Use of isometric handgrip for the indirect assessment of left ventricular function in patients with coronary atherosclerotic heart disease

Siegel, Wayne; Gilbert, Charles A.; Nutter, Donald O.; Schlant, Robert C.; Hurst, J. Willis

doi:10.1016/0002-9149(72)90124-5

Cited by 65 publications

(16 citation statements)

References 11 publications

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“…5). This is in contrast to the studies of Siegel, Gilbert, Nutter, Schlant, and Hurst, who found no change during SHG in a smaller number of subjects; and it also differs from the response of LVETI to isotonic exercise during which no change occurs (45).…”

Section: Discussioncontrasting

confidence: 99%

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Autonomic Mechanisms in Hemodynamic Responses to Isometric Exercise

Martin¹,

Shaver²,

Leon³

et al. 1974

J. Clin. Invest.

203

113

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A B S T R A C T Selective autonomic blockade with intravenous propranolol, practolol, atropine, and combined atropine-propranolol was utilized to elucidate the role of the autonomic nervous system in the hemodynamic responses in young adult male volunteers to handgrip sustained at 30% of maximal voluntary contraction for 3 min. The initial 30 s of the tachycardia response was found to be mediated by withdrawal of vagal dominance, as evidenced by blockade of this response by prior atropinization. The mid and late portion of the heart rate response curve was demonstrated to be sympathetic in origin, since it was unaffected by atropine, but was suppressed by combined atropine-propranolol blockade. Sympathetic stimulation appears to be a secondary mechanism for increasing the heart rate, however, as it becomes operative only after the first mechanism of vagal withdrawal has been utilized. This was confirmed by the finding that beta adrenergic receptor blockade alone had little effect on the heart rate response curve.The pressor response to handgrip was accompanied by increased cardiac output and no change in calculated systemic vascular resistance. After propranolol, handgrip resulted in increased peripheral resistance and an equivalent rise in arterial pressure, but no increase in cardiac output. It was concluded that the increase in resistance was the result of sympathetically induced vasoconstriction. This response was shown to be independent of peripheral beta adrenergic receptor blockade by the use of practolol, a cardio-selective beta adrenergic receptor-blocking drug which caused identical hemoPortions of this study were presented previously in abstract form.

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Section: Discussioncontrasting

confidence: 99%

“…5), although previous reports are conflicting (44,45). Recently, PEP was also found not to change during SHG in patients with primary myocardial and coronary heart disease (46).…”

Section: Discussionmentioning

confidence: 98%

Autonomic Mechanisms in Hemodynamic Responses to Isometric Exercise

Martin¹,

Shaver²,

Leon³

et al. 1974

J. Clin. Invest.

203

113

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show abstract

“…9 In normal subjects it is associated with 15% Control HGP A and intracoronary nitroglycerin despite increases in systemic pressure, heart rate, and double product that were virtually identical to those during the first handgrip test. This nitroglycerin dose has been previously shown to have no effect on systemic hemodynamics, including central venous pressure.20 21 Thus, constriction of severe coronary stenoses, and not increased double product, appears to be the principal mechanism for ischemic left ventricular dysfunction during isometric exercise.…”

Section: Discussionmentioning

confidence: 96%

Reflex constriction of significant coronary stenosis as a mechanism contributing to ischemic left ventricular dysfunction during isometric exercise.

Brown¹,

Lee²,

Bolson³

et al. 1984

Circulation

216

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“…The isometric stress can be easily done in that it may be useful to elicit latent left ventricular dysfunction4, [5][6][7][8] . Therefore, in the present study, cardiac reserve was assessed using the isometric handgrip exercise.…”

Section: S -49 Discussionmentioning

confidence: 99%

Evaluation of Cardiac Reserve in Hyperthyroid Patients with or without Beta-Adrenoreceptor-Blockade by Handgrip Exercise

Nakagawa

1988

The Journal of Kansai Medical University

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To evaluate latent left ventricular dysfunction in patients with Graves' disease, hemodynamic response to isometric exercise were examined in 93 patients and 18 controls by impedance cardiography. All patients were treated with anti-thyroid drugs and 64 patients were stll clinically thyrotxic with elevated triiodothyronine (T3) in serum. The remaining 29 patients were clinically free of thyrotoxicosis with normal serum T3. Thirty three of 93 patients received beta-bloccker.The distinct elevation of cardiac index (CI) , associated with elevation of cardiac work index (CWI) and total peripheral resistance index (TPRI) , was observed during the exercise in control group. Values for CWI and TPRI were apparently elevated in all patients studied, and the magnitude of the alterations in CWI and TPRI before and during the exercise was almost the same as that observed in control group. However, the CI values were almost unchanged before and during the exercise in hyperthyroid patients without beta-blockade, suggesting the impaired cardiac reserve in hyperthyroidism.Moreover, it was noteworthy that CI values before and during the exercise were also unchanged even in euthyroid patients without beta-blockade. This result supports the contention that a biochemical euthroid state may be achieved many weeks before normalization of contractile response to exercise.There was a significant correlation between serum T3 and CI at rest in 60 patients without beta-blockade, but this correlation was lost in 33 patients, who received beta-blocker. The beta-blocker induced reduction of the resting CI was evident in hyperthyroid patients, and this reduction of CI values was also observed in these patients with beta-blocker during exercise,showing negative inotropic effects of the beta-adrenoreceptor blocking drugs. Thus, beta-blocker may be beneficial in lowering heart rate in severe hyperthyroidism, but the beta-blockade should be avoided in euthyroid patients, who showed the delayed recovery of left ventricular function after antithyroid treatment.

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Use of isometric handgrip for the indirect assessment of left ventricular function in patients with coronary atherosclerotic heart disease

Cited by 65 publications

References 11 publications

Autonomic Mechanisms in Hemodynamic Responses to Isometric Exercise

Autonomic Mechanisms in Hemodynamic Responses to Isometric Exercise

Reflex constriction of significant coronary stenosis as a mechanism contributing to ischemic left ventricular dysfunction during isometric exercise.

Evaluation of Cardiac Reserve in Hyperthyroid Patients with or without Beta-Adrenoreceptor-Blockade by Handgrip Exercise

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