We showed previously that the handgrip apexcardiographic test (HAT) is a
useful method for detecting left ventricular (LV) diastolic
abnormalities in patients with coronary artery disease and systemic
hypertension, This study evaluates the use of HAT for assessing the
prevalence and types of exercise-induced diastolic abnormalities in
patients with obstructive (n = 31) and nonobstructive (n = 35)
hypertrophic cardiomyopathy (HC) as well as its potential value for
separating healthy subjects and athletes from patients with HC. We
obtained a HAT in 66 consecutive patients with HC and in 72 controls (52
healthy volunteers and 20 athletes), A positive HAT was defined by the
presence of one of the following: (1) relative A wave to fetal height
(A/H) during or after handgrip >21% (compliance type), (2) total
apexcardiographic relaxation time (TART) >143 ms or the heart rate
corrected TART (TARTI) during handgrip <0.14, (relaxation type), (3)
both types present (mixed type), and (4) diastolic amplitude time index
(DATI = TARTI/[A/D]) during handgrip <0.27. Of the controls, only 1 of
52 healthy subjects and 1 of 20 athletes showed a positive HAT, whereas
of the total HC cohort 63 of 66 patients (95%) herd a positive result.
There was no significant difference in the distribution of these types
between obstructive and nonobstructive HC. Further, no LV diastolic
abnormalities were present in 10 of 35 patients (29%) with
nanobstructive HC at rest and in 3 of 35 patients (9%) during handgrip,
whereas of the patients with obstructive HC only 1 of 31 (3%) had no LV
diastolic abnormalities at rest and none during handgrip. Based on HAT
data, our study demonstrates that in HC (1) LV diastolic abnormalities
are very frequent during handgrip; (2) patients with nonobstructive HC
show significantly fewer LV diastolic abnormalities at rest than those
with obstructive HC; and (3) no significant difference exists between
obstructive and nonobstructive HC in the prevalence of types of
handgrip-induced LV diastolic abnormalities. Consequently, HAT appears
to be of clinical value as an additional tool for separating normal
patients and athletes from patients with HC. (C) 1998 by Excerpta
Medics, Inc
