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. 2009 Feb 3;24(11):735–743. doi: 10.1002/clc.4960241109

Identification of patients with coronary artery disease by assessing diastolic abnormalities during isometric exercise

Jan Manolas 1,✉, Christina Chrysochoou 1, Stamatis Kastelanos 1, Konstantina Aggeli 1, Demosthenes B Panagiotakos 2, Christodoulos Stefanadis 3, Pavlos Toutouzas 3
PMCID: PMC6655190  PMID: 11714132

Abstract

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 handgrip 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) transmittal 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.

Keywords: coronary artery disease, diastolic function, Doppler echocardiography, sometric exercise, handgrip‐pressocar‐diographic test

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