INTRODUCTION AND OBJECTIVES: In patients with systolic dysfunction, different ventricular filling patterns are associated with different prognoses. The load changes resulting from nitroprusside infusion or long-term therapy for heart failure induce alterations in filling pattern that have been shown to serve as outcome markers. Our aim was to investigate the prognostic value of the Doppler-detected change in pseudonormal or restrictive left ventricular filling pattern induced by the Valsalva maneuver in patients with systolic dysfunction. MATERIAL AND METHOD: The study included 36 patients in sinus rhythm with a depressed ejection fraction and an E/A ratio greater than 1. Filling velocities were recorded before and after 3 Valsalva maneuvers. RESULTS: The E/A ratio remained greater than 1 in 12 patients (group A); in 24 patients (group B), it fell below 1, indicating an abnormal relaxation pattern (i.e., a reversible pattern). During a mean follow-up period of 18 months, 8 patients died: 6 in group A (50%) and 2 in group B (8.3%; P=.005). Moreover, 12 patients either died or suffered severe heart failure: 8 in group A (67%) and 4 in group B (17%; P=.003). A reversible filling pattern was associated with lower risks of death (hazard ratio [HR]=0.06; 95% confidence interval [CI], 0.01-0.48) and of hospitalization or death (HR=0.11; 95% CI, 0.03-0.43). CONCLUSIONS: Change of a pseudonormal or restrictive left ventricular filling pattern into an abnormal relaxation pattern after the Valsalva maneuver in patients with systolic dysfunction predicts a lower risk of death or severe heart failure.
RCT Entities:
INTRODUCTION AND OBJECTIVES: In patients with systolic dysfunction, different ventricular filling patterns are associated with different prognoses. The load changes resulting from nitroprusside infusion or long-term therapy for heart failure induce alterations in filling pattern that have been shown to serve as outcome markers. Our aim was to investigate the prognostic value of the Doppler-detected change in pseudonormal or restrictive left ventricular filling pattern induced by the Valsalva maneuver in patients with systolic dysfunction. MATERIAL AND METHOD: The study included 36 patients in sinus rhythm with a depressed ejection fraction and an E/A ratio greater than 1. Filling velocities were recorded before and after 3 Valsalva maneuvers. RESULTS: The E/A ratio remained greater than 1 in 12 patients (group A); in 24 patients (group B), it fell below 1, indicating an abnormal relaxation pattern (i.e., a reversible pattern). During a mean follow-up period of 18 months, 8 patients died: 6 in group A (50%) and 2 in group B (8.3%; P=.005). Moreover, 12 patients either died or suffered severe heart failure: 8 in group A (67%) and 4 in group B (17%; P=.003). A reversible filling pattern was associated with lower risks of death (hazard ratio [HR]=0.06; 95% confidence interval [CI], 0.01-0.48) and of hospitalization or death (HR=0.11; 95% CI, 0.03-0.43). CONCLUSIONS: Change of a pseudonormal or restrictive left ventricular filling pattern into an abnormal relaxation pattern after the Valsalva maneuver in patients with systolic dysfunction predicts a lower risk of death or severe heart failure.