The Use of The Handgrip Maneuver to Identify Left-Ventricular Diastolic Function Abnormalities by Doppler-Echocardiography in Patients with Coronary-Artery Disease

Doppler echocardiography accurately identifies diastolic dysfunction through the assessment of transmitral flow patterns during the application of the handgrip (HG) maneuver. In this study, 45 normal control patients (mean age 46 +/- 9, group A) and 13 patients with coronary artery disease (CAD) (mean age 51 +/- 6, group B) were involved. The effects of handgrip maneuver on transmitral flow patterns were studied by Doppler echocardiography. Group B patients had higher peak late diastolic filling velocities (A), lower peak early (E) to late diastolic filling velocity ratios (E /A) and longer isovolumic relaxation times (TVRT) compared to group A. On the other hand, systolic blood pressure (SBP), heart rate (HR) and peak E velocity (E) did not change significantly (p > 0.05) in either group, at rest. During the supine handgrip maneuver, NR (mean +/- standard error of mean, +21 +/- 13%, p < 0.05) and SBP (+21 +/- 9%, p < 0.05) increased significantly in both group A and 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 both groups (-10 +/- 6% vs -9 +/- 6%, p < 0.05). Isovolumic relaxation time (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 groups 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.