Effect of the Valsalva Maneuver on Diastolic Indices in Patients with Essential Hypertension

Diastolic dysfunction is one of the earliest signs of hypertensive heart disease. However, in some of the hypertens ive patients echocardiographic examination cannot reveal any pathologic findings. The aim of our study was to investigate the effect of the Valsalva maneuver on diastolic indices in hypertensive patients with normal mitral flow pattern and to compare the results with a healthy control group and with hypertensive patients with diastolic dysfunction. Sixty-eight hypertensive patients without evidence of coronary artery disease (28 female, 40 male, age 50±7) were divided in two groups according to their E/A ratio as those with diastolic dysfunction (n=36) and no diastolic dysfunction (n=32) (DD-). DDpatients and the control group (n=20) performed Valsalva maneuver and their pulsed-Doppler measurements were repeated at the straining phase. In 72% of DD- patients E velocity decreased during Valsalva maneuver, but E/A ratio feJI below 1.0 because A velocity did not change or increased in some of the patients. However, in the control group E and A velocity showed a similar decrease and no difference could be observed in E/A ratio. In 47% of the patients with a positive response to Valsalva maneuver myocardial perfusion scintigraphy revealed reversible defects whereas none of the patients whose E/A ratio remained over 1.0 had perfusion defects. It is concluded that, a substantial proportion of hypertensive individuals have left ventricular diastolic abnormalities; in patients with normal E/A ratio the Valsalva maneuver should be performed in order to unmask a probable falsely normal finding and diastolic dysfunction develops together with a decrease in coronary reserve.