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Prognostic implications of the blood pressure response to the Valsalva manoeuvre in elderly cardiac patients
  1. J J Remmen1,*,
  2. R W M M Jansen1,
  3. W R M Aengevaeren2,
  4. M A Brouwer2,
  5. F W A Verheugt2
  1. 1Department of Geriatric Medicine, University Medical Center Nijmegen, Nijmegen, The Netherlands
  2. 2Heartcenter, Department of Cardiology, University Medical Center Nijmegen, Nijmegen, The Netherlands
  1. Correspondence to:
    Dr Jaap J Remmen
    670 Department of Cardiology, University Medical Center Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands; j.remmen{at}cardio.umcn.nl

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Heart failure is primarily a disorder of the elderly. The prognosis of patients with heart failure is poor; half of them will die within four years.1 Estimation of life expectancy of an individual patient can contribute to the well-being of the patient. The blood pressure response to the Valsalva manoeuvre is related to pulmonary capillary wedge pressure (PCWP),2 which is raised in heart failure and related to mortality.3 In this study, we examined the relationship between the blood pressure response to the Valsalva manoeuvre and mortality in a heterogeneous group of elderly patients with cardiac disease undergoing right-sided cardiac catheterisation.

METHODS

Between March 2000 and April 2002, consecutive elderly patients (n  =  104) scheduled to undergo right-sided catheterisation were initially enrolled. The data of 11 patients were discarded for various reasons, leaving 93 patients (38 women), aged 71 (SD 5) years, eligible for analysis. The study was approved by the Ethics Committee for Research on Human Subjects of the University Medical Center Nijmegen.

PCWP was determined with a Swan–Ganz catheter (Baxter, Irvine, California, USA). Non-invasive continuous blood pressure and heart rate were measured on a finger with a Finapres device (Model 2300; Ohmeda, Englewood, Colorado, USA).

Immediately after measurement of PCWP, the Valsalva manoeuvre was performed with …

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