Diastolic Handgrip Stress Test Using an External Pressure Transducer: on the road for a New Initial Screening Test for Preclinical Coronary Artery Disease?

Abstract

The initial screening of asymptomatic coronary artery disease (CAD) can be done mainly out of hospitals, where sophisticated techniques cannot and should not be applied widely. This great diagnostic problem could be potentially solved by applying widely a diastolic handgrip stress test by placing an external pressure transducer over the left ventricular (LV) impulse transthoracically and recording a pressocardiogram (Presso Test). Pressocardiogram reflects in time, slope and pulse amplitude LV pressure curve at rest and exercise and some diastolic indexes correlate significantly with corresponding standard diastolic measures of LV pressure. During handgrip, above the pressocardiographic A wave shows in CAD a dramatic increase that corresponds the dramatic rise in LV end-diastolic and atrial pressures in presence of induced ischemia. A high prevalence of these typical and exactly definable “ischemic diastolic changes” have been found in patients with or without symptoms who subsequently showed in angiography significant or non-obstructive CAD. Thus, Presso Test could become a useful diagnostic tool for indentifying even asymptomatic patients in daily practice.