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Identification of patients with coronary artery disease by assessing diastolic abnormalities during isometric
J Manolas1, C Chrysochoou, S Kastelanos
1University of Athens, Medical School, Department of Cardiology, Hippokration Hospital, Greece.
Insights
Handgrip-Doppler and pressocardiography effectively identify coronary artery disease (CAD). Pressocardiography showed higher accuracy in diagnosing CAD compared to handgrip-Doppler, offering a valuable noninvasive tool for suspected cases.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Noninvasive Cardiovascular Testing
Background:
- Previous studies indicate handgrip-induced diastolic abnormalities in patients with coronary artery disease (CAD).
- Noninvasive methods are sought to complement invasive diagnostics for CAD.
Purpose of the Study:
- To assess the diagnostic utility of Doppler echocardiography and pressocardiography during handgrip exercise.
- To differentiate between patients with coronary artery disease (CAD) and those with normal coronary arteries.
Main Methods:
- Doppler echo- and pressocardiography were performed on 96 patients with suspected CAD before coronary angiography.
- Abnormalities were defined by specific echocardiographic (E/A ratio) and pressocardiographic (A wave/total excursion, relaxation time) parameters during handgrip.
Main Results:
- Handgrip-Doppler showed abnormalities in patients with normal coronary arteries, while pressocardiography (HAT) remained within normal limits.
- In CAD patients, HAT demonstrated a significant increase in A wave/total excursion and a decrease in relaxation time.
- HAT achieved 95% sensitivity and 78% specificity in CAD detection, outperforming handgrip-Doppler.
Conclusions:
- Noninvasive stress tests, particularly pressocardiography, show promise for diagnosing suspected coronary artery disease.
- These methods offer a valuable, noninvasive approach for detecting unknown or suspected CAD.
Background:
Previous clinical studies using invasive and noninvasive methods have shown handgrip-induced diastolic abnormalities in patients with coronary artery disease (CAD).
Hypothesis:
The study was undertaken to determine the utility of Doppler echo- and pressocardiography during hand-grip in discriminating patients with coronary artery disease (CAD) and in those with normal coronary arteries.
Methods:
Both methods were obtained in 96 patients with suspected CAD within 24 h before coronary angiography. An abnormal handgrip-Doppler was defined by an early (E) to late (A) transmitral flow velocities ratio (E/A) < 1 during handgrip and a positive handgrip pressocardiographic test (HAT) by an abnormal increase in the A wave/total excursion or prolongation of the absolute or relative (heart-rate corrected) total relaxation time during isometric exercise.
Results:
Of the 96 patients studied, 23 had normal coronary arteries and 73 showed CAD. In patients with normal coronary arteries, handgrip-Doppler showed an abnormal average E/A at rest and during handgrip, whereas all variables of HAT were within normal limits. In patients with CAD, handgrip-Doppler showed only a moderate handgrip-induced increase in average A (+ 19%, p < 0.001), whereas HAT showed a significant (p < 0.001) increase in mean A wave/total excursion (+ 60%) and decrease in the relative total relaxation time (- 17%). Furthermore, handgrip-Doppler and HAT were abnormal in 15 of 23 (65%, specificity 35%) and the HAT in 5 of 23 (22%, specificity 78%) patients with normal coronary arteries, as well as in 57 of 73 (sensitivity 78%) and 69 of 73 (95%) patients with CAD.
Conclusions:
Our study demonstrates that these noninvasive stress tests can become a useful new diagnostic modality for detecting patients with unknown or suspected CAD.