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Handgrip-apexcardiographic test: a new mode of detecting patients with silent exercise-induced myocardial ischemia
1Diagnostic and Therapeutic Center of Athens Hygeia, Greece.
Insights
The novel Handgrip-Apexcardiogram-Test (HAT) effectively identifies silent myocardial ischemia. This noninvasive stress test shows high sensitivity for detecting left ventricular diastolic abnormalities in patients with coronary artery disease.
Area of Science:
- Cardiology
- Noninvasive Diagnostic Tools
- Myocardial Ischemia Research
Background:
- Silent myocardial ischemia often presents with early left ventricular diastolic abnormalities.
- Current noninvasive stress tests struggle to detect these diastolic changes.
- The left ventricular apexcardiogram (ACG) reflects diastolic pressure curves and can be measured during isometric handgrip (HG) exercise.
Purpose of the Study:
- To evaluate the clinical validity of the Handgrip-Apexcardiogram-Test (HAT) for identifying silent ischemia.
- To assess HAT's sensitivity in patients with confirmed coronary artery disease and no symptoms.
Main Methods:
- 16 patients with coronary artery disease underwent the HAT.
- HAT positivity was defined by specific criteria related to ACG A-wave, total ACG relaxation time (TART), and diastolic amplitude time index (DATI) during HG.
- Criteria were established using data from 253 healthy volunteers.
Main Results:
- The HAT demonstrated 88% sensitivity, with 14 out of 16 patients testing positive.
- Positive results were based on new definitions of HAT positivity criteria.
- The test identified patients with proven silent ischemia.
Conclusions:
- The Handgrip-Apexcardiogram-Test (HAT) is a sensitive and simple clinical tool for detecting silent myocardial ischemia.
- HAT aids in identifying left ventricular diastolic dysfunction associated with ischemia.
- This noninvasive method offers a new approach for diagnosing silent ischemia.
Abstract:
There are no simple noninvasive stress tests for detecting silent myocardial ischemia by assessing left ventricular (LV) diastolic abnormalities which are known to occur early on the onset of every ischemic episode. It has been proved that the LV apexcardiogram (ACG) reflects the LV pressure curve in early and late diastole and can be recorded during isometric handgrip (HG) exercise. To determine the clinical validity of HG-ACG-Test (HAT) in identifying patients with silent ischemia, 16 patients (8 with prior infarction) with angiographically documented coronary artery disease, positive treadmill electrocardiographic test and without symptoms were examined. According to the largest and lowest individual values in 253 healthy volunteers, the positivity of HAT was defined by the presence of at least one of the criteria: 1) The relative A-wave to total height of ACG during or/and after HG greater than 21%. 2) The total ACG relaxation time (TART) during HG longer than at rest and also longer than 143 ms or/and the heart rate corrected TART during HG less than 0.14, or 3) the combined index of overall diastolic function DATI (= diastolic amplitude time index) during HG less than 0.27. Based on this definition 14/16 (sensitivity: 88%) patients showed a positive test result. It is concluded that, using new definitions of positivity, HAT shows a high sensitivity for detecting patients with proved silent ischemia providing, thus, providing a new simple clinical tool for the identification of these patients.