Prediction of hemodynamic conditions by noninvasive arterial tonometry in mitral stenosis

To predict the hemodynamic conditions in patients with mitral stenosis (MS), continuous blood pressure responses were monitored noninvasively at the bedside by arterial tonometry during the Valsalva maneuver in 18 MS patients aged 54.2 +/- 9.1 (40 approximately 77) years (6 men, 12 women). Two indices during the Valsalva maneuver (blood pressure decline value at phase III (BPdec) and subsequent blood pressure overshoot value at phase IV (BPov)) were compared with hemodynamic data obtained by the cardiac catheterization method, and the correlations between the changes in these parameters were examined. In these 18 patients, BPdec showed a significant negative correlation with the mean diastolic pressure gradient between the left atrium and left ventricle and showed a significant negative correlation with pulmonary capillary wedge pressure (PCWP) (r = - 0.62, p < 0.01, r = - 0.53, p < 0.05, respectively). Mitral valve area (MVA) showed a significant positive correlation with BPdec (r = + 0.63, p < 0.01). Similarly, BPov showed a significant positive correlation with cardiac output (CO), cardiac index (CI) and MVA (r = + 0.60, p < 0.01, r = + 0.64, p < 0.01, r = + 0.65, p < 0.01, respectively). Thus, continuous monitoring of blood pressure by arterial tonometry during the Valsalva maneuver is useful for predicting the hemodynamic conditions in patients with MS.