Open AccessAdjunctive handgrip during dobutamine stress echocardiography: Invasive assessment of myocardial oxygen consumption in humans
Author(s) -
Khan Ijaz A.,
Otero F. Javier,
FontCordoba Jose,
McCulloch Marti,
Sheahan Richard G.,
Parmar Rohit,
Defilippi Christopher R.
Publication year - 2005
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.4960280709
Subject(s) - medicine , dobutamine , cardiology , ejection fraction , coronary sinus , hemodynamics , heart rate , pulmonary wedge pressure , isometric exercise , blood pressure , heart failure
Background : Adjunctive isometric exercise in the form of sustained submaximal handgrip (HG) is considered to increase the sensitivity of dobutamine stress echo (DSE) for detection of functionally significant coronary artery disease. Hypothesis : The study was undertaken to quantify invasive‐ly the impact of HG in humans on hemodynamics and myocardial oxygen consumption (MVO 2 ) during DSE. Methods : An invasive hemodynamic evaluation was performed during DSE and with addition of adjunctive HG in 11 subjects. Coronary sinus (CS) blood flow, right‐sided and systemic pressures, oxygen saturations, and transthoracic two‐dimensional echocardiography were obtained at each 3‐min stage and after adding HG at peak DSE. Myocardial oxygen consumption was calculated by the Fick method and circumferential end‐systolic wall stress (ESWS) by Mirsk's formula. Results : At peak DSE, heart rate, left ventricular ejection fraction, CS flow, and MVO 2 increased, whereas pulmonary capillary wedge pressure (PCWP) and circumferential end‐systolic wall stress (ESWS) decreased from baseline. Compared with peak DSE, the addition of isometric HG at peak DSE caused an increase in PCWP (7 ± 3 vs. 8.4 ± 3 mmHg, p < 0.05), ESWS (112 ± 25 × 103 vs. 125 ± 32 × 103 dyne·s·cm 2 , p = 0.02), and CS flow (260 ± 92 vs. 301 ± 105 ml/min, p < 0.05). There was a minimal increase in left ventricular volumes, heart rate, and systolic blood pressure. The MVO 2 increased from 29 ± 8 ml/min at peak DSE to 31 ± 9 ml/min with adjunctive HG (p = 0.03). Conclusion : Handgrip adjunctive to peak DSE results in a modest increase in MVO 2 , primarily by an increase in end‐systolic wall stress.