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

T. Jake Samuel, Rhys Beaudry, Mark J. Haykowsky, Satyam Sarma, Suwon Park, Thomas Dombrowsky, Paul S. Bhella, Michael D. Nelson

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


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 (ΔE/e': 3.4 ± 1.1), whereas the remaining 6 elderly subjects showed very little change (ΔE/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.

Original languageEnglish (US)
Pages (from-to)1247-1255
Number of pages9
JournalClinical Cardiology
Issue number12
StatePublished - Dec 2017


  • Aging
  • Diastolic Function
  • Diastolic Stress Test
  • Isometric Handgrip
  • Stress Echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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