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Systolic Blood Pressure Response to Valsalva is a Simple Bedside Tool for Estimating Pulmonary Capillary Wedge Pressure in Patients with Pulmonary Hypertension

Frances Rogers


Paul R. Forfia


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Conference: 2009 PH Resource Network Symposium

Release Date: 09.24.2009

Presentation Type: Abstracts

Frances Rogers, MSN, CRNP; Paul Forfia, MD
Pulmonary Hypertension Program, Hospital of the University of Pennsylvania, Philadelphia, PA

BACKGROUNDMany relevant clinical questions can be asked in the initial evaluation of patients with pulmonary hypertension. One of the most relevant is the following: Is pulmonary hypertension occurring in association with a normal or elevated pulmonary capillary wedge pressure (PCWP)?

HYPOTHESISDoes the systolic blood pressure (SBP) response to Valsalva Maneuver (VSM) distinguish a normal from an elevated PCWP in the initial assessment of patients with Pulmonary Hypertension?

METHODSThirty-nine consecutive patients were referred for an evaluation of pulmonary hypertension. The initial screening was made by Doppler echo. None of the patients had right-heart catheterization prior to first visit to the center. All patients had SBP response to VSM obtained during their initial visit. Response was graded as square wave negative (SQWV-) or normal or response was deemed SQWV+. All patients underwent right heart catheterization thereafter (median 12 days after initial clinic visit). Hemodynamics were compared between SQWV- and SQWV+ patients.

RESULTSIn our sample, a SQWV+ response identified WHO Group II patients in the vast majority of cases (82%). A SQWV- response identified WHO Group I patients (71%) >> WHO Group III (18%) >>WHO Group II (12%). These findings extend the diagnostic utility of SBP response to VSM from patient with left ventricular dysfunction to patients with pulmonary hypertension.

CONCLUSIONSThe Systolic Blood Pressure response to Valsalva Maneuver is a simple bedside tool that identifies differences in PCWP between undifferentiated patients with pulmonary hypertension. More research is needed to determine the clinical utility of SBP response to Valsalva when integrated into the entire noninvasive assessment (echocardiographic parameters, BNP, 6 minute walk distance, etc).