title: Hemodynamic change in transmitral gradient during Valsalva maneuver and its relation with left atrial function, functional capacity, and pulmonary artery pressure in patients with mitral stenosis in sinus rhythm.
abstract: BACKGROUND
  The hemodynamic factors contributing to the clinical symptomatology in patients with mitral stenosis (MS) have been under investigation. The objective of this study was to evaluate the use of the Valsalva maneuver in patients with MS and whether there is an association between the degree of the hemodynamic changes in transmitral gradient (TG) in response to Valsalva maneuver and functional status, systolic pulmonary artery pressure, and left atrial function in patients with MS in sinus rhythm.
  
  
  METHODS
  The study prospectively evaluated 42 patients (37 female, mean age 40 +/- 10 years) with a diagnosis of pure MS in sinus rhythm. Patients were divided into 3 groups according to their New York Heart Association (NYHA) functional class. In all, 12 patients were in NYHA functional class I, 17 patients in class II, and 13 patients in class III. TG, including the mitral peak, mean, and late filling gradients, were calculated by the modified Bernoulli equation at rest and during the strain phase of Valsalva maneuver. The percentage changes in all TG in response to Valsalva were calculated. Traditional echocardiographic parameters for atrial function were also measured.
  
  
  RESULTS
  We found that, in patients who were more symptomatic according to NYHA classification, a reduction in TG in response to Valsalva maneuver was blunted and associated with higher systolic pulmonary artery pressure compared with those who were asymptomatic or had mild symptoms. Patients in NYHA class III decreased mitral mean pressure gradient by only 13.5%, significantly less (P < .001) than those in classes I (53.9%) and II (41.7%). However, despite the fact that left atrial ejection fraction was low in all patients, it was not associated with functional status in patients with MS.
  
  
  CONCLUSIONS
  This study, for the first time, suggests that echocardiographically determined changes in TG in response to the Valsalva maneuver may provide an objective, noninvasive means of evaluating patients with MS.
authors.affiliation: Yuksek Ihtisas Hospital, Department of Cardiology, Ankara, Turkey. ozcanozeke@gmail.com
authors.forename: Ozcan
authors.initials: O
authors.lastname: Ozeke
authors.forename: Huda Hamid Mohamed
authors.initials: HH
authors.lastname: Elhassan
authors.forename: Dursun
authors.initials: D
authors.lastname: Aras
authors.forename: Omac
authors.initials: O
authors.lastname: Tufekcioglu
authors.forename: Orhan
authors.initials: O
authors.lastname: Maden
authors.forename: M Timur
authors.initials: MT
authors.lastname: Selcuk
authors.forename: Serkan
authors.initials: S
authors.lastname: Topaloglu
authors.forename: Bulent
authors.initials: B
authors.lastname: Deveci
authors.forename: Ali
authors.initials: A
authors.lastname: Yildiz
authors.forename: Hakan
authors.initials: H
authors.lastname: Ulupinar
authors.forename: Onur
authors.initials: O
authors.lastname: Sahin
authors.forename: Kumral
authors.initials: K
authors.lastname: Ergun
authors.forename: Mehmet K
authors.initials: MK
authors.lastname: Celenk
authors.forename: Zehra
authors.initials: Z
authors.lastname: Golbasi
mesh_terms: D000222:Adaptation, Physiological; D000328:Adult; D016279:Atrial Function, Left; D001794:Blood Pressure; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000503:physiopathology*; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D011379:Prognosis; D011651:Pulmonary Artery / Q000503:physiopathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013223:Statistics as Topic; D014463:Ultrasonography; D014636:Valsalva Maneuver