Assessment of sympathetic index from the Valsalva maneuver
Open accessAbstract
OBJECTIVE: Blood pressure (BP) decline and recovery during the Valsalva maneuver (VM) are used to evaluate the degree of sympathetic failure (SF) but a reliable sympathetic index (SI) derived from VM is lacking. METHODS: Patients with mild (n=20), moderate (n=65), and severe (n=60) SF and 23 healthy controls were evaluated using a standardized battery of autonomic tests. SF was defined as mild (associated with reduced sudomotor volumes at distal leg); moderate (associated with a fall in systolic BP ≥10< 30 mm Hg during the tilt test); and severe (associated with a fall in systolic BP ≥30 mm Hg during the tilt test). Six SIs were compared: SI1 (BP fall during phase 2), SI2 (BP recovery during phase 2), SI3 (the difference in BP between baseline and the end of phase 2), SI4 (the magnitude of phase 4), SI5 (BP recovery time), and SI6 (baroreflex sensitivity index). RESULTS: All indexes showed overall significant differences among tested groups (p<0.05). Only SI3 differentiated all subject groups. Compared to other SIs, SI3 correlated the most with orthostatic hypotension (OH; r=0.62, p < 0.05) during the tilt. CONCLUSIONS: SI3 is the optimal method for calculation of SI since it 1) easily differentiates between healthy controls and those with SF; 2) correlates with the OH, a proxy for a sympathetic failure; 3) tracks the full spectrum of SF (mild-moderate-severe). SI3 expands the utility of quantitative autonomic testing.
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The degree of hypotension and/or lack of compensation during forced expiration usually correlate with the degree of autonomic dysfunction and related symptoms.
“There is strong evidence that the absence of a BP overshoot and an absence of a HR increase during the Valsalva is pathognomonic for neurogenic OH, occurring in primary and secondary autonomic failure, and the degree of hypotension and/or lack of compensation during forced expiration usually correlate with the degree of autonomic dysfunction and related symptoms. 138-143”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [139]
The Autonomic testing section says BP recovery during forced expiration is reduced or absent in sympathetic failure, and the Results report that Valsalva BP measures correlate with BP falls during tilt testing. The paper does not establish that these responses correlate with the severity of related symptoms; it reports monitoring symptoms during tilt testing, not analyzing that relationship. Page numbers are unavailable in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe absence of a BP overshoot and an absence of a HR increase during the Valsalva is pathognomonic for neurogenic OH, occurring in primary and secondary autonomic failure.
“There is strong evidence that the absence of a BP overshoot and an absence of a HR increase during the Valsalva is pathognomonic for neurogenic OH, occurring in primary and secondary autonomic failure, and the degree of hypotension and/or lack of compensation during forced expiration usually correlate with the degree of autonomic dysfunction and related symptoms. 138-143”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [139]
The Autonomic testing section says blood-pressure recovery during Valsalva is reduced or absent in sympathetic failure, and the Discussion treats neurogenic orthostatic hypotension as a proxy for sympathetic dysfunction after non-neurogenic causes are excluded. The copy does not establish that the combined absence of a BP overshoot and HR increase is pathognomonic for neurogenic OH, or report the claimed absent HR increase during Valsalva. Page numbers were not provided. (LLM, conf=0.85)
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Research works printed but not linked: 1
- Goldstein DS, Tack C. Non-invasive detection of sympa- thetic neurocirculatory failure. Clin Autonom Res 2000; 10:285-291.
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2018 ESC Guidelines for the diagnosis and management of syncope
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- Authors
- Novak, P.
- Affiliations
- From the Department of Neurology, University of Massachusetts, Worcester.
- Venue
- Neurology
- Published
- 2011-06-07
- Volume
- 76
- Issue
- 23
- Pages
- 2010-2016
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- PMC
- PMC3269073
- OpenAlex
- W2014840726
- Cited by
- 88
- References
- 20
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 7 · 2023: 4 · 2022: 5 · 2021: 5 · 2020: 2 · 2019: 6 · 2018: 5 · 2017: 8 · 2016: 7 · 2015: 12 · 2014: 6 · 2013: 7
- FWCI
- 4.58
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Neurology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Keywords
- Valsalva maneuver, orthostatic hypotension, blood pressure reduction, baroreflex sensitivity, autonomic dysfunction, sudomotor function, tilt table test
- MeSH terms
- Aged, Autonomic Nervous System Diseases, Blood Pressure, Female, Humans, Male, Middle Aged, Retrospective Studies, Sympathetic Nervous System, Valsalva Maneuver, Vasoconstriction
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