A Noninvasive, Hand-Held Device for Assessing Left Ventricular End-Diastolic Pressure Based on Finger Photoplethysmography and the Valsalva Maneuver. Panagis Galiatsatos , MD Johns Hopkins Bayview Medical Center February 2 nd 2013. No Disclosures. Outline. Background information
A Noninvasive, Hand-Held Device for Assessing Left Ventricular End-Diastolic Pressure Based on Finger Photoplethysmography and the Valsalva Maneuver
Johns Hopkins Bayview Medical Center
February 2nd 2013
- Created by Antonio Maria Valsalva
- Effects on the cardiovascular system
Phase 1: Initial blood pressure increase
Phase 2: Maintaining the strain – decrease in pressure
Phase 3: Release of the strain – short decrease of arterial pressure
Phase 4: Distinct overshoot of pressure
Bedside technique with sphygmomanometry
1. No standardization of technique
2. Does not yield continuous measure
“Finger photoplethysmography during the Valsalva maneuver reflects left ventricular filling pressure”
Silber HA et al. Am J Physiol Heart Circ Physiol 2012
Pulse Amplitude Ratio (PAR)
Validate a new hand-held, battery-powered device that inputs finger PPG and expiratory pressure signals during the Valsalva maneuver, guides subject performance and calculates PAR automatically.
A Ventricular End-Diastolic Pressure Based on Finger
Mouthpiece / pressure transducer
Photoplethysmography (PPG) probe
Patients who were scheduled to undergo a cardiac catheterization including the measurement of LVEDP.
Expiratory pressure during Valsalva was measured by having the subject place a tube in their mouth that was connected to a pressure transducer input into the device.
The subject was coached to keep the expiratory effort at about 20 mmHg during a 10-second Valsalva maneuver.
The output measure of the device is the ratio of the amplitude of the PPG waveform near the end of Valsalva to the amplitude at baseline
PAR > 0.72 was 78% sensitive and 100% specific in identifying LVEDP > 15 mmHg.