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Ischemic and nonischemic patterns of diastolic abnormalities during isometric handgrip exercise
1Diagnostic and Therapeutic Center of Athens Hygeia, Greece.
Insights
The handgrip-apexcardiographic test (HAT) effectively differentiates diastolic abnormalities in coronary artery disease (CAD) patients from those with hypertrophic cardiomyopathy (HCM). This stress test identifies distinct patterns, aiding in diagnosing cardiac conditions.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Physiology
Background:
- Distinguishing diastolic dysfunction in coronary artery disease (CAD) from hypertrophic cardiomyopathy (HCM) is clinically significant.
- Existing diagnostic methods may not fully capture exercise-induced diastolic abnormalities.
Purpose of the Study:
- To establish the clinical value of the handgrip-apexcardiographic test (HAT) for differentiating exercise-induced diastolic abnormalities.
- To identify distinct patterns of diastolic response to isometric stress in CAD and HCM patients.
Main Methods:
- A handgrip-apexcardiographic test (HAT) was administered to 305 healthy volunteers, 39 CAD patients, and 17 HCM patients.
- Defined 'ischemic diastolic response' (compliance/relaxation changes) and 'nonischemic diastolic response' based on apex-cardiogram indices during handgrip.
- Assessed handgrip-induced changes in diastolic indices.
Main Results:
- 72% of CAD patients exhibited an 'ischemic diastolic response'.
- 94% of HCM patients demonstrated a 'nonischemic diastolic response'.
- Distinct patterns of diastolic abnormalities were observed between CAD and HCM groups.
Conclusions:
- The HAT reliably differentiates between CAD and HCM based on diastolic response patterns to isometric stress.
- This simple stress test shows potential utility in separating CAD patients from those with nonischemic myocardial diseases.
- HAT provides valuable insights into diastolic function during isometric exertion.
Abstract:
This study establishes the clinical value of the recently introduced handgrip-apexcardiographic test (HAT) as an additional tool for distinguishing exercise-induced diastolic abnormalities in coronary artery disease (CAD) patients from those in patients with hypertrophic cardiomyopathy (HCM). This stress test reliably assessing differences in diastolic indices during handgrip between 305 healthy volunteers and 39 patients with CAD without prior infarction as well as 17 patients with HCM showed two different patterns of handgrip-induced pathological changes in these indices. An 'ischemic diastolic response' was empirically defined by the presence of either a handgrip-induced more than doubling of a resting normal relative A wave to total height of the apex-cardiogram (ischemic compliance response) or a pathological prolongation of a resting normal total apexcardiographic relaxation time (ischemic relaxation response); whereas a 'nonischemic diastolic response' was defined by the presence of a positive HAT and by absence of the above-mentioned ischemic criteria. An ischemic pattern of diastolic abnormalities was present in 72% of CAD patients, whereas 94% of HCM patients showed a 'nonischemic' diastolic response. These results confirm that in CAD patients there is a typical response of diastolic apexcardiographic indices to isometric stress and, therefore, this simple stress test could be potentially useful in separating these patients from those with nonischemic myocardial disease states.