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Isometric handgrip echocardiography: A noninvasive stress test to assess left ventricular diastolic function.

ABSTRACT: BACKGROUND:Cycle exercise echocardiography is a useful tool to "unmask" diastolic dysfunction; however, this approach can be limited by respiratory and movement artifacts. Isometric handgrip avoids these issues while reproducibly increasing afterload and myocardial oxygen demand. HYPOTHESIS:Isometric handgrip echocardiography (IHE) can differentiate normal from abnormal diastolic function. METHODS:First recruited 19 young healthy individuals (mean age, 24 ± 4 years) to establish the "normal" response. To extend these observations to a more at-risk population, we performed IHE on 17 elderly individuals (mean age, 72 ± 6 years) with age-related diastolic dysfunction. The change in the ratio of mitral valve inflow velocity to lateral wall tissue velocity (E/e'), a surrogate for left ventricular filling pressure, was used to assess the diastolic stress response in each group. RESULTS:In the young subjects, isometric handgrip increased heart rate and mean arterial pressure (25 ± 12 bpm and 26 ± 17 mmHg, respectively), whereas E/e' changed minimally (0.6 ± 0.9). In the elderly subjects, heart rate and mean arterial pressure were similarly increased with isometric handgrip (19 ± 16 bpm and 25 ± 11 mmHg, respectively), whereas E/e' increased more dramatically (2.3 ± 1.7). Remarkably, 11 of the 17 elderly subjects had an abnormal diastolic response (?E/e': 3.4 ± 1.1), whereas the remaining 6 elderly subjects showed very little change (?E/e': 0.3 ± 0.7), independent of age or the change in myocardial oxygen demand. CONCLUSIONS:IHE is a simple, effective tool for evaluating diastolic function during simulated activities of daily living.

SUBMITTER: Jake Samuel T

PROVIDER: S-EPMC6490388 | biostudies-literature | 2017 Dec

REPOSITORIES: biostudies-literature

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Isometric handgrip echocardiography: A noninvasive stress test to assess left ventricular diastolic function.

Jake Samuel T T Beaudry Rhys R Haykowsky Mark J MJ Sarma Satyam S Park Suwon S Dombrowsky Thomas T Bhella Paul S PS Nelson Michael D MD

Clinical cardiology 20171216 12

<h4>Background</h4>Cycle exercise echocardiography is a useful tool to "unmask" diastolic dysfunction; however, this approach can be limited by respiratory and movement artifacts. Isometric handgrip avoids these issues while reproducibly increasing afterload and myocardial oxygen demand.<h4>Hypothesis</h4>Isometric handgrip echocardiography (IHE) can differentiate normal from abnormal diastolic function.<h4>Methods</h4>First recruited 19 young healthy individuals (mean age, 24 ± 4 years) to esta ...[more]

PMID: 29247511

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Project description:BackgroundEarly detection of diastolic dysfunction is crucial for patients with incipient heart failure. Although this evaluation could be performed from phase-contrast (PC) cardiovascular magnetic resonance (CMR) data, its usefulness in clinical routine is not yet established, mainly because the interpretation of such data remains mostly based on manual post-processing. Accordingly, our goal was to develop a robust process to automatically estimate velocity and flow rate-related diastolic parameters from PC-CMR data and to test the consistency of these parameters against echocardiography as well as their ability to characterize left ventricular (LV) diastolic dysfunction.ResultsWe studied 35 controls and 18 patients with severe aortic valve stenosis and preserved LV ejection fraction who had PC-CMR and Doppler echocardiography exams on the same day. PC-CMR mitral flow and myocardial velocity data were analyzed using custom software for semi-automated extraction of diastolic parameters. Inter-operator reproducibility of flow pattern segmentation and functional parameters was assessed on a sub-group of 30 subjects. The mean percentage of overlap between the transmitral flow segmentations performed by two independent operators was 99.7 ± 1.6%, resulting in a small variability (<1.96 ± 2.95%) in functional parameter measurement. For maximal myocardial longitudinal velocities, the inter-operator variability was 4.25 ± 5.89%. The MR diastolic parameters varied significantly in patients as opposed to controls (p < 0.0002). Both velocity and flow rate diastolic parameters were consistent with echocardiographic values (r > 0.71) and receiver operating characteristic (ROC) analysis revealed their ability to separate patients from controls, with sensitivity > 0.80, specificity > 0.80 and accuracy > 0.85. Slight superiority in terms of correlation with echocardiography (r = 0.81) and accuracy to detect LV abnormalities (sensitivity > 0.83, specificity > 0.91 and accuracy > 0.89) was found for the PC-CMR flow-rate related parameters.ConclusionsA fast and reproducible technique for flow and myocardial PC-CMR data analysis was successfully used on controls and patients to extract consistent velocity-related diastolic parameters, as well as flow rate-related parameters. This technique provides a valuable addition to established CMR tools in the evaluation and the management of patients with diastolic dysfunction.

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Isometric handgrip echocardiography: A noninvasive stress test to assess left ventricular diastolic function.

Publications

Isometric handgrip echocardiography: A noninvasive stress test to assess left ventricular diastolic function.

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