Teste de Valsalva ortostático no refluxo venoso Upright Valsalva's test in venous reflux

Objective: To test sensitivity, specificity and accuracy of the modified upright Valsalva’s test described by the authors for diagnosing the reflux, when compared to phlebography, which is used as gold standard. Method: One hundred sixty one patients with chronic venous insufficiency (C4, 5 or 6EPASDPPR) were prospectively examined. The patients were submitted to hemodynamic evaluation, including the standard supine Valsalva’s test and the new modified upright Valsalva’s test. Descending phlebography was used as a gold standard, to which the hemodynamic tests were compared. A ROC curve (Receiver Operator Characteristic) was plotted to determine the upper limit of normality for the new test. The observed sensitivity, specificity and accuracy values of each test were compared using Dunn’s test. The significance level of 5% was adopted. Results: The standard supine Valsalva’s test reached a sensitivity of 65%, specificity of 81% and accuracy of 66%, whereas the upright Valsalva’s test reached a sensitivity of 80% (P < 0.01), specificity of 63% (P = 0.43) and accuracy of 78% (P < 0.05). Conclusion: The modification in the Valsalva’s test proposed by the authors seems to determine better sensitivity and accuracy without significant decrease in specificity, proving to be useful in reflux evaluation of chronic venous insufficiency.