Identification of patients with coronary artery disease by assessing diastolic abnormalities during isometric exercise

Background: Previous clinical studies using invasive and noninvasive method s have shown handgrip-induced diastolic abnormalities in patients with coro nary artery disease (CAD). Hypothesis: The study was undertaken to determine the utility of Doppler ec ho- and pressocardiography during handgrip in discriminating patients with coronary artery disease (CAD) and in those with normal coronary arteries. Methods: Both methods were obtained in 96 patients with suspected CAD withi n 24 h before coronary angiography. An abnormal handgrip-Doppler was define d by an early (E) to late (A) transmittal flow velocities ratio (E/A) < 1 d uring handgrip and a positive handgrip pressocardiographic test (HAT) by an abnormal increase in the A wave/total excursion or prolongation of the abs olute or relative (heart-rate corrected) total relaxation time during isome tric exercise. Results: Of the 96 patients studied, 23 had normal coronary arteries and 73 showed CAD. In patients with normal coronary arteries, handgrip-Doppler sh owed an abnormal average E/A at rest and during handgrip, whereas all varia bles of HAT were within normal limits. In patients with CAD, handgrip-Doppl er showed only a moderate handgrip-induced increase in average A (+19%, p < 0.001), whereas HAT showed a significant (p < 0.001) increase in mean A wa ve/total excursion (+ 60%) and decrease in the relative total relaxation ti me (- 17%). Furthermore, handgrip-Doppler and HAT were abnormal in 15 of 23 (65% specificity 35%) and the HAT in 5 of 23 (22%, specificity 78%) patien ts with normal coronary arteries, as well as in 57 of 73 (sensitivity 78%) and 69 of 73 (95%) patients with CAD. Conclusions: Our study demonstrates that these noninvasive stress tests can become a useful new diagnostic modality for detecting patients with unknow n or suspected CAD.