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Evaluation of left ventricular performance in coronary heart disease: use of isometric handgrip stress test
Insights
Isometric handgrip exercise combined with left ventriculography offers valuable insights into left ventricular function in coronary artery disease patients. Localized contraction abnormalities, not disease extent, significantly impact overall performance.
Area of Science:
- Cardiology
- Cardiovascular Physiology
- Diagnostic Imaging
Background:
- Coronary artery disease (CAD) significantly impacts left ventricular (LV) function.
- Assessing LV function is crucial for managing CAD patients.
- Non-invasive stress tests are vital for evaluating cardiac performance.
Purpose of the Study:
- To evaluate the utility of isometric handgrip (IHG) exercise in assessing LV function in patients with CAD.
- To determine if the extent of coronary disease or collateral circulation influences the IHG response.
- To correlate IHG-induced changes with ventriculographic findings.
Main Methods:
- 27 patients with angiographically confirmed CAD underwent IHG stress testing.
- Coronary arteriography was used to assess disease extent and collateralization.
- Left ventriculography was performed to evaluate LV function and regional wall motion abnormalities.
- IHG response was categorized as normal or abnormal.
Main Results:
- 11 patients had a normal IHG response; 4 had normal ventriculograms, 7 had abnormal LV function (6 with inferior hypokinesis).
- 16 patients had an abnormal IHG response; 15 had abnormal ventriculograms (9 with anterior akinesis).
- No correlation was found between collateral presence and IHG response; extensive CAD (2-3 vessels) was common in both normal and abnormal IHG responders.
Conclusions:
- IHG stress combined with left ventriculography provides additional information on LV performance, particularly regarding localized contraction abnormalities.
- The extent of coronary obstructive disease and collateralization are not primary determinants of LV performance during IHG stress.
- LV contraction abnormality location, severity, and extent likely play a significant role in determining overall LV performance.
Abstract:
The usefulness of isometric handgrip exercise in the assessment of left ventricular function was studied in 27 patients, all of whom had angiographically documented coronary artery disease. The effect of extensiveness of coronary disease and presence or absence of collaterals (both delineated by coronary arteriography) on the response to handgrip stress was also evaluated. Of 11 patients with a normal handgrip response, 4 exhibited a normal left ventriculogram and 7 were abnormal. Of these 7, 6 had inferior hypokinesis. Conversely, of 16 patients with an abnormal response to handgrip, 15 had abnormal ventriculograms. Of these, 9 had anterior akinesis. Of patients with a normal handgrip response 82% had two- or three-vessel coronary disease, and 94% with an abnormal response exhibited two- or three-vessel obstruction. There was no observed correlation between the presence or absence of collaterals and the response to handgrip. This study indicates that (1) handgrip stress, when combined with left ventriculography, often yields important additional information regarding the effect of localized contraction abnormalities on overall left ventricular performance; (2) the extent of coronary obstructive disease or the presence of collaterals per se do not appear to be the primary determinants of left ventricular performance; (3) it is possible that the location as well as severity and extent of left ventricular contraction abnormality may play an important role in determining overall left ventricular performance.