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.

The present study examines the efficacy of the exercise electrocardiogram using the isotonic bicycle ergometer and isometric handgrip in predicting the extent of coronary obstructive disease, coronary collaterals, and abnormalities of left ventricular contraction (asynergy) in 65 patients. Of 32 patients with a normal isotonic

The usefulness of isometric handgrip exercise in the assessment of left ventricular function was studied in 27 patients, all of whom had angiographically documented coronary artery disease. The effect of extensiveness of coronary disease and presence or absence of collaterals (both delineated by coronary arteriography) on the response to handgrip stress was also evaluated. Of 11 patients with a normal handgrip response, 4 exhibited a normal left ventriculogram and 7 were abnormal. Of these 7, 6 had inferior hypokinesis. Conversely, of 16 patients with an abnormal response to handgrip, 15 had abnormal ventriculograms. Of these, 9 had anterior akinesis. Of patients with a normal handgrip response 82% had two- or three-vessel coronary disease, and 94% with an abnormal response exhibited two- or three-vessel obstruction. There was no observed correlation between the presence or absence of collaterals and the response to handgrip. This study indicates that (1) handgrip stress, when combined with left ventriculography, often yields important additional information regarding the effect of localized contraction abnormalities on overall left ventricular performance; (2) the extent of coronary obstructive disease or the presence of collaterals per se do not appear to be the primary determinants of left ventricular performance; (3) it is possible that the location as well as severity and extent of left ventricular contraction abnormality may play an important role in determining overall left ventricular performance.