Summary
There are few data avallable about the hemodynamic effects of isometric handgrip in severe congestive heart failure and its role in the evaluation of vasodilatory therapy. Therefore, we studied 20 patients with dilated cardiomyopathy at rest, during isometric handgrip, and during supine bicycle exercise before and after a single 25-mg dose of captopril. During handgrip, heart rate (p<0.001); systemic vascular resistance (p<0.01); systolic, mean, and diastolic pulmonary artery pressure (p<0.01) increased significantly; stroke volume index fell (p<0.05); wheras mean arterial pressure showed only a small increase, and cardiac index did not change. In contrast, mean arterial pressure and cardiac index increased during dynamic exercise (p<0.001), and peripheral resistance decreased (p<001). During both handgrip and bicycle exercise, captopril induced a decrease of arterial pressure (p<0.01 and p<0.001; respectively), peripheral resistance (p<0.001 and p<0.01; respectively), and systolic (p<0.01 and p<0.001, respectively) mean (p<0.001), and diastolic pulmonary artery pressure (p<0.001). Captopril induced and increase in stroke volume indes (p<0.01) and cardiac index (p<0.001 and p<0.01 respectively) during both types of exercise. The increase in heart rate (p<0.001), systolic (p<0.01), mean (p<0.001), and diastolic pulmonary artery pressure (p<0.01), as well as the increase in stroke volume index (p<0.05) and cardiae index (p<0.001) was significantly higher in dynamic exercise. In contrast, systemic vascular resistance was clearly higher in isometric than in dynamic exercise (p<0.001). After captopril, these changes were nearly the same. Isometric exercise induced—in contrast to dynamic exercise—vasoconstriction which was blunted by the application of captopril. From that it is concluded that because of the different changes in systemic vascular resistance, isometric exercise seems preferable to dynamic exercise in the evaluation of vasodilatory drugs in congestive heart failure.
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Hertrich, F.F., Winkelmann, B.R. & Leinberger, H. Isometric exercise for the evaluation of vasodilatory therapy in severe congestive heart failure. Cardiovasc Drug Ther 2, 287–293 (1988). https://doi.org/10.1007/BF00054635
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DOI: https://doi.org/10.1007/BF00054635