Reliability of the blood pressure response during performance of bedside Valsalva maneuver and association with NT-pBNP levels

Zuverlässigkeit der Blutdruckreaktion während der Durchführung eines bettseitigen Valsalva-Manövers und Assoziation mit NT-pBNP-Werten

Abstract

Background

Heart failure (HF) is common in older people. The diagnosis of HF, however, is difficult in older subjects, especially in settings without direct access to further diagnostics. The type of blood pressure response during the performance of a Valsalva maneuver has been suggested as an easily applicable bedside test to detect HF; however, the reliability of this maneuver and the association with HF is unknown in geriatric patients.

Methods

This study included 89 patients admitted for geriatric rehabilitation. Systolic blood pressure was taken while the patient performed a Valsalva maneuver. The systolic blood pressure response was classified as sinusoidal (type A), absent overshoot (type B) or square pattern (type C). To test interrater reliability systolic blood pressure response was evaluated independently by two investigators. The procedure was repeated after 1h to estimate test-retest reliability. Both investigators were blinded to the results of the other. Interrater reliability and test-retest reliability were calculated using Cohen’s kappa. Blood samples for N‑terminal pro brain natriuretic peptide (NT-pBNP) were obtained on the morning the Valsalva maneuver was performed.

Results

Blood pressure response was sinusoidal in 37 (42%), showed an absent overshoot in 17 (19%) and had a square wave pattern in 34 (38%) patients. Cohen’s kappa was 0.911 (95% CI 0.837–0.985) for interrater reliability and 0.929 (95% CI 0. 0.862–0.996) for test-retest reliability. The interrater and test-retest agreement were 94% and 96%, respectively. The mean NT-pBNP plasma levels and the interquartile ranges (IQR) in subjects with types A, B and C blood pressure response pattern were 213 (153–324) pg/ml, 805 (622–1332) pg/ml and 3964 (2595–5906) pg/ml, respectively (p < 0.001).

Conclusion

The blood pressure response during a Valsalva maneuver shows an excellent reliability in older subjects. The type of response is associated with the NT-pBNP plasma level.

Zusammenfassung

Hintergrund

Die Herzinsuffizienz (HI) ist häufig bei älteren Menschen. Die Diagnose einer HI ist bei älteren Probanden schwierig, da die Symptome unspezifisch sind und oft der Zugang zur weiteren Diagnostik fehlt. Die Art des Blutdruckverhaltens während der Durchführung eines Valsalva-Manövers ist ein einfacher Test zum Nachweis einer HI. Die Zuverlässigkeit dieses Manövers und die Assoziation mit einer HI sind jedoch bei geriatrischen Patienten unbekannt.

Methodik

Insgesamt 89 Patienten einer Akutgeriatrie wurden untersucht. Der systolische Blutdruck wurde gemessen, während der Patient ein Valsalva-Manöver durchführte. Die systolische Blutdruckreaktion wurde als sinusförmig (Typ A), ohne Überschwingen (Typ B) oder als quadratisches Muster (Typ C) klassifiziert. Um die Interraterreliabilität zu testen, wurde die systolische Blutdruckreaktion von zwei Untersuchern unabhängig voneinander bewertet. Das Verfahren wurde nach einer Stunde wiederholt, um die Test-Retest-Reliabilität abzuschätzen. Die Interraterreliabilität und die Test-Retest-Reliabilität wurden mittels Cohen’s Kappa berechnet. Am Morgen des Valsalva-Manövers wurden Blutproben zur Bestimmung des N‑terminalen Pro-Brain-Peptids (NT-pBNP) genommen.

Ergebnisse

Die Blutdruckreaktion war bei 37 (42 %) Patienten sinusförmig, zeigte bei 17 (19 %) Patienten kein Überschwingen und wies bei 34 (38 %) Patienten ein Rechteckwellenmuster auf. Cohen’s Kappa ergab einen Wert von 0,911 (95 % Konfidenzintervall [KI] 0,837–0,985; p < 0,001) für die Interraterreliabilität und 0,929 (95 % KI 0,862–0,996) für die Test-Retest-Reliabilität. Die Übereinstimmungsraten betrugen für die Interrater- und Test-Retest-Untersuchungen 94 % bzw. 96 %. Der mittleren NT-pBNP-Plasmaspiegel und die Interquartilbereiche (IQRs) bei Probanden mit Blutdruckreaktionsmustern vom Typ A, B und C betrugen 213 (153–324) pg/ml, 805 (622–1332) pg/ml und 3964 (2595–5906) pg/ml (p < 0,001).

Schlussfolgerung

Die Blutdruckreaktion während eines Valsalva-Manövers zeigt bei älteren Probanden eine hervorragende Zuverlässigkeit. Die Art der Reaktion hängt signifikant mit dem NT-pBNP-Plasmaspiegel zusammen.

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Correspondence to H. Frohnhofen MD.

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Conflict of interest

J. Schlitzer, H. J. Heppner and H. Frohnhofen declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. The protocol documents were approved by the chamber of physicians (North Rhine, Germany) and the trial was registered in the German Clinical Trials Register (DRKS-ID: DRKS00004898). Informed consent was obtained from all individual participants included in the study.

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Schlitzer, J., Heppner, H.J. & Frohnhofen, H. Reliability of the blood pressure response during performance of bedside Valsalva maneuver and association with NT-pBNP levels. Z Gerontol Geriat (2021). https://doi.org/10.1007/s00391-021-01849-z

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Keywords

  • Heart failure
  • Natriuretic peptide
  • Interrater reliability
  • Test-retest reliability
  • Biomarker

Schlüsselwörter

  • Herzinsuffizienz
  • Natriuretisches Peptid
  • Interraterreliabilität
  • Test-Retest-Reliabilität
  • Biomarker