Document Detail

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.
MedLine Citation:
PMID:  17000363     Owner:  NLM     Status:  MEDLINE    
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. CONCLUSION: 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.
Ozcan Ozeke; Huda Hamid Mohamed Elhassan; Dursun Aras; Omac Tufekcioglu; Orhan Maden; M Timur Selcuk; Serkan Topaloglu; Bulent Deveci; Ali Yildiz; Hakan Ulupinar; Onur Sahin; Kumral Ergun; Mehmet K Celenk; Zehra Golbasi
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Publication Detail:
Type:  Controlled Clinical Trial; Journal Article    
Journal Detail:
Title:  Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography     Volume:  19     ISSN:  1097-6795     ISO Abbreviation:  J Am Soc Echocardiogr     Publication Date:  2006 Oct 
Date Detail:
Created Date:  2006-09-26     Completed Date:  2006-10-24     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8801388     Medline TA:  J Am Soc Echocardiogr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1245-50     Citation Subset:  IM    
Yuksek Ihtisas Hospital, Department of Cardiology, Ankara, Turkey.
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MeSH Terms
Adaptation, Physiological
Atrial Function, Left*
Blood Pressure*
Mitral Valve / physiopathology*
Mitral Valve Stenosis / physiopathology*,  ultrasonography*
Pulmonary Artery / physiopathology*
Reproducibility of Results
Sensitivity and Specificity
Statistics as Topic
Valsalva Maneuver*

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