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STUDY OBJECTIVES: To determine the BP response to the Valsalva maneuver (VM) at baseline and after changes in therapy and to compare this response to the invasively measured pulmonary capillary wedge pressure (PCWP). DESIGN: Comparison of the BP response to the VM with invasively measured PCWP. In a subset of patients, direct PCWP and pulse amplitude ratio (PAR) measurements were repeated (mean +/- SD) 3.2 +/- 4.5 months later after adjusting the therapy. SETTING: Tertiary-care center. PATIENTS: Forty-two stable patients (8 women; mean age, 58 +/- 13 years) undergoing right heart catheterization who were in sinus rhythm. MEASUREMENTS: PAR calculated between the end and the beginning of the VM using the last two beats and the first three beats of the straining phase and simultaneous measurement of PCWP. RESULTS: There was a highly significant correlation between the invasively measured PCWP (range, 2 to 32 mm Hg) and the PAR (range, 0.28 to 1.15; R(2) = 0.75; p < 0.001). In addition, changes of PCWP during follow-up (-16 to 13 mm Hg) were well-correlated (R(2) = 0.93; p < 0.001; n = 11) with changes in PAR (-0.44 to 0.47). The administration of medication (eg, beta-blockers, amiodarone, angiotensin-converting enzyme inhibitor, and digoxin) did not influence the results. CONCLUSIONS: PCWP and changes during therapy can be estimated noninvasively by measuring the PAR during the VM with acceptable accuracy in stable patients with cardiac conditions. Thus, this method may be a useful tool in detecting an elevated PCWP and hemodynamic response to therapy.