THE USE OF THE HANDGRIP MANEUVER TO IDENTIFY LEFT-VENTRICULAR DIASTOLIC FUNCTION ABNORMALITIES BY DOPPLER-ECHOCARDIOGRAPHY IN PATIENTS WITHCORONARY-ARTERY DISEASE

Doppler echocardiography accurately identifies diastolic dysfunction t hrough the assessment of transmitral flow patterns during the applicat ion of the handgrip (HG) maneuver. In this study, 45 normal control pa tients (mean age 46 +/- 9, group A) and 13 patients with coronary arte ry disease (CAD) (mean age 51 +/- 6, group B) were involved. The effec ts of handgrip maneuver on transmitral flow patterns were studied by D oppler echocardiography. Group B patients had higher peak late diastol ic filling velocities (A), lower peak early (E) to late diastolic fill ing velocity ratios (E /A) and longer isovolumic relaxation times (TVR T) compared to group A. On the other hand, systolic blood pressure (SB P), heart rate (HR) and peak E velocity (E) did not change significant ly (p > 0.05) in either group, at rest. During the supine handgrip man euver, NR (mean +/- standard error of mean, +21 +/- 13%, p < 0.05) and SBP (+21 +/- 9%, p < 0.05) increased significantly in both group A an d group B (+20 +/- 13%, p < 0.05, +22 +/- 15%, p < 0.05, respectively) . In group B, E/A ratio (-28 +/- 7%) decreased significantly (p < 0.05 ) compared to group A (-20 +/- 6%), as a consequence of significantly increased peak ii velocity in group B (+7 +/- 5%) compared to group A (+6 +/- 3%, p < 0.05). Deceleration time decreased significantly in bo th groups (-10 +/- 6% vs -9 +/- 6%, p < 0.05). Isovolumic relaxation t ime (TVRT) significantly increased in both groups (+18 +/- 7% vs +16 /- 6%, p < 0.001). Peak E/A ratios were >1.0 in all patients of both g roups in the supine position. This parameter remained greater than 1.0 only in group A during the HG maneuver. Therefore HG was effective in identifying diastolic function abnormalities in patients with CAD.