Adjunctive handgrip during dobutamine stress echocardiography: Invasive assessment of myocardial oxygen consumption in humans

Abstract

SummaryBackground: Adjunctive isometric exercise in the form of sustained submaximal handgrip (HG) is considered to increase the sensitivity of dobutamine stress echo (DSE) for detection of functionally significant coronary artery disease.Hypothesis: The study was undertaken to quantify invasively the impact of HG in humans on hemodynamics and myocardial oxygen consumption (MVO2) during DSE.Methods: An invasive hemodynamic evaluation was performed during DSE and with addition of adjunctive HG in 11 subjects. Coronary sinus (CS) blood flow, right-sided and systemic pressures, oxygen saturations, and transthoracic two-dimensional echocardiography were obtained at each 3-min stage and after adding HG at peak DSE. Myocardial oxygen consumption was calculated by the Fick method and circumferential end-systolic wall stress (ESWS) by Mirsky's formula.Results: At peak DSE, heart rate, left ventricular ejection fraction, CS flow, and MVO2 increased, whereas pulmonary capillary wedge pressure (PCWP) and circumferential endsystolic wall stress (ESWS) decreased from baseline. Com-

Lower limb pneumatic compression during dobutamine stress echocardiography in patients with normal resting wall motion: will it increase diagnostic accuracy?

“…Using this value for all patients makes our protocol comparable with the previous study by Sohn et al [6]. Isometric handgrip exercise during DSE is another method of increasing peripheral vascular resistance and has been reported to be associated with similar benefits to pneumatic limb compression [14][15][16][17]. The advantage of handgrip exercise over pneumatic limb compression is that it is easier to perform because it does not require any special equipment (such as pneumatic trousers); however, it is inferior to pneumatic limb compression in terms of standardisation, in terms of the magnitude of increase in peripheral vascular resistance, and for not being suitable for the long duration of the test.…”

Adjunctive application of handgrip exercise associated with dobutamine stress echocardiography

“…Use of isometric HG exercise with dobutamine-atropine stress echocardiography (DASE) decreases time to target heart rate, recovery time, overall study time, and mean dosage of dobutamine and atropine [9]. Adjunctive isometric exercise in the form of sustained submaximal HG to peak of dobutamine stress echocardiography (DSE) without atropine results in a modest increase in MVO2, primarily by an increase in end-systolic wall stress [10] and can significantly lower the fractional flow reserve (FFR) and potentially improve its ability to detect physiologically significant stenoses [11]. The safety, feasibility and efficacy of the use of isometric HG exercise with DSE has been demonstrated and that it may lead to improved diagnostic capacity of the test [12].…”

“…Dobutamine [2][3][4][5] and vasodilators (at appropriately high doses) are equally potent ischemic stressors for inducing wall motion abnormalities in presence of a critical coronary artery stenosis [6] and although vasodilators may have advantages for the assessment of myocardial perfusion, dobutamine is preferred when the test is based on assessment of regional wall motion [7]. Muscle sympathetic nerve activity (MSNA) and handgrip (HG) exercise have been rarely studied also in heart failure [8] and in stress echocardiography [9][10][11]. Use of isometric HG exercise with dobutamine-atropine stress echocardiography (DASE) decreases time to target heart rate, recovery time, overall study time, and mean dosage of dobutamine and atropine [9].…”

Handgrip exercise: From an alternative test to a promising associated cardiovascular technique of noninvasive diagnosis of coronary artery disease

“…Use of adjunctive isometric HG exercise with dobutamine-atropine stress echocardiography (DASE) decreased time to target heart rate, recovery time, overall study time, and mean dosage of dobutamine and atropine [11]. Adjunctive isometric exercise in the form of sustained submaximal HG to peak of dobutamine stress echocardiography (DSE) without atropine resulted in a modest increase in MVO2, primarily by an increase in end-systolic wall stress [12] and a potential improvement of its ability to detect physiologically significant stenoses has been reported [13]. Recently, it has been demonstrated the safe , feasibility and efficacy of use of isometric HG exercise with DSE and that it may lead to improve diagnostic capacity of the test [14,15].…”

“…Although vasodilators may have advantages for assessment of myocardial perfusion, dobutamine is preferred when the test is based on assessment of regional wall motion [10]. Handgrip (HG) exercise has been rarely studied in stress echocardiography [11][12][13]. Use of adjunctive isometric HG exercise with dobutamine-atropine stress echocardiography (DASE) decreased time to target heart rate, recovery time, overall study time, and mean dosage of dobutamine and atropine [11].…”