Cough maneuver is superior to Valsalva maneuver for detecting mild-extent right-to-left shunt. (2nd January 2020)

• Record Type: Journal Article
• Authors: Zhang, Yun-Xia; Zhang, Xiao-Yong; Zhang, Qi
• Is Part Of: Scandinavian cardiovascular journal. Volume 54:Number 1(2020)
• Page Start: 32
• Page End: 36
• Publication Date: 2020-01-02
• Subjects: Quiet respiration -- cough maneuver -- Valsalva maneuver -- right-to-left shunt -- contrast transthoracic echocardiography; Cardiovascular system -- Diseases -- Periodicals; 617.41
• DOI: 10.1080/14017431.2019.1694172
• Languages: English
• ISSNs: 1401-7431

Abstract

Abstract: Objective : The purpose of this study was to explore the different provocative maneuvers in detecting right-to-left shunt during contrast transthoracic echocardiography (cTTE). Methods : We evaluated 378 patients for right-to-left shunt detection by cTTE at the quiet respiration, during Valsalva maneuver (blowing into a face mask connected to a sphygmomanometer at 40 mmHg for 10 s), and during cough maneuver, performed in random order, and the degree of right-to-left shunt as the number of microbubbles in the left atrium per frame after each provocative maneuver was recorded. Results : The detection rates of right-to-left shunt for quiet respiration, Valsalva maneuver, and cough maneuver were 16%, 33%, and 38%, respectively ( p < .001). The detection rate for cough maneuver was significantly higher than that for Valsalva maneuver ( p < .001). There was no significant difference between Valsalva maneuver and cough maneuver in terms of detecting moderate- or severe-extent right-to-left shunt ( p > .05), but cough maneuver was significantly better than Valsalva maneuver at detecting mild-extent right-to-left shunt ( p = .001). Conclusions : Cough maneuver is an effective alternative to Valsalva maneuver, with a higher detection rate for mild-extent right-to-left shunt during cTTE, maybe due to its own mechanical characteristics.