title: Handgrip exercise associated with dobutamine stress echocardiography.
abstract: BACKGROUND
  Stress echocardiography is today the best possible imaging choice in the field of noninvasive diagnosis of coronary artery disease. Dobutamine stress echocardiography (DSE) and Dobutamine-atropine stress echocardiography (DASE) have been studied. Handgrip (HG) exercise has been rarely studied in stress echocardiography. Aim of the study was to investigate the safe, feasibility and efficacy of use of HG associated with DSE and if it may lead to improved diagnostic capacity of the test.
  
  
  METHODS
  DSE was performed in 96 consecutive patients. Seventy-seven patients reached their target heart rate age-adjusted and were excluded. To 19 patients who have not reached their target hr age-adjusted, HG at 50% maximum effort was applied for a minute and 16 patients reached the maximum heart rate.
  
  
  RESULTS
  Of these 16 patients, 8 were positive for myocardial ischemia induced. Of the 3 other patients, 2 were positive for myocardial ischemia before reaching the target hr. One patient, without reaching the max hr and without being positive for myocardial ischemia, refused other investigations. Therefore, a total of 10 patients presented an inducible myocardial ischemia. Coronary angiography revealed a significant coronary artery disease in all these 10 patients (10/10 patients, 100%).
  
  
  CONCLUSIONS
  Our study concludes for the safe, feasibility and efficacy of use of HG with DSE and that it may lead to improved diagnostic capacity of the test. Large studies need to be done to confirm these preliminary results but our study is very encouraging for the application and validity of this type of test mixture.
authors.affiliation: Clinical and Experimental Department of Medicine and Pharmacology. University of Messina, Messina, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Dattilo
authors.forename: Salvatore
authors.initials: S
authors.lastname: Patanè
authors.forename: Concetta
authors.initials: C
authors.lastname: Zito
authors.forename: Annalisa
authors.initials: A
authors.lastname: Lamari
authors.forename: Domenico
authors.initials: D
authors.lastname: Tulino
authors.forename: Filippo
authors.initials: F
authors.lastname: Marte
authors.forename: Scipione
authors.initials: S
authors.lastname: Carerj