USEFULNESS OF ISOMETRIC HAND GRIP EXERCISE IN DETECTING CORONARY-ARTERY DISEASE DURING DOBUTAMINE ATROPINE STRESS ECHOCARDIOGRAPHY IN PATIENTS WITH EITHER STABLE ANGINA-PECTORIS OR ANOTHER TYPE OF POSITIVE STRESS TEST

Dobutamine atropine stress echocardiography (DASE) detects coronary ar tery disease (CAD) by increasing myocardial oxygen demand causing isch emia. The sensitivity of the test for detection of CAD is reduced in p atients with submaximal stress. We hypothesized that increasing cardia c work load by adding isometric exercise would improve the detection o f ischemia during DASE. We studied 31 patients, mean age 57 +/- 11 yea rs, with angiographically documented CAD. Patients underwent DASE usin g incremental dobutamine doses from 5 to 40 mu g/kg/min, followed by a tropine if peak heart rate was <85% of predicted maximal. Hand grip wa s then performed for 2 minutes at 33% of maximal voluntary contraction , while dobutamine infusion was maintained at the peak dose. The addit ion of hand grip during dobutamine stress was associated with a signif icant increase in systolic blood pressure (143 +/- 21 vs 164 +/- 24 mm Hg, p = 0.001) and left ventricular end-systolic circumferential wall stress (72 +/- 30 x 10(3) dynes/cm(2) vs 132 +/- 34 x 10(3) dynes/cm( 2), p = 0.004). Wall motion score index increased from 1.0 at rest to 1.15 +/- 0.18 with dobutamine (p = 0.0004 vs rest), and increased furt her to 1.29 +/- 0.22 with the addition of hand grip (p = 0.004 vs dobu tamine). Ischemia was detected in 19 patients (62%) with dobutamine-at ropine stress alone and in 25 (83%) after the addition of hand grip (p < 0.05). The addition of hand grip during DASE is feasible, and impro ves the detection of myocardial ischemia. (C) 1998 by Excerpta Medica, Inc.