Evaluation of left ventricular performance in coronary heart disease: Use of isometric handgrip stress test

Helfant, Richard H.; Devilla, Maria A.; Banka, Vidya S.

doi:10.1002/ccd.1810020108

Cited by 12 publications

(1 citation statement)

References 18 publications

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“…The observation that asynergy can be made to decrease or disappear by interventions such as sublingual nitroglycerine [30], postextrasystolic potentiation [31], inotropic drugs [32], or coronary bypass surgery [33] has provided evidence that ischemia can cause abnormal wall motion in the absence of fibrosis. Conversely, several studies have indicated that latent ischemic asynergy can be un-masked or worsened by the stress of atrial pacing [34], dynamic leg exercise [35], or isometric hand grip exercise [36].…”

Section: Cardiac Catheterizationmentioning

confidence: 99%

Selection of patients for direct myocardial revascularization

Anderson

Ring

1978

World j. surg.

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The high incidence of ischemic heart disease and its associated mortality, morbidity, and socioeconomic implications have stimulated a great deal of interest and controversy regarding the relative roles of surgical and medical therapy. There is general agreement that stable angina pectoris can be substantially improved or relieved by coronary artery bypass grafting in at least 80% of patients, and that stable angina not responding to medical treatment is a firm indication for this procedure if adequate distal vessels for grafting are present. The effect of myocardial revascularization on longevity in stable angina patients is not certain except in the presence of significant obstruction of the left main coronary artery, where improved prognosis has been demonstrated. Evidence appears to be accumulating that surgical treatment improves prognosis in disease involving 3 vessels and 2 vessels, particularly if reversible left ventricular dysfunction is present. The prognosis in single-vessel coronary artery disease does not appear to be influenced by surgical therapy.Unstable angina pectoris appears to be best managed initially by intensive medical therapy and coronary angiography, with urgent surgery being done for significant left main coronary artery disease or uncontrolled angina, and elective surgery being done for multiple-vessel disease. Coronary artery bypass grafting for acute myocardial infarction remains of limited value unless complications such as cardiogenic shock occur, when the prognosis may be somewhat improved by an early aggressive surgical approach in selected cases.Improved selection of patients for direct myocardial revascularization in the future appears to depend on the de-

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Section: Cardiac Catheterizationmentioning

confidence: 99%

Selection of patients for direct myocardial revascularization

Anderson

Ring

1978

World j. surg.

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The relationship between left ventricular functional response to isometric exercise and asynergic contraction and diastolic stiffness

Ludbrook

Gowda

Tiefenbrunn

et al. 1982

Cathet. Cardiovasc. Diagn.

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Either augmentation or impairment of left ventricular function has previously been reported in different patients, in response to isometric exercise. To identify the mechanisms associated with these disparate responses, the effects of submaximal sustained handgrip upon left ventricular systolic and diastolic properties were studied in 29 patients during diagnostic catheterization. In 16 patients (group I), ejection fraction, mean Vcf, and the mean systolic ejection rate remained constant, while the ratio of peak systolic pressure to end systolic volume increased significantly from 2.81 +/- 0.6 to 3.17 +/- 0.6 ml/mm Hg. In 13 patients (group II) ejection fraction declined from 0.6 +/- 0.03 to 0.51 +/- 0.03, Vcf from 0.96 +/- 0.09 to 0.85 +/- 0.09 circ/sec, mean normalized systolic ejection rate from 1.79 +/- 0.1 to 1.50 +/- 0.09 sec-1, and the peak systolic pressure to end systolic volume ratio from 2.23 +/- 0.3 to 1.99 +/- 0.3 (p less than 0.05 for each). Systemic arterial mean pressure increased similarly by 19% and 21% in groups I and II, respectively (p less than 0.05 for each). Systemic vascular resistance increased significantly by 23% in group I and by 5% in group II (p less than 0.05). Left ventricular end diastolic volume declined from 85.4 +/- 7 to 77.3 +/- 11 ml/m2 in group I, while end diastolic and end systolic volumes increased by 13% and 35%, respectively in group II (p less than 0.05 for each). In both groups, baseline exponential pressure-volume relations were similar, though higher intercepts on the pressure-volume relations upon the Y-axis suggested greater "diastolic tone," and steeper volume-normalized pressure-volume elasticity relations indicated "stiffer" left ventricular chambers in group II patients. While the incidence of coronary artery disease was similar, both the severity and extent of left ventricular asynergy were greater in group II patients. We conclude that dilatation and deterioration of left ventricular ejection function in response to isometric exercise are causally related to, and comprise a useful predictor of, severe underlying left ventricular asynergy and impaired chamber distensibility.

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