Valsalva Maneuver is a Simple and Effective Clinical Tool for Pseudo Normal Diastolic Dysfunction

Abstract

Background: Dystolic dysfunction is a major contribution to heart failure with preserved ejection fraction (HFPEF) and can be difficult to diagnose using traditional echocardiography. This study compares the superior clinical effect of Valsalva maneuver in diagnosing diastolic dysfunction (degree II) with the lateral anulus tissue Doppler –imaging (TDI). Methods: We included 100 patients with suspected diastolic dysfunction, which had normal mitral inflow velocities, ratio and tissue Doppler E′ velocity. Valsalva maneuver was used to determine its utility by detecting diastolic dysfunction. The most important clinical criteria were a reversible change from normal (E/A: 0.9-1.4) to slow relaxation pattern (<0.9) during the procedure. Results: In all cases who have normal mitral influx and tissue Doppler E′ velocity by baseline echocardiogram, a Valsalva maneuver is performed. All patients experienced a reduction in E/A ratio ≥50%, reflecting diastolic dysfunction of degree II type.  Conclusion: Valsalva maneuver is more effective than lateral annulus tissue Doppler E′ velocity in detection of degree II diastolic dysfunction. Including this in regular echocardiographic assessment can improve clinical treatment for patients with HFPEF symptoms.