Handgrip Exercise Test Research Articles

Detection of myocardial ischemia by 31P magnetic resonance spectroscopy during handgrip exercise.

The metabolic changes of myocardial ischemia in patients with coronary artery disease assessed by 31P magnetic resonance spectroscopy (MRS) have been reported previously. A significant decrease in the ratio of phosphocreatine (PCr) to ATP during handgrip exercise in a group of patients with severe coronary artery disease has been demonstrated. However, there are no reports at present that directly compare cardiac 31P MRS data with exercise 201Tl myocardial scintigraphy, now established as one of the most important clinical methods to assess myocardial ischemia. The purpose of this study was to investigate whether 31P MRS with handgrip exercise testing is able to detect myocardial ischemia, demonstrated by exercise 201Tl scintigraphy. Twenty-seven patients with severe stenosis of the left anterior descending coronary artery (> or = 75%) and 11 normal control subjects composed the present study. Patients were divided into two groups on the basis of exercise 201Tl scintigraphy: a reversible 201Tl defect group (RD[+]) who demonstrated redistribution at the late image and a fixed 201Tl defect group (RD[-]). While lying supine within the magnet, subjects performed handgrip exercise at 30% of maximal force once in every two cardiac cycles. 31P MR spectra were collected before and during handgrip exercise. Data were corrected for the saturation factor. ANOVA revealed significant differences among the three groups with respect to the mean +/- SD PCr/ATP ratio at rest (control, 1.85 +/- 0.28 > RD(+), 1.60 +/- 0.19 > RD(-), 1.24 +/- 0.30; P < .05). The PCr/ATP ratio decreased significantly from 1.60 +/- 0.19 at rest to 0.96 +/- 0.28 during exercise (P < .001) in the RD(+) group (n = 15). However, in the RD(-) group (n = 12), the ratio did not change significantly during handgrip exercise (1.24 +/- 0.30 at rest versus 1.19 +/- 0.28 during exercise). Similarly, the ratio did not change in the control group (n = 11) (1.85 +/- 0.28 at rest versus 1.90 +/- 0.23 during exercise). Contrary to normal subjects or patients with fixed thallium defects, the PCr/ATP ratio was significantly altered by exercise in patients with reversible thallium defects. These results suggest that 31P MRS with handgrip exercise testing is a sensitive method for detecting myocardial ischemia.

Early detection of anthracycline cardiotoxicity in children with acute leukemia using exercise-based echocardiography and Doppler echocardiography.

We performed both supine bicycle ergometer (BEx) and hand-grip (HGx) exercise tests to evaluate cardiac function in 13 asymptomatic children with leukemia who had completed a general treatment protocol. We calculated fractional shortening (FS), end-systolic stress-volume index (ESS/ESVI), left ventricular diastolic filing velocity ratio (A/E) and normalized peak rate of diastolic increase in left ventricular internal dimension (dLVDt/dt/LVDt). Before the exercise, we found that dLVDt/dt/LVDt was decreased in the high-dose anthracycline group (anthracycline cumulative dose of 480-570 mg/m2), even though other cardiac function parameters were not different from those in the control. In BEx, the percent change in ESS/ESVI decreased in an anthracycline cumulative dose-dependent fashion. In HGx, ESS/ESVI showed a decreased response only in the high-dose anthracycline group. Therefore, we conclude that: 1) the diastolic function parameter dLVDt/dt/LVDt might show abnormalities prior to other systolic function parameters, 2) the percent change in ESS/ESVI in BEx is the most sensitive parameter studied, and could detect cardiac function abnormalities even in the small-dose anthracycline group (anthracycline cumulative dose of 175 mg/m2), and 3) BEx is more suitable for the early detection of anthracycline cardiotoxicity than HGx.

Is white coat hypertension innocent? Structure and function of the heart in the elderly.

To evaluate the morphological and functional characteristics of the heart in elderly patients with white coat hypertension, we performed an echocardiographic study in 67 elderly individuals older than 60 years: 17 patients with white coat hypertension, 34 patients with true hypertension, and 16 normotensive control subjects. White coat hypertension was defined as a mean 24-hour ambulatory systolic blood pressure of less than 140 mm Hg associated with office hypertension. Cardiac responses to an isometric handgrip exercise test were used to evaluate left ventricular functional reserve. Left atrial dimension and left ventricular mass index were significantly greater in the white coat hypertension group than in the normotension group (P < .05) but were similar to values in the true hypertension group. Left ventricular diastolic function, expressed by peak late-early filling ratio of diastolic mitral flow, showed increasing impairment in the order of the normotension, white coat hypertension, and true hypertension groups (analysis of variance, P < .05); the ratio in the white coat hypertension group tended to be higher than that in the normotension group (unpaired t test, P = .054). The relation between fractional shortening and end-systolic stress did not shift downward after handgrip exercise in the white coat hypertension group, indicating that functional reserve in the left ventricle was maintained. Thus, patients with white coat hypertension had a moderately increased left atrial dimension and left ventricular mass in association with a tendency for disturbed diastolic function, although systolic functional reserve remained the same. These findings suggest that white coat hypertension in the elderly may not be innocent.

Hematological and Pressor Hormone Responses to Mental Stress in Essential Hypertensive Patients: A Comparison with Isometric Handgrip Exercise.

We carried out both mental stress (MS) and isometric handgrip exercise (IHG) tests in 20 mild hypertensive patients to compare responses of blood pressure, heart rate, blood cell count and pressor hormones between the two tests. Increments of blood pressure and heart rate by MS (mean±SEM, 42± 2/17±1mmHg and 8±1beats/mm) were similar to those by IHG (39 ±3/17±2mmHg and 6±1beats/ min). Packed cell volume, erythrocytes, leukocytes, and platelets significantly increased in the MS test (1.3±0.3%, 1.7±0.3%, 10.3±2.1% and 2.8±1.6%, respectively) and in the IHG test (1.3±0.3%, 1.0 ±0.3%, 6.2±1.2% and 1.9±0.8% respectively). In both tests the percent increase was significantly greater in leukocytes than in erythrocytes and platelets (p<0.01). A comparison between the two tests revealed that the increase in leukocyte count was significantly greater in the MS than in the IHG test (p <0.05). Plasma noradrenaline, adrenaline and vasopressin levels significantly increased in both tests and there were no significant differences in responses of these pressor hormones between the two tests. Plasma active renin and aldosterone levels significantly increased in the MS test, but remained unchanged in the IHG test. Although the responses to both stressors are mainly induced by the sympathoadrenal excitation, there are some differences in details between the two tests. We concluded that MS induced a greater increase in leukocyte count than IHG with equipressor response and activated the renin-angiotensin-aldosterone system, which was not stimulated by the latter. (Hypertens Res 1992; 15: 33-39)

Cardiovascular response to static handgrip in trained and untrained men

The influence of aerobic capacity on the cardiovascular response to handgrip exercise, in relation to the muscle mass involved in the effort, was tested in 8 trained men (T) and 17 untrained men (U). The subjects performed handgrip exercises with the right-hand (RH), left-hand (LH) and both hands simultaneously (RLH) at an intensity of 25% of maximal voluntary contraction force. Maximal aerobic capacity was 4.3 l.min-1 in T and 3.21 l.min-1 in U (P less than 0.01). The endurance time for handgrip was longer in T than in U by 29% (P less than 0.05) for RH, 38% (P less than 0.001) for LH and 24% (P less than 0.001) for RLH. Heart rate (fc) was significantly lower in T than in U before handgrip exercise, and showed smaller increases (P less than 0.01) at the point of exhaustion: 89 vs 106 beats.min-1 for RH, 93 vs 100 beats.min-1 for LH and 92 vs 108 beats.min-1 for RLH. Stroke volume (SV) at rest was greater in T than in U and decreased significantly (P less than 0.05) during handgrip exercise in both groups of subjects. At the point of exhaustion SV was still greater in T than in U: 75 vs 57 ml for RH, 76 vs 54 ml for LH and 76 vs 56 ml for RLH. During the last seconds of handgrip exercise, the left ventricular ejection time was longer in T than in U. Increases in cardiac output (Qc) and systolic blood pressure did not differ substantially between T and U, nor between the handgrip exercise tests.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of preload reserve during isometric exercise testing in patients with old myocardial infarction: Doppler echocardiographic study

To estimate the preload reserve in response to an increase in aflerload in patients with old myocardial infarction, the relation between the Doppler echocardiographic inflow velocity pattern and lett ventricular end-diastolic pressure was investigated during isometric handgrip exercise testing. The study population consisted of 16 normal subjects and 40 patients with old myocardial infarction. The 40 patients were subdivided into two groups according to left ventricular end-diastolic pressure at rest: group I (22 patients), less than 18 mm Hg; group II (18 patients), 18 mm Hg or more.At rest, the ratio of peak velocity in atrial contraction phase to peak velocity in early diastolic filling phase (A/E) was significantly higher in the patients with old myocardial infarction than in normal subjects; values in the two subgroups of myocardial infarction did not differ significantly. The A/E ratio and left ventricular end-diastolic pressure increased significantly during exercise in group I. Conversely, the change in left ventricular end-diastolic pressure during exercise in group II was significantly greater than that in group I, and was associated with a decrease in the A/E ratio.Thus, an atrial compensatory mechanism operated effectively in response to the increase in afterload in patients with a normal left ventricular filling pressure, whereas this compensatory mechanism deteriorated in patients with elevated left ventricular filling pressure due to a limited preload reserve.

陳旧性心筋梗塞の予後評価 ｀２０１´Ｔｌ心筋シンチグラフィ，｀９９ｍ´Ｔｃ心シンチグラフィを用いて

To evaluate the prognosis in 57 patients with old myocardial infarctions, 201Tl myocardial scintigraphy and 99mTc-HSA gated blood pool scan had been done as a 5-year follow up study. We subdivided into two groups; group I (over 60 years) and group II (under 60 years). Cardiac index (CI) and right ventricular ejection fraction (RVEF) did not change significantly, however left ventricular ejection fraction (LVEF) changed significantly (p less than 0.05). Correlationship between CAG score and delta LVEF by handgrip exercise test was y = -1.34 x +3.61 (n = 44, r = -0.400, p less than 0.01). Otherwise, Tl defect ratio between first and final examination did not show the significant change in two groups. In conclusion, nuclear examination (cardiac function and myocardial blood flow) is significant to evaluate the prognosis in patients with myocardial infarction.

Heart rate and blood pressure changes during postural change and isometric handgrip exercise in patients with panic disorder and normal controls

Changes in heart rate (HR) and blood pressure (BP) were measured serially during postural changes and isometric hand grip exercise test (IHT) in 30 patients with panic disorder and 30 normal controls. Though there were no significant differences in the delta increase of HR or systolic or diastolic BP during these tests, the resting supine and standing diastolic BP were significantly higher in panic disorder patients than in controls. The standing mean BP was also significantly higher in panic disorder patients. These findings are suggestive of an increase in adrenergic tone in panic disorder patients.

Weight carrying versus handgrip exercise testing in men with coronary artery disease

The clinical merits of handgrip and weight carrying tests were compared in 30 patients with documented coronary artery disease. The static loads in the 2 tests were matched by percentage of maximal static effort and corresponded to 25 and 45% of maximal voluntary handgrip contraction and 25 and 45% of maximal 1-hand lift capacity. Each static load in both tests was continued for ≤3 minutes. At the 25% maximal effort stage, 93 and 90% of patients were able to complete 3 minutes of handgrip and weight carrying, respectively. Only 13 and 10% were able to complete 3 minutes at the 45% maximal effort stage with handgrip and weight carrying, respectively. Arm fatigue and an increase in diastolic blood pressure >120 mm Hg were the predominant endpoints. Weight carrying resulted in significantly higher (p < 0.05) heart rate, systolic blood pressure, pressure-rate product, ventilation and oxygen consumption compared to handgrip. Diastolic blood pressure responses did not differ between the tests. None of the patients demonstrated ischemic responses to either handgrip or weight carrying and the incidence of arrhythmias was rare. The diastouc blood pressure response to static effort is equally evaluated by handgrip and weight carrying tests. However, the greater myocardial oxygen demand, reflected by the pressure-rate product, in addition to the greater total body oxygen consumption, imposed by weight carrying, enhances the clinical application of the weight carrying test.

Seasonal influences on blood pressure in high normal to mild hypertensive range.

To investigate the seasonal influences on various arterial blood pressure measurements, 22 subjects in the high normal to mild hypertensive range were examined twice following the same protocol. In one group (13 subjects), measurements were first done in warm conditions and repeated 5-7 months later in cold conditions; in the second group (nine subjects) a reverse sequence was followed. Blood pressure was measured under casual conditions during a hand grip exercise test, mental arithmetic test, and submaximal multistage bicycle exercise test; during the following 24 hours, blood pressure was measured serially with a noninvasive ambulatory blood pressure recorder. Daily outdoor maximum and indoor laboratory temperatures were also obtained. In the cold season, significantly higher values (on the average by 5-10 mm Hg, p less than 0.01) were obtained in both groups for mean diastolic daytime blood pressure. For other measurements, a trend toward higher values in the cold season was observed in both groups, although statistical significance was not obtained in all instances. For nighttime measurements, irrespective of the seasonal sequence, lower values were observed in the second session. Significant correlations were found between the differences in the average daytime ambulatory blood pressures and the corresponding changes of daily maximum outdoor temperatures after 5-7 months. These observations indicate that arterial blood pressure may be strongly influenced by environmental temperature. This phenomenon should be taken into account both in the evaluation of the individual hypertensive patients and in the design and analysis of studies on arterial hypertension, especially when ambulatory blood pressure techniques are employed.

Behaviour and hypertension: a pathophysiological puzzle

Patients with borderline hypertension typically show enhanced sympathetic and decreased parasympathetic tone, characteristic personality traits (submissiveness, hostility) and hyperreactivity to mental stress. It has been proposed that the hypertensive personality results in a persistent 'defence reaction', enhancing sympathetic outflow from the central nervous system and reactivity to stress. But evidence from pharmacological intervention trials suggests that blood pressure reactivity is controlled independently of average baseline blood pressure. A study comparing the effects of the centrally-acting alpha 2-agonist, clonidine, and the selective beta 1-blocker, atenolol, demonstrated that both drugs had a comparable antihypertensive action on baseline blood pressure. However, neither agent affected stress responses to mental arithmetic, submaximal isometric handgrip exercise or cold pressor testing. We conclude that studies of stress reactivity, while of interest to students of circulatory control, are unlikely to yield insights into the causes of human hypertension.

Reproducibility of haemodynamic and plasma catecholamine responses to isometric exercise and mental arithmetic in normo- and hyper-tensive subjects.

1. To determine the reproducibility of a mental arithmetic stress test and a handgrip exercise test, we studied the responses of blood pressure, heart rate, forearm blood flow and plasma catecholamines on two occasions, with an interval of at least 1 week, in 24 normotensive and 22 hypertensive subjects. 2. The SE of a single observation of the percentage changes of blood pressure ranged from 3.9 to 9.3% in normotensive subjects and from 3.9 to 7.4% in hypertensive subjects in both tests. For heart rate, these values were 4.9-12.3% in the normotensive subjects and 4.8-5.7% in the hypertensive subjects. However, there was a wide individual scatter of these haemodynamic responses during both tests. The forearm blood flow, only measured during mental arithmetic, had an SE of a single observation of 33.7%. 3. In 10 normotensive subjects the SE of a single observation of the change in plasma noradrenaline was 0.16 nmol/l during handgrip exercise and 0.09 nmol/l during mental arithmetic. The corresponding values for plasma adrenaline were 0.04 and 0.05 nmol/l. 4. In conclusion, although both tests showed a rather low SE of a single observation for the blood pressure and heart rate responses in normo- and hyper-tensive subjects, there was a considerable individual variability. If related to the mean forearm blood flow responses, the SE of a single observation of the forearm blood flow response was of similar magnitude. The limited intra-individual reproducibility of both tests should be borne in mind when interpreting pharmacological intervention studies or studies evaluating sympathoadrenal reactivity in cardiovascular disorders.

Evaluation of cardiovascular responses to handgrip tests in patients with ischemic heart disease by radionuclide method

Left ventricular responses to handgrip exercise test in patients with ischemic heart disease were assessed by RI methods. We subdivided into three groups (A: delta EF more than 5% increased, B: delta EF -5%-+5% no change, C: delta EF less than 5% reduced), left ventricular contractility (LVEF/LVET) and Tl defect score changed significantly in global EF reduced group, moreover the usefulness of handgrip test was assured. This instrument is low cost, safety, small size, and available for wide ranged ages.

The Effect of Labetalol on the Pressure Responses to Isometric Exercise and a Cold Pressor Test in Pregnancy-Induced Hypertension

Ten patients with pregnancy-induced hypertension were subjected to an isometric handgrip exercise test (IHG) and a cold pressor test (CPT) before and during treatment with oral labetalol 200mg three times daily. The drug reduced resting blood pressure but not heart rate. During IHG heart rate and mean arterial blood pressure increased significantly both before and during treatment. Treatment did, however, not attenuate the responses. During CPT blood pressure increased significantly both before and during treatment without significant difference between the two occasions. Heart rate remained essentially unchanged both before and during labetalol treatment. It is suggested that not only the traditional measuring of resting blood pressure but also the blood pressure response to physical stress should be taken into account as indicator of the effect of an antihypertensive treatment in pregnancy-induced hypertension.

Ventricular arrhythmias induced by dynamic and static exercise in relation to coronary artery bypass grafting

The effect of coronary artery bypass grafting (CABG) on exercise-induced ventricular arrhythmias was examined in 53 patients. A bicycle exercise test and an isometric handgrip exercise test were performed before and 3 months after CABG. Exercise-induced ventricular arrhythmias were detected preoperatively in 14 patients (26%), in 13 during the bicycle test and in 11 during the handgrip test, and in 18 patients (34%) after CABG. Thus, CABG had no significant effect on the occurrence of exercise-induced ventricular arrhythmias. Nine patients had new exercise-induced ventricular arrhythmias after CABG, 8 of whom had evidence of previous myocardial infarction, whereas only 8 of the 35 patients (23%) without postoperative ventricular arrhythmias had had a previous infarction. The rate of graft patency or improvement in exercise tolerance in patients with new postoperative arrhythmias did not differ from that in patients who did not have exercise-induced arrhythmias after CABG. The results confirm that CABG has no influence on the occurrence of ventricular arrhythmias induced by physical exercise. Patients with a previous myocardial infarction appear to be prone to new ventricular arrhythmias despite successful revascularization.

Effect of coronary artery bypass grafting on left ventricular response to isometric exercise

The left ventricular (LV) response to isometric exercise was evaluated in 20 patients who performed handgrip exercise tests before and 3 months after coronary artery bypass grafting. Preoperative LV ejection fraction (EF) decreased during the handgrip test from 0.57 ± 0.08 to 0.49 ± 0.09 (p < 0.001); the ratio between the LV peak systolic pressure (PSP) and end-systolic volume index (ESVI) did not change. In 12 patients with patent grafts, the LVEF after operation did not change (0.54 ± 0.06 at rest and 0.56 ± 0.06 during handgrip exercise) and PSP ESVI ratio increased from 4.5 ± 1.5 to 5.6 ± 2.1 mm Hg/ml·m −2 (p <0.001) during exercise. In 8 patients with occluded grafts, the LVEF after operation decreased from 0.56 ± 0.10 to 0.48 ± 0.06 (p <0.02), whereas PSP ESVI did not change during handgrip exercise. Thus, the LV response to isometric handgrip exercise appears to improve after coronary artery bypass grafting in patients with patent grafts, but not in patients with 1 or more occluded grafts.

Value of isometric exercise testing during cardiac catheterization in mitral stenosis

To examine the value of preoperative isometric exercise testing during cardiac catheterization in patients with mitral stenosis, the isometric handgrip exercise test was performed on 28 patients during preoperative diagnostic catheterization. Eighteen patients who subsequently underwent mitral valve surgery were recatheterized and reevaluated clinically 12 months after operation. Preoperatively, the patients were divided into 2 groups: 16 whose mean mitral valve pressure gradient increased > 4 mm Hg during isometric exercise (group A) and 12 whose pressure gradient decreased or increased < 4 mm Hg (group B). The ejection fraction remained unchanged and the peak systolic pressure/end-systolic volume ratio increased during isometric exercise in group A (p < 0.001). In group B, the ejection fraction decreased (p < 0.001) and the peak systolic pressure/end-systolic volume ratio remained unchanged. In the total group, a positive correlation existed between the change in mean mitral valve pressure gradient during isometric exercise and the changes in measures of left ventricular function during exercise. The patients in group A had a significant improvement in both symptoms and in exercise tolerance as determined by symptom-limited bicycle ergometry after surgery. The patients in group B showed minimal or no symptomatic improvement and their exercise tolerance did not improve. The change in mitral valve pressure gradient during isometric exercise appears to reflect the left ventricular response to exercise.

Comparative plasma catecholamine and hemodynamic responses to handgrip, cold pressor and supine bicycle exercise testing in normal subjects

Serial hemodynamic and plasma catecholamine responses were compared among 10 healthy men (27 +/- 3 years) (+/- 1 standard deviation) during symptom-limited handgrip (33% maximal voluntary contraction for 4.4 +/- 1.8 minutes), cold pressor testing (6 minutes) and symptom-limited supine bicycle exercise (22 +/- 5 minutes). Plasma catecholamine concentrations were measured by radioenzymatic assays: ejection fraction and changes in cardiac volumes were assessed by equilibrium radionuclide angiography. During maximal supine exercise, plasma norepinephrine and epinephrine concentrations increased three to six times more than during either symptom-limited handgrip or cold pressor testing. Additionally, increases in heart rate, systolic blood pressure, rate-pressure product, stroke volume, ejection fraction and cardiac output were significantly greater during bicycle exercise than during the other two tests. A decrease in ejection fraction of 0.05 units or more was common in young normal subjects during the first 2 minutes of cold pressor testing (6 of 10 subjects) or at symptom-limited handgrip (3 of 10), but never occurred during maximal supine bicycle exercise. The magnitude of hemodynamic changes with maximal supine bicycle exercise was greater, more consistent and associated with much higher sympathetic nervous system activation, making this a potentially more useful diagnostic stress than either handgrip exercise or cold pressor testing.

Detection of coronary heart disease using radionuclide determined regional ejection fraction at rest and during handgrip exercise: correlation with coronary arteriography.

The detection of regional asynergy provides strong evidence for a critical reduction of coronary blood flow to that zone. In the present study, the usefulness of combining computer-assisted radionuclide angiography and isometric handgrip exercise testing to detect coronary heart disease (CHD) was evaluated. One hundred twenty-nine patients with chest pain undergoing cardiac catheterization were evaluated using radionuclide angiography. Thirty-four patients were found to have severe contraction abnormalities during the initial radionuclide angiographic study. Of these, 33 had significant CHD. Ninety-five patients had normal or borderline normal left ventricular contraction and therefore underwent a second radionuclide angiogram during handgrip. Radionuclide angiogram data were quantitatively analyzed by computer to determine regional left ventricular contribution to ejection fraction during handgrip stress. Of the 95 patients, 30 had normal coronary arteries of whom 26 (87%) had normal relative regional ejection fraction. Sixty-five patients had CHD; 20 had single and 45 had two or three vessel obstructive disease. Overall, of the 95 patients who underwent isometric handgrip stress, sensitivity was 86% for detection of CHD and specificity was 87% for accurately defining the patients with normal coronary arteries. The results of the present study suggest that the radionuclide angiographic assessment of relative regional ejection fractionmore » during isometric handgrip exercise may provide a useful new diagnostic approach for patients with suspected CHD as well as providing important additional data concerning its location and severity.« less

Blood levels of adrenergic amines during exercise.

Blood levels of adrenergic amines during exercise.