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Prolongation of left atrial augmentation after handgrip stress in coronary artery disease: observation using pulsed
T Tanaka1, K Mizushige, H Masugata
1Second Department of Internal Medicine, Kagawa Medical University, Kita, Japan.
Insights
Doppler echocardiography revealed that coronary artery disease patients show prolonged impaired left ventricular diastolic function after handgrip exercise. This suggests handgrip stress Doppler can aid in detecting and monitoring coronary artery disease.
Area of Science:
- Cardiology
- Echocardiography
- Diastolic Function
Background:
- Left ventricular diastolic filling dynamics can change during myocardial ischemia.
- Limited data exist on temporal changes in left ventricular filling during recovery from ischemia.
Purpose of the Study:
- To evaluate transmitral inflow patterns during and after handgrip exertion in coronary artery disease (CAD) patients.
- To assess the utility of handgrip stress Doppler for detecting and monitoring CAD.
Main Methods:
- Doppler echocardiography was used to record transmitral inflow velocities.
- Measurements were taken at baseline, during handgrip exercise, and for 5 minutes post-exercise.
- The study included 18 normal subjects and 47 CAD patients (MILD, SVD, MVD).
Main Results:
- Normal and MILD groups showed return to baseline diastolic function within 3 minutes post-exercise.
- Single-vessel disease (SVD) and multivessel disease (MVD) groups exhibited continued impaired left ventricular inflow patterns at 3 minutes post-exercise.
- Increases in atrial (A) wave and A/E ratio were significantly higher in SVD and MVD compared to normal and MILD groups.
Conclusions:
- Coronary artery disease is associated with impaired left ventricular inflow patterns persisting after handgrip exercise.
- This impairment may reflect prolonged diastolic dysfunction caused by ischemia.
- Temporal observation of left ventricular inflow patterns via handgrip stress Doppler may aid in CAD detection and follow-up.
Abstract:
Although alterations in left ventricular diastolic filling dynamics have been observed during myocardial ischemia, few data exist regarding temporal changes in left ventricular filling during recovery. Therefore, the authors evaluated transmitral inflow pattern during and after handgrip exertion in coronary artery disease (CAD) by using Doppler echocardiography. The study population consisted of 18 normal (N) subjects and 47 patients with CAD. Of the CAD patients, 17 had coronary lesions associated with a limited area of underperfused myocardium (seven with good collateral circulation and 10 with distal lesions) (MILD), 15 patients exhibited a proximal lesion in a single vessel (SVD), and 15 patients had significant multivessel disease (MVD). Transmitral inflow velocities were continuously recorded at baseline, during handgrip exercise (50% of maximal for 1 minute), and for 5 minutes of recovery. Mean blood pressure, heart rate, early diastolic (E) and late atrial (A) inflow velocities, A/E ratio, and percent changes in E, A, and A/E from baseline were measured. In N and MILD, respectively, left ventricular inflow pattern returned to baseline at 3 minutes after handgrip (%E: 0.7 +/- 7.6%, 6.4 +/- 13.7%; %A: -0.2 +/- 7.9%, 3.1 +/- 6.5%; %A/E: -0.1 +/- 9.7%, -1.7 +/- 12.9%). In SVD and MVD, respectively, change in left ventricular inflow pattern was continued at 3 minutes after handgrip (%E: 7.2 +/- 9.4%, -4.3 +/- 17.2%, %A: 15.4 +/- 11.7%, 20.4 +/- 14.6%, %A/E: 7.9 +/- 10.0%, 29.2 +/- 25.6%). Increases in A and A/E in SVD and MVD were significantly higher than in N and MILD. Impaired left ventricular inflow pattern was observed at 3 minutes after handgrip in CAD, which may be reflected from prolonged impairment of diastolic function produced by ischemia. Therefore, temporal observation of left ventricular inflow pattern using the handgrip stress Doppler method may be useful for detection or follow-up of CAD.