Isometric handgrip echocardiography: A noninvasive stress test to assess left ventricular diastolic function

Abstract

Background Cycle exercise echocardiography is a useful tool to “unmask” diastolic dysfunction; however, this approach can be limited by respiratory and movement artifacts. Isometric handgrip avoids these issues while reproducibly increasing afterload and myocardial oxygen demand. Hypothesis Isometric handgrip echocardiography (IHE) can differentiate normal from abnormal diastolic function. Methods First recruited 19 young healthy individuals (mean age, 24 ± 4 years) to establish the “normal” response. To extend these observations to a more at‐risk population, we performed IHE on 17 elderly individuals (mean age, 72 ± 6 years) with age‐related diastolic dysfunction. The change in the ratio of mitral valve inflow velocity to lateral wall tissue velocity (E/e'), a surrogate for left ventricular filling pressure, was used to assess the diastolic stress response in each group. Results In the young subjects, isometric handgrip increased heart rate and mean arterial pressure (25 ± 12 bpm and 26 ± 17 mmHg, respectively), whereas E/e' changed minimally (0.6 ± 0.9). In the elderly subjects, heart rate and mean arterial pressure were similarly increased with isometric handgrip (19 ± 16 bpm and 25 ± 11 mmHg, respectively), whereas E/e' increased more dramatically (2.3 ± 1.7). Remarkably, 11 of the 17 elderly subjects had an abnormal diastolic response (ΔE/e': 3.4 ± 1.1), whereas the remaining 6 elderly subjects showed very little change (ΔE/e': 0.3 ± 0.7), independent of age or the change in myocardial oxygen demand. Conclusions IHE is a simple, effective tool for evaluating diastolic function during simulated activities of daily living.

Dynamic handgrip exercise for the evaluation of mitral valve regurgitation: an echocardiographic study to identify exertion induced severe mitral regurgitation

“…Handgrip exercise (HG) is a simple bedside maneuver to increase the intensity of murmur of mitral regurgitation (MR) during auscultation [ 1 ]. In addition, HG has been used in echocardiography as a means of stress test to identify exertion induced ischemia or exertion induced left ventricular diastolic dysfunction [ 2 , 3 ]. Furthermore, HG has been used in combination with dobutamine stress echocardiography to identify patients with MR who would probably benefit from percutaneous mitral valve repair [ 4 ].…”

The possibility that long‐term isometric handgrip exercise contributes to left atrial enlargement in patients with hypertension

“…However, a previous study on stress echocardiography showed that left ventricular (LV) diastolic dysfunction clearly appeared during IHG in hypertensive patients compared with healthy subjects 12 . Another study reported that E/E′, which was correlated with LV filling pressure, changed minimally during IHG in healthy young subjects, whereas E/E′ increased more dramatically in elderly subjects 13 . One possible explanation for the different results in healthy young and elderly hypertensive subjects may be that diastolic dysfunction during IHG is associated with relative myocardial ischemia caused by increases in LV afterload and myocardial oxygen demand.…”

Echocardiography in patients with heart failure: recent advances and future perspectives

“…Both bicycle (preferably supine) and treadmill exercise protocols are useful for this purpose [15]. Passive leg lifting and isometric exercise with handgrip may be potential alternatives to dynamic exertion, but need to be more extensively validated to be recommended for clinical use [29][30][31].…”