title: Is blood pressure response to the Valsalva maneuver related to neurohormones, exercise capacity, and clinical findings in heart failure?
abstract: OBJECTIVE
  To investigate the relationship of the BP response to the Valsalva maneuver (VM) to parameters of congestive heart failure (CHF) other than hemodynamic measures.
  
  
  METHODS
  Comparison of neurohormones (atrial natriuretic peptide [ANP], brain natriuretic peptide [BNP], norepinephrine [NE]), parameters of spiroergometry, and clinical parameters with BP response to the VM.
  
  
  METHODS
  Tertiary care center.
  
  
  METHODS
  Forty-five patients with stable CHF (ejection fraction, 28 +/- 7%).
  
  
  METHODS
  Pulse amplitude ratio (PAR) calculated between the end and the beginning of the VM using the last two and the first three beats of the straining phase. Failure of the systolic BP to fall below the resting level during the VM.
  
  
  RESULTS
  Patients in the New York Heart Association class III (n = 15) had a higher PAR than those in class II (0.82 +/- 0.21 vs 0.63 +/- 0.20; p < 0.01). There was a close correlation between PAR and ANP (r = 0.76) and BNP (r = 0.62), whereas other parameters were less well correlated (eg, for peak f1.gif" BORDER="0">O(2), r = -0.35; p < 0.05). Patients with failure of the systolic BP to fall below the resting level (n = 24) had higher neurohormones (mean ANP, 246 +/- 158 vs 84 +/- 43 pg/mL; mean BNP, 282 +/- 289 vs 81 +/- 85 pg/mL; p < 0.001; mean NE, 3.9 +/- 1.7 vs 3.4 +/- 1.5 nmol/L; nanosecond), lower exercise capacity (19.8 +/- 5.2 vs 23.0 +/- 3.7 mL/kg/min; p < 0.05), and their quality of life (Minnesota questionnaire) was more compromised (31 +/- 19 vs 18 +/- 15; p < 0. 05).
  
  
  CONCLUSIONS
  The BP response to the VM is related to a broad range of clinical and neurohumoral parameters of CHF. Whether or not it is also related to prognosis remains to be determined. Nevertheless, this easily applicable test should be part of the assessment of patients with CHF.
authors.affiliation: Department of Internal Medicine, Division of Cardiology. hanspeter.brunner@baker.edu.au
authors.forename: H P
authors.initials: HP
authors.lastname: Brunner-La Rocca
authors.forename: D
authors.initials: D
authors.lastname: Weilenmann
authors.forename: H
authors.initials: H
authors.lastname: Rickli
authors.forename: F
authors.initials: F
authors.lastname: Follath
authors.forename: W
authors.initials: W
authors.lastname: Kiowski
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D002908:Chronic Disease; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018377:Neurotransmitter Agents / Q000502:physiology*; D011237:Predictive Value of Tests; D013599:Systole / Q000502:physiology; D014636:Valsalva Maneuver / Q000502:physiology*; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology
chemical_list: D018377:Neurotransmitter Agents