title: Isometric handgrip exercise during dobutamine-atropine stress echocardiography increases heart rate acceleration and decreases study duration and dobutamine and atropine dosage.
abstract: BACKGROUND
  Dobutamine-atropine stress echocardiography (DASE) is an established test for the diagnosis and risk stratification of patients with coronary artery disease. Atropine use to attain target heart rate prolongs test time.
  
  
  OBJECTIVE
  The aim of this study was to assess the utility of isometric handgrip exercise (33% maximal voluntary contraction x 4 min) with DASE.
  
  
  METHODS
  We prospectively evaluated 131 patients undergoing DASE randomized to handgrip exercise or no handgrip. Effect of handgrip exercise on endpoints: time to target heart rate (85% maximum predicted), recovery time, total test time, mean dobutamine and atropine dosage, and the number of ischemic responses were assessed. Effect of current beta-blocker medication use was also evaluated.
  
  
  RESULTS
  Heart rate rose more quickly in the handgrip group. At 6-10 min (peak handgrip), mean heart rate rose 51 +/- 14 beats/min in the handgrip group compared with 38 +/- 18 beats/min in the no handgrip group (p < 0.0001). With handgrip, overall dobutamine study time was reduced by a mean of 4.3 min (16.4 +/- 6.9 vs. 20.7 +/- 8.4, p = 0.004) in all patients, and by a mean of 5.9 min in patients not on beta-blocker medication (p = 0.001). The handgrip group also had a lower mean dose of dobutamine (25.8 +/- 13.5 vs. 32.4 +/- 16.4 mg, p = 0.025). The mean atropine dose was also lower (0.2 +/- 0.4 vs. 0.4 +/- 0.5 mg, p = 0.04). Handgrip exercise, however, did not decrease endpoints in patients on beta-blocker medication.
  
  
  CONCLUSIONS
  Use of isometric handgrip exercise with DASE decreases time to target heart rate, recovery time, overall study time, and mean dosage of dobutamine and atropine. In patients not on beta-blocker medication, handgrip exercise should be routinely incorporated into all DASE protocols.
authors.affiliation: Division of Cardiology, St. Luke's-Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York, New York 10019, USA.
authors.forename: Siu-Sun
authors.initials: SS
authors.lastname: Yao
authors.forename: Sonja
authors.initials: S
authors.lastname: Moldenhauer
authors.forename: Mark V
authors.initials: MV
authors.lastname: Sherrid
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001285:Atropine; D002316:Cardiotonic Agents; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000503:physiopathology; D004280:Dobutamine; D025401:Echocardiography, Stress / Q000379:methods* / Q000592:standards; D005240:Feasibility Studies; D005260:Female; D018737:Hand Strength; D006339:Heart Rate / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007537:Isometric Contraction; D008297:Male; D008875:Middle Aged; D010276:Parasympatholytics; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors
chemical_list: D000319:Adrenergic beta-Antagonists; D002316:Cardiotonic Agents; D010276:Parasympatholytics; D004280:Dobutamine; D001285:Atropine