Sustained isometric handgrip exercise was studied in 28 patients, 19 with and nine without catheterization evidence of heart disease. Significant increases occurred in left ventricular systolic and left ventricular end-diastolic pressures (LVEDP), heart rate, cardiac output, and cardiac index, with decreases in stroke volume and stroke index. When control and abnormal groups were compared, no differences could be demonstrated in systolic pressure or heart rate increases. However, the LVEDP increase in the abnormal subjects (9.7 ± 1.7) was significantly (
P
< 0.01) higher than in the controls (2.1 ± 0.7). In addition, cardiac index rose significantly (
P
< 0.025) in the controls (0.8 ± 0.2), but not (
P
< 0.1) in the abnormal subjects (0.2 ± 0.1). Conversely, there was a significant fall in stroke index in the abnormal (
P
< 0.005) but not in the control (
P
< 0.4) group.
When work or stroke-work index-LVEDP relations were compared, the controls uniformly exhibited steep curves, whereas abnormal patients demonstrated curves that were either less steep or flat. ΔWork/ΔLVEDP ratio was [See Equation in PDF File]1.0 in the controls, with one exception, and [See Equation in PDF File]0.77 in the abnormal subjects, with one exception.
The test was performed in less than 4 min and no adverse effects were observed. By virtue of its ease, simplicity, safety, and ability to distinguish normal and abnormal ventricular performance, sustained handgrip is a valuable new stress test.
SUMMARYThe value of nitroglycerin in determining the potential reversibility of asynergy was examined in 35 patients with coronary heart disease. Ventriculograms performed at rest and after sublingual nitroglycerin were analyzed for (1) location of asynergy relative to distribution of the 3 major coronary arteries and (2) Received NMarch 11, 1974; accepted for publication March 25, 1974. 108 determine both the risk and potential benefits of bypass surgery. 12 The present study was undertaken to determine whether sublingual nitroglycerin, by pharmacologically improving the balance between oxygen supply and demand, unmasks residual contractile ability of asynergic zones. In addition the effects of nitroglycerin were compared with the results of coronary bypass surgery on wall motion in the same left ventricular zones.
MethodsStudies were performed in 35 patients undergoing cardiac catheterization for evaluation of coronary heart disease.Criteria for admission to the study were: (1) asynergy on ventriculography (defined as a localized abnormality of left ventricular contraction), (2) significant (greater than 75%) obstruction of one or more of the three major coronary arteries, (left anterior descending, right and circumflex arteries), and (3) absence by catheterization of other etiologic heart disease. All patients were postabsorptive and premedicated intramuscularly with 50 mg nembutal, 50 mg demerol, and 0.4 mg atropine.Right heart catheterization was performed via an antecubital vein cutdown and left heart catheterization either via a right brachial arteriotomy or percutaneously utilizing a femoral artery. Following recording of left ven-
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