Isometric handgrip exercise during dobutamine-atropine stress echocardiography increases heart rate acceleration and decreases study duration and dobutamine and atropine dosage.

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.

Hypothesis: 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.