P800 Effect of Valsalva Maneuver on echocardiographic systolic and diastolic parameters in patients with acute coronary syndrome, a comparison between normal and high ventricular filling pressures
Authors: Sharifkazemi M B , Mehdinejad E , Karami M Y 
Published: January 2020

Abstract

Funding Acknowledgements
Nil

OnBehalf
Nil

Introduction
Echocardiography is used as a useful and common method for the assessments of left and right ventricular (LV & RV) systolic and diastolic functions. Valsalva Maneuver (VM) with the increase in the intra-thoracic and intra-abdominal pressure is often used as a simple, inexpensive and non-invasive method to diagnose some clinical conditions such as heart murmurs. However, in terms of echocardiography, the use of VM is limited to a few parameters for many years. On the other hand, blood level of N-Terminal Pro–B-Type Natriuretic Peptide (NT Pro–BNP) indirectly discriminates normal or high ventricular filling pressure (FP).

Purpose
The purposes of this research is to provide a comprehensive review of the technique and to compare the effect of VM in ACS patients, with and without elevated FP on either RV and LV diastolic and systolic echocardiographic parameters.

Methods
Thirty-eight patient, who were diagnosed with possible ACS; Unstable Angina Pectoris, NSTEMI and STEMI, underwent coronary angiography enrolled in this double–blinded clinical trial study. The mild Coronary Artery Disease (CAD) with normal levels of NT Pro–BNP were included in study group one and patients with significant CAD and high level of NT Pro–BNP who underwent PCI were included in study group two. All the systolic and diastolic indicators of both ventricles, totally twenty-four parameters those had mentioned in the academic literature previously, have been evaluated; once before Valsalva and once during stage 2 of the maneuver. Echocardiography is performed by an advanced echo machine and by an expert cardiologist- echocardiographer, which the recorded images were reviewed by the second echocardiographer separately.

Results
Between the two groups, LV parameter analysis showed significant difference in LV EF pre and post VM. However, there was statistically insignificant difference regarding other systolic as well as diastolic parameters. Between the two groups, RV parameters analysis showed no significant difference in systolic and diastolic parameters pre and post VM.

Conclusion
To the best of our knowledge, this is the first report assessing post VM changes in four chambers as well as mitral and tricuspid valves parameters in ACS patients with normal versus high level of FP. Previously, LV diastolic dysfunction and Doppler mitral inflow pattern correlation with VM were approved. In the present study, in addition to those known findings from before, except the LV ejection fraction (LVEF) that showed there was statistically significant difference in pre– and post-VM, other systolic parameters, as well as diastolic indicators in either RV and LV, were identical.
Therefore, we do not recommend conducting Valsalva maneuver on the rest of the other parameters to diagnose systolic and diastolic dysfunction in ACS patients with mild versus significant CAD who were assumed to have normal or elevated filling pressures.