ArticleFrontiers in cardiovascular medicine2025
Diaphragmatic downward excursion as a novel metric for assessing Valsalva maneuver efficacy in patent foramen ovale detection by contrast transthoracic echocardiography.
Article in Frontiers in cardiovascular medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: Contrast transthoracic echocardiography (c-TTE) is widely used for the diagnosis of patent foramen ovale (PFO), where the Valsalva maneuver (VM) serves as the standard provocative maneuver to optimize detection. This study aimed to evaluate diaphragmatic downward excursion (DDE) as a novel c-TTE-based parameter for objectively quantifying VM efficacy, thereby establishing a standardized assessment metric. Methods: We studied 145 patients with high clinical suspicion of PFO-related conditions. All participants underwent both c-TTE and contrast transesophageal echocardiography (c-TEE) examinations. Based on intraoral expiratory pressure exceeding 40 mmHg under c-TTE, patients were divided into adequate Valsalva maneuver (AVM) group ( Results: DDE-RRA was significantly lower in the AVM group than in the non-AVM group (7.3 mm vs. 3.1 mm, Conclusion: DDE provides a simple and objective method for assessing VM efficacy under c-TTE, showing superior diagnostic performance compared with conventional intracardiac parameters. As this represents an initial attempt, further studies incorporating invasive validation are needed to confirm its clinical value.
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