Prognosis After Myocardial Infarction- Prediction in Ambulatory Patients by Use of the Bedside Valsalva Maneuver

Abstract

One hundred survivors of first myocardial infarction were studied prior to hospital discharge by 24 hour ambulatory electrocardiography as well as radio nuclide ventriculography. The bedside Valsalva maneuver, with simple sphyg momanometric determination of arterial pressure response, was performed 6 weeks post infarction and patients were followed for a mean of 22 months. The arterial pressure response pattern provided a semiquantitative estimate of rest ing left ventricular systolic function when related to the radionuclide ejection fraction (SIN, 0.56±0.13; ABO, 0.43±0.18; SQW, 0.16±0.06) (P < 0.02). Ab normal Valsalva responses (ABO and SQW) were found more commonly in patients with diminished left ventricular systolic function and high grade ven tricular arrhythmias. The SQW response pattern was highly predictive of fu ture sudden cardiac death. The bedside Valsalva maneuver, performed 2-4 weeks after hospital discharge, upon the ambulatory patient is a simple, safe, inexpensive and uniformly applicable method which may serve as the basis for a strategy with which to approach the post-infarction patient regarding risk stratification and further clinical management.