title: Handgrip-enhanced myocardial fractional flow reserve for assessment of coronary artery stenoses.
abstract: BACKGROUND
  Fractional flow reserve (FFR) may yield false-negative results in up to 12% of lesions tested, and there is a zone of uncertainty at borderline values.
  
  
  METHODS
  Forty-eight patients were investigated by means of dobutamine stress echocardiography (DSE), coronary angiography, and FFR assessment of 48 coronary lesions before, during, and immediately after handgrip exercise.
  
  
  RESULTS
  Mean FFR values were lower during and immediately after handgrip exercise as compared with baseline (0.86 +/- 0.09 vs 0.87 +/- 0.08 vs 0.88 +/- 0.08, P < .05, respectively). The sensitivity of FFR < or = 0.75 for predicting myocardial ischemia on DSE was 17.6% before handgrip exercise, 52.9% during, and 35.5% immediately after exercise. The specificity of FFR < or = 0.75 before, during, and immediate after exercise was 100%, 93.5%, and 96.8%, respectively. In 10 patients, FFR values > 0.75 before handgrip became < or = 0.75 during or immediately after handgrip exercise (P = .01). All these patients had angina and/or DSE indicating ischemia in the territory of the vessel studied, and underwent coronary intervention. At 6 months follow-up, all patients were asymptomatic with negative DSE tests.
  
  
  CONCLUSIONS
  The addition of handgrip exercise can significantly lower the FFR and potentially improve its ability to detect physiologically significant stenoses.
authors.affiliation: Department of Cardiology, Athens Euroclinic, Athens, Greece. dkatrits@otenet.gr
authors.forename: Demosthenes G
authors.initials: DG
authors.lastname: Katritsis
authors.forename: Socrates
authors.initials: S
authors.lastname: Korovesis
authors.forename: Evangelia
authors.initials: E
authors.lastname: Karvouni
authors.forename: Eleftherios
authors.initials: E
authors.lastname: Giazitzoglou
authors.forename: Ilias
authors.initials: I
authors.lastname: Karabinos
authors.forename: Efthalia
authors.initials: E
authors.lastname: Tzanalaridou
authors.forename: Demosthenes
authors.initials: D
authors.lastname: Panagiotakos
authors.forename: Michael M
authors.initials: MM
authors.lastname: Webb-Peploe
mesh_terms: D000787:Angina Pectoris / Q000150:complications; D002316:Cardiotonic Agents; D017023:Coronary Angiography; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000175:diagnosis*; D004280:Dobutamine; D025401:Echocardiography, Stress; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000175:diagnosis; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine