The Valsalva load test and spectral tracking echocardiography effectiveness in the diagnosis of heart failure with preserved left ventricular ejection fraction

Aim      To determine the applicability of speckle-tracking EchoCG (STE) and the Valsalva maneuver for diagnosis of heart failure with preserved left ventricular ejection fraction (CHFpEF).

Material and methods  Transthoracic STE with simultaneous electrocardiogram (ECG) recording was performed for patients with CHFpEF and healthy sex- and age-matched subjects (control group) at rest and during the Valsalva maneuver. The study was conducted in compliance with standards of Good Clinical Practice and principles of the Helsinki Declaration. The study protocol was approved by the Ethical Committee of the St. Petersburg State University.

Results During the Valsalva maneuver, deviations of both global and segmental myocardial strain were more pronounced than at rest. In patients of the study group performing the Valsalva maneuver, LV end-diastolic volume and LV end-systolic volume (99 %) were increased. Heart rate was considerably reduced (significance of difference >99%) in patients with CHFpEF during the Valsalva maneuver compared to the control group. The increased predictive value of these parameters during the Valsalva maneuver can justify the inclusion of this method in early detection and prognostic assessment of CHFpEF.

Conclusion      Speckle-tracking EchoCG with the Valsalva maneuver is a noninvasive, generally available, and easily reproducible outpatient method for diagnosis of CHFpEF.

1. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Colvin MM et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Journal of the American College of Cardiology. 2017;70(6):776–803. DOI: 10.1016/j.jacc.2017.04.025

2. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European Heart Journal. 2016;37(27):2129–200. DOI: 10.1093/eurheartj/ehw128

3. Kapłon-Cieślicka A, Kupczyńska K, Dobrowolski P, Michalski B, Jaguszewski MJ, Banasiak W et al. On the search for the right definition of heart failure with preserved ejection fraction. Cardiology Journal. 2020;27(5):449–68. DOI: 10.5603/CJ.a2020.0124

4. Serezhina E.K., Obrezan A.G. New imaging techniques in the diagnosis of heart failure with preserved ejection fraction. Russian Medical Journal. Medical Review. 2019;3(1–2):52–6.

5. Blum M, Hashemi D, Motzkus LA, Neye M, Dordevic A, Zieschang V et al. Variability of Myocardial Strain During Isometric Exercise in Subjects With and Without Heart Failure. Frontiers in Cardiovascular Medicine. 2020;7:111. DOI: 10.3389/fcvm.2020.00111

6. Gudieva Kh.M., Safarova A.F., Kobalava Zh.D. Application of the HFA-PEFF algorithm for diagnosis of heartfailure with preserved left ventricular ejection fraction. Clinical pharmacology and therapy. 2020;29(2):47–50. DOI: 10.32756/0869-5490-2020-2-47-50

7. Saldaña García J, Torremocha López A, Dawid Milner MS. Influence of repetitions on the Valsalva maneuver. Clinical Neurophysiology Practice. 2020;5:104–11. DOI: 10.1016/j.cnp.2020.04.003

8. Zema MJ. Diagnosing Heart Failure by the Valsalva Maneuver. JACC: Heart Failure. 2018;6(11):969–71. DOI: 10.1016/j.jchf.2018.07.004

9. Zema MJ, Restivo B, Sos T, Sniderman KW, Kline S. Left ventricular dysfunction – bedside Valsalva manoeuvre. Heart. 1980;44(5):560–9. DOI: 10.1136/hrt.44.5.560

10. Gilotra NA, Wanamaker BL, Rahim H, Kunkel K, Yenokyan G, Schulman SP et al. Usefulness of Noninvasively Measured Pulse Amplitude Changes During the Valsalva Maneuver to Identify Hospitalized Heart Failure Patients at Risk of 30-Day Heart Failure Events (from the PRESSURE-HF Study). The American Journal of Cardiology. 2020;125(6):916–23. DOI: 10.1016/j.amjcard.2019.12.027

11. Liniado GE, Beck MA, Gimeno GM, González AL, Cianciulli TF, Castiello GG et al. Clinical examination and the Valsalva maneuver in heart failure. Medicina. 2018;78(3):163–70. PMID: 29940542

12. Sharpey-Schafer EP. Effects of Valsalva’s Man uvre on the Normal and Failing Circulation. BMJ. 1955;1(4915):693–5. DOI: 10.1136/bmj.1.4915.693

13. Greenfield JC, Cox RL, Hernandez RR, Thomas C, Schoonmaker FW. Pressure-Flow Studies in Man During the Valsalva Maneuver with Observations on the Mechanical Properties of the Ascending Aorta. Circulation. 1967;35(4):653–61. DOI: 10.1161/01.CIR.35.4.653

14. McKay RG, Spears JR, Aroesty JM, Baim DS, Royal HD, Heller GV et al. Instantaneous measurement of left and right ventricular stroke volume and pressure-volume relationships with an impedance catheter. Circulation. 1984;69(4):703–10. DOI: 10.1161/01.CIR.69.4.703

15. Mitchell C, Rahko PS, Blauwet LA, Canaday B, Finstuen JA, Foster MC et al. Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults: Recommendations from the American Society of Echocardiography. Journal of the American Society of Echocardiography. 2019;32(1):1–64. DOI: 10.1016/j.echo.2018.06.004