

References 43 publications

A finger photoplethysmography waveform during the valsalva maneuver detects changes in left heart filling pressure after hemodialysis

A finger photoplethysmography waveform during the valsalva maneuver detects changes in left heart filling pressure after hemodialysis

Cerebral Autoregulation: An Overview of Current Concepts and Methodology with Special Focus on the Elderly

Current clinical applications of spectral tissue Doppler echocardiography (E/E' ratio) as a noninvasive surrogate for left ventricular diastolic pressures in the diagnosis of heart failure with preserved left ventricular systolic function

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