Exercise-Induced Diastolic Abnormalities Assessed by Handgrip-Apexcardiographic Test in Syndrome X

Abstract

It has been shown recently that the handgrip-apexcardiographic test (HAT) represents a new mode of stress test, which shows a high sensitivity in identifying coronary patients by assessing exercise-induced ischemic left ventricular diastolic abnormalities. To assess the prevalence of left ventricular diastolic abnormalities and the usefulness of HAT as a diagnostic tool in patients with syndrome X (angina pectoris in the presence of normal coronary arteries), HAT was obtained in 275 clinically normal subjects and in 9 patients who presented with typical chest pain and who were subsequently found to have a positive treadmill ECG test and no coronary artery disease by angiography. As diastolic indices served: the relative A wave to total height (A/H) and to diastolic amplitude (A/D) of the apex tracing, the total apexcardiographic relaxation time (TART), TART corrected for the duration of diastole (TARTI) and the diastolic amplitude time index [DATI = TARTI/(A/D)]. Positivity of HAT was defined by the presence of at least one of the following recently introduced criteria: (1) A/H during or after handgrip > 21%, (2) TART during handgrip > TART at rest > 143 ms or/and TARTI during handgrip < 0.14 or (3) DATI during handgrip < 0.27. At rest, in 6/9 (67%) patients all variables were within normal limits, whereas in 3/9 (33%) patients an abnormal A/H or TARTI was observed. During and after handgrip, however, all patients showed abnormal changes in at least two diastolic variables, DATI and A/H being most frequently abnormal (67 and 56%, respectively). Further, using the above-mentioned positivity criteria, all patients had a positive HAT result. It can be concluded that according to our present findings an exercise-induced diastolic dysfunction is frequently present in syndrome X patients. Furthermore, using diastolic abnormalities as cutoff points and criteria of positivity, HAT shows a 100% sensitivity for detecting patients with this clinical setting.

Age and Gender Differences in Left Ventricular Function among Patients with Stable Angina and a Matched Control Group

“…One reason for the gender dif ference in left ventricular systolic function might be that more female patients have 'small vessel disease', with syn drome X [20]. In these patients, left ventricular function is normal under resting conditions but becomes abnormal during isometric exercise [21]. Diastolic abnormalities were more frequent in female patients with angina and clinical heart failure.…”

Invasive and Noninvasive Assessment of Exercise-induced Ischemic Diastolic Response Using Pressure Transducers

“…In patients with angiographically verified CAD, a positive presso test (ischemic or non-ischemic) has been found in 86-93% of outpatients [ 30 - 34 ] and 95% of hospitalized patients with CAD [ 35 ]. Moreover, patients with hypertension [ 41 , 42 ], hypertrophic cardiomyopathy [ 43 , 44 ] and syndrome X [ 45 ] showed a positive presso test in 70%, 95% and 100%, respectively.…”

Patterns of Diastolic Abnormalities during Isometric Stress in Patients with Systemic Hypertension

“…Thirty-one of the patients with hypertension had a stable typical angina pectoris and 23/132 a positive treadmill exercise, whereas 14/23 had an angina during this stress test. Of the 20 study patients with hypertension in whom a coronary Exercisc-Induced Diastolic Dysfunction in Hypertension angiography was performed, 14 had CAD (4 single-, 3 double-and 7 triple-vessel disease) whereas 6 patients had normal coronary arteries but a typical angina as well as a positive stress ECG (syndrome X) [49], Table 1 shows the overall data derived from the apexcardiographic measurements at rest and during isometric exercise. The mean values of all diastolic variables showed both at rest and during exercise significant differ ences between hypertensives and controls; the A/H and A/D were significantly higher, TART prolonged, TARTl and DATI decreased.…”

“…HAT proved to show in a high percentage positive results in patients with angina pectoris [43] as well as in those with angiographically documented CAD [46] and with silent ischemia [44]. Further, HAT showed a surprisingly high sensitivity (95%) in identifying patients with one-vessel disease [46] and a 100% sensitivity in syndrome X [49] and cardiomyopathy [50], Further, the mean sensitivity of HAT in detecting demand ischemia in CAD patients has been proved to be significantly higher than that of treadmill exercise ECG (94 vs. 75%) [47], Moreover, HAT has been shown to be useful in detecting the progres sion of CAD [45] as well as in separating an ischemic from a nonischemic pattern of diastolic abnormalities [50].…”

“…In hypertensives, the ear ly and late diastolic abnormalities at rest and during handgrip arc both significantly less pronounced and occur less frequently than in patients with hypertrophic cardio myopathy. whereas an ischemic pattern is more frequent ly present in hypertensives [50], On the other hand, a pos itive HAT result is in hypertensives significantly less fre quent than in patients with coronary artery disease [43, 44,46,47] or syndrome X [49], Additionally, an ischemic pattern occurs much less frequently in hypertensives than in coronary patients without history of hypertension and prior infarction (29 vs. 72%) [50], Finally, it should be emphasized that in hypertensives no diastolic variables at rest or during exercise showed any significant correlation with systolic or diastolic blood pressure or the duration of hypertension. It appears, thus, that an increased afterload per se does not represent the most important factor responsible for the development of diastolic abnormalities.…”