PMID- 17000363
OWN - NLM
STAT- MEDLINE
DCOM- 20061024
LR  - 20161124
IS  - 1097-6795 (Electronic)
IS  - 0894-7317 (Linking)
VI  - 19
IP  - 10
DP  - 2006 Oct
TI  - 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.
PG  - 1245-50
AB  - 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.
FAU - Ozeke, Ozcan
AU  - Ozeke O
AD  - Yuksek Ihtisas Hospital, Department of Cardiology, Ankara, Turkey. 
      ozcanozeke@gmail.com
FAU - Elhassan, Huda Hamid Mohamed
AU  - Elhassan HH
FAU - Aras, Dursun
AU  - Aras D
FAU - Tufekcioglu, Omac
AU  - Tufekcioglu O
FAU - Maden, Orhan
AU  - Maden O
FAU - Selcuk, M Timur
AU  - Selcuk MT
FAU - Topaloglu, Serkan
AU  - Topaloglu S
FAU - Deveci, Bulent
AU  - Deveci B
FAU - Yildiz, Ali
AU  - Yildiz A
FAU - Ulupinar, Hakan
AU  - Ulupinar H
FAU - Sahin, Onur
AU  - Sahin O
FAU - Ergun, Kumral
AU  - Ergun K
FAU - Celenk, Mehmet K
AU  - Celenk MK
FAU - Golbasi, Zehra
AU  - Golbasi Z
LA  - eng
PT  - Controlled Clinical Trial
PT  - Journal Article
PL  - United States
TA  - J Am Soc Echocardiogr
JT  - Journal of the American Society of Echocardiography : official publication of the 
      American Society of Echocardiography
JID - 8801388
SB  - IM
MH  - Adaptation, Physiological
MH  - Adult
MH  - *Atrial Function, Left
MH  - *Blood Pressure
MH  - Female
MH  - Hemodynamics
MH  - Humans
MH  - Male
MH  - Mitral Valve/*physiopathology
MH  - Mitral Valve Stenosis/*diagnostic imaging/*physiopathology
MH  - Prognosis
MH  - Pulmonary Artery/*physiopathology
MH  - Reproducibility of Results
MH  - Sensitivity and Specificity
MH  - Statistics as Topic
MH  - Ultrasonography
MH  - *Valsalva Maneuver
EDAT- 2006/09/27 09:00
MHDA- 2006/10/25 09:00
CRDT- 2006/09/27 09:00
PHST- 2006/01/24 00:00 [received]
PHST- 2006/09/27 09:00 [pubmed]
PHST- 2006/10/25 09:00 [medline]
PHST- 2006/09/27 09:00 [entrez]
AID - S0894-7317(06)00412-3 [pii]
AID - 10.1016/j.echo.2006.04.034 [doi]
PST - ppublish
SO  - J Am Soc Echocardiogr. 2006 Oct;19(10):1245-50. doi: 10.1016/j.echo.2006.04.034.