title: Finger photoplethysmography during the Valsalva maneuver reflects left ventricular filling pressure.
abstract: It is often challenging to assess cardiac filling pressure clinically. An improved system for detecting or ruling out elevated cardiac filling pressure may help reduce hospitalizations for heart failure. The blood pressure response to the Valsalva maneuver reflects left heart filling pressure, but its underuse clinically may be due in part to lack of continuous blood pressure recording along with lack of standardization of expiratory effort. In this study, we tested whether Valsalva-induced changes in the pulse amplitude of finger photoplethysmography (PPG), a technology already widely available in medical settings, correlate with invasively measured left ventricular end-diastolic pressure (LVEDP). We tested 33 subjects before clinically scheduled cardiac catheterizations. A finger photoplethysmography waveform was recorded during a Valsalva effort of 20 mmHg expiratory pressure sustained for 10 s, an effort most patients can achieve. Pulse amplitude ratio (PAR) was calculated as the PPG waveform amplitude just before release of expiratory effort divided by the waveform amplitude at baseline. PAR was well correlated with LVEDP (r = 0.68; P < 0.0001). For identifying LVEDP > 15 mmHG, PAR > 0.4 was 85% sensitive [95% confidence interval (95CI): 54-97%] and 80% specific (95CI: 56-93%). In conclusion, finger PPG, a technology already ubiquitous in medical centers, may be useful for assessing clinically meaningful categories of left heart filling pressure, using simple analysis of the waveform after a Valsalva maneuver effort that most patients can achieve.
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. hsilber@jhmi.edu
authors.forename: Harry A
authors.initials: HA
authors.lastname: Silber
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Trost
authors.forename: Peter V
authors.initials: PV
authors.lastname: Johnston
authors.forename: W Lowell
authors.initials: WL
authors.lastname: Maughan
authors.forename: Nae-Yuh
authors.initials: NY
authors.lastname: Wang
authors.forename: Edward K
authors.initials: EK
authors.lastname: Kasper
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Aversano
authors.forename: David E
authors.initials: DE
authors.lastname: Bush
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D001810:Blood Volume / Q000502:physiology*; D006328:Cardiac Catheterization; D005240:Feasibility Studies; D005260:Female; D005385:Fingers / Q000098:blood supply*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017156:Photoplethysmography / Q000379:methods*; D014636:Valsalva Maneuver / Q000502:physiology*; D016277:Ventricular Function, Left / Q000502:physiology*