Paradoxical increase in global longitudinal strain by handgrip exercise despite left ventricular diastolic
Ko Motoi1, Hiroyuki Iwano2,3, Suguru Ishizaka1
1Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
Echocardiography (Mount Kisco, N.Y.)
|July 14, 2023
Summary
Global longitudinal strain (GLS) changes during handgrip exercise reveal myocardial dysfunction. Advanced diastolic dysfunction, not decreased GLS, was linked to increased GLS in cardiovascular patients.
Area of Science:
- Cardiology
- Echocardiography
- Myocardial mechanics
Background:
- Global longitudinal strain (GLS) is a sensitive indicator of left ventricular (LV) dysfunction.
- The influence of afterload on GLS is a recognized factor.
- The study investigated GLS response to handgrip exercise to assess intrinsic myocardial function.
Purpose of the Study:
- To evaluate if a decrease in GLS during handgrip exercise is a more sensitive marker of intrinsic myocardial dysfunction than previously established.
- To explore the relationship between handgrip exercise-induced GLS changes and left ventricular (LV) diastolic function.
- To investigate factors influencing GLS changes during handgrip exercise in cardiovascular disease patients.
Main Methods:
- Handgrip exercise-stress echocardiography was performed in 90 patients with cardiovascular disease and preserved LV ejection fraction.
- Diastolic wall stress (DWS), left atrial (LA) volume index to early diastolic mitral annular velocity (LAVI/a') ratio, and LA strains were measured.
- Significant changes in GLS were defined by test-retest variability (2.65%).
Main Results:
- Mean GLS did not change significantly with exercise, but substantial individual variations occurred (decreased, unchanged, increased).
- Patients with increased GLS showed advanced LV diastolic dysfunction and blunted heart rate response.
- Diastolic wall stress, left atrial booster strain, and grade II+ diastolic dysfunction predicted increased GLS.
Conclusions:
- Contrary to hypothesis, increased GLS with handgrip exercise is associated with advanced LV diastolic dysfunction in patients with preserved LV ejection fraction.
- Handgrip exercise's effect on afterload is not uniform in heart failure patients, leading to variable GLS changes.
- GLS response to handgrip exercise may provide insights into complex myocardial and diastolic function interactions.
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