ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. General Cardiovascular Medicine
Role of Valsalva maneuver electrocardiography in the diagnosis of coronary artery disease in senior adults: a prospective cross-sectional study
Yefei Zhan 1,2
Lingbo Zhou 1
Chunling Lu 1
Lu Zhang 1
Zhen Wang 1
Fangyuan Guan 1
1. Ningbo No 2 Hospital, Ningbo, China
2. Zhejiang Pharmaceutical University, Ningbo, China
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Abstract
Background: Coronary artery disease (CAD) is the leading cause of death worldwide. The exercise treadmill test (ETT) is widely used for CAD diagnosis but unsuitable for patients who are elderly, frail, or have mobility issues. This study examined whether electrocardiogram monitoring during the Valsalva maneuver, known as Valsalva maneuver electrocardiography (VM-ECG), is a potential screening instrument for CAD in these patients. Methods: This prospective cross-sectional study enrolled 106 elderly patients aged 60– 75 years. All participants underwent the ETT, VM-ECG, and coronary imaging (invasive coronary angiography or computed tomography coronary angiography). Diagnostic performance metrics, including sensitivity, specificity, and accuracy, were calculated for VM-ECG. Adverse reactions during ETT and VM-ECG were recorded and compared. Patients were categorized into negative, equivocal, and positive groups based on VM-ECG results. Sequential logistic regression analysis was performed to identify factors that independently influenced VM-ECG outcomes. Results: VM-ECG demonstrated a maximum sensitivity of 71.4%, specificity of 76.5%, and accuracy of 73.9% for CAD diagnosis. The incidence of adverse reactions was significantly lower during VM-ECG than the ETT (2.8% vs. 20.8%, P<0.0001). Sequential logistic regression analysis identified the maximum heart rate during the expiratory phase (odds ratio=1.118, 95% confidence interval: 1.046–1.211, P=0.002) as factor independently influencing VM-ECG outcomes. Conclusions: The VM-ECG exhibits potential as a screening tool for CAD in elderly populations, comparable to the ETT. The observation that the maximum heart rate during the expiratory phase correlates with an increased positivity rate on VM-ECG indicates its potential utility as a critical diagnostic parameter. Further research is necessary to substantiate its long-term diagnostic accuracy, cost-effectiveness, and applicability in real-world settings.
Summary
Keywords
computed tomographic coronaryangiography, Coronary Artery Disease, Exercise treadmill test, invasive coronary angiography, Valsalva Maneuver
Received
12 February 2026
Accepted
16 February 2026
Copyright
© 2026 Zhan, Zhou, Lu, Zhang, Wang and Guan. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Fangyuan Guan
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