Abstract
Heart failure (HF) is primarily a disorder of the elderly. However, in the elderly, physical examination and radiographic methods are not accurate in the diagnosis of HF. Pulmonary capillary wedge pressure (PCWP) provides an estimate of cardiac filling pressure and can be used to diagnose HF. However, PCWP can only be assessed invasively. A non-invasive method for estimation of PCWP would be useful for detection of HF. Therefore, we investigated the relationship of PCWP and the blood pressure (BP) response to the Valsalva Manoeuvre (VM) in healthy elderly subjects and elderly cardiac patients. In healthy elderly subjects, we performed right-sided catheterisation in order to acquire normal values of the BP response to the Valsalva manoeuvre, which was non-invasively measured with Finapres, and of PCWP. Although the BP response and PCWP correlated moderately, it was sensitive and specific for detection of elevation of PCWP, which was accomplished by inflation of an anti-Gravity garment. Furthermore, we compared cardiac output assessed by thermodilution to cardiac output derived from arterial pulse wave analysis. We found a large and clinically significant difference between these methods of assessment of cardiac output. Therefore, arterial pulse wave analysis was not appropriate to measure absolute cardiac output in healthy elderly subjects. The relationship between PCWP and the BP response to the VM was also studied in elderly patients with various cardiac disorders. PCWP and the BP response to VM correlated strongly. The BP response was highly sensitive and specific for detection of elevated PCWP and could therefore be a useful non-invasive tool to diagnose HF. Interestingly, the BP response to the VM was an independent predictor of mortality, in a model with age, gender, left ventricular function, heart failure admittance, myocardial infarction, heart rate, presence of pulmonary rales, and functional class.
