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Comment
. 2019 Oct;12(10):2095-2097.
doi: 10.1016/j.jcmg.2019.07.023.

Diastolic Stress Testing: Have You Considered Isometric Handgrip Echocardiography?

T Jake Samuel, Mark J F Haykowsky, Satyam Sarma, Michael D Nelson
Comment

Diastolic Stress Testing: Have You Considered Isometric Handgrip Echocardiography?

T Jake Samuel et al. JACC Cardiovasc Imaging. 2019 Oct.
No abstract available

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Figures

FIGURE 1
FIGURE 1. Illustration Highlighting Potential Mechanisms and Early Evidence Promoting IHE as a Diastolic Discriminator
(A) Isometric handgrip echocardiography (IHE) performed at 40% of maximal voluntary contraction for 3–5 min reproducibly leads to an increase in arterial blood pressure (BP) and heart rate by stimulating the exercise pressor reflex (top), which acts as a diastolic stressor via 2 dominant mechanisms (bottom). First, the increase in heart rate and BP challenges the myocardial oxygen supply-demand balance, which can compromise adenosine triphosphate (ATP) production. Second, the elevated afterload stress can lead to impaired calcium handling, leading to delayed and prolonged myocardial relaxation. (B) Similar to 20-W cycle exercise, IHE leads to a rise in the ratio between Doppler-derived early mitral inflow velocity and early annular tissue velocity (E/e′) in a subset of elderly asymptomatic individuals, termed responders (top). This rise in E/e′, induced by IHE, mirrors the response observed in clinically diagnosed heart failure with preserved ejection fraction (HFpEF) patients (n = 3), which is not seen in young healthy individuals (below). Data are expressed as mean ± SD. Adapted with permission from Samuel et al. (–5). NCX = sodium-calcium exchanger.
See this image and copyright information in PMC

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  • The Authors Reply.
    Smiseth OA, Ha JW, Andersen OS, Sletten OJ. Smiseth OA, et al. JACC Cardiovasc Imaging. 2019 Oct;12(10):2097-2098. doi: 10.1016/j.jcmg.2019.08.006. JACC Cardiovasc Imaging. 2019. PMID: 31601383 No abstract available.
  • The Authors Reply.
    Obokata M, Reddy YNV, Borlaug BA. Obokata M, et al. JACC Cardiovasc Imaging. 2019 Oct;12(10):2098-2099. doi: 10.1016/j.jcmg.2019.07.024. JACC Cardiovasc Imaging. 2019. PMID: 31601384 No abstract available.

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References

    1. Ha JW, Andersen OS, Smiseth OA. Diastolic stress test: invasive and noninvasive testing. J Am Coll Cardiol Img 2019. June 12 [E-pub ahead of print]. - PubMed
    1. Obokata M, Reddy YNV, Borlaug BA. Diastolic dysfunction and heart failure with preserved ejection fraction: understanding mechanisms by using noninvasive methods. J Am Coll Cardiol Img 2019. June 12 [E-pub ahead of print]. - PubMed
    1. Samuel TJ, Beaudry R, Haykowsky MJ, Sarma S, Nelson MD. Diastolic stress testing: similarities and differences between isometric handgrip and cycle echocardiography. J Appl Physiol (1985) 2018;125:529–35. - PubMed
    1. Samuel TJ, Beaudry R, Haykowsky MJ, et al. Isometric handgrip echocardiography: A noninvasive stress test to assess left ventricular diastolic function. Clin Cardiol 2017;40:1247–55. - PMC - PubMed
    1. Samuel TJ, Beaudry R, Sarma S, Zaha V, Haykowsky MJ, Nelson MD. Diastolic stress testing along the heart failure continuum. Curr Heart Fail Rep 2018;15:332–9. - PubMed