The Utility of Valsalva Maneuver in the Diagnosis of Orthostatic Disorders (P5.121)

OBJECTIVE: To assess patterns of systolic blood pressure (SBP) fluctuations during Valsalva maneuver (VM) and head-up tilt (HUT) testing in orthostatic intolerance (OI).BACKGROUND: VM is a reliable clinical tool in the autonomic assessment, which allows for assessment of important cardiovascular markers including baroreflex sensitivity (BRS). The VM offers immediate quantitative analyses of hemodynamic responses, which have been shown to demonstrate reproducible patterns. VM patterning may improve the diagnosis of various autonomic disorders characterized by orthostasis, where a single estimation of BRS is often compromised due to severe adrenergic failure. Given that OI can be a substantial cause of morbidity, improved clinical assessment of orthostasis would be beneficial. Therefore, our goal was to clarify the utility of the VM in the diagnosis of OI.METHODS: Patients with neurogenic orthostatic hypotension (NOH, n=26), postural tachycardia syndrome (POTS, n=26) and symptomatic orthostatic intolerance (SOI, n=14) were compared to a healthy population (Control, n=107) and inappropriate sinus tachycardia (IST, n=7). Quantitative VM analysis included adrenergic and vagal BRS measurements (BRSa/BRSa 1 and BRSv). Repeated VM trials during the same visit were evaluated for reproducibility with rANOVA.RESULTS: In NOH, cardiovagal SBP decrements in VM and HUT were correlated (r=0.660, p 1 did not reveal changes vs. Controls (pu003e0.05) and was not applicable in 60[percnt] of NOH. In SOI, compared to Controls there were larger cardiovagal SBP decrements (p 1 that contradicted greater adrenergic dysfunction (defined by the Composite Autonomic Severity Score). Overshoot in phase IV dipped below baseline or dropped ≥10mmHg over 8s in POTS (“N” pattern), but by only 3s in IST (“M” pattern”).CONCLUSIONS: Pathological hemodynamic responses to the VM may compromise BRSa evaluation; however, SBP patterning is a valuable tool for detecting and differentiating OI. Disclosure: Dr. Palamarchuk has nothing to disclose. Dr. Baker has nothing to disclose. Dr. Kimpinski has nothing to disclose.