Usefulness of dipyridamole-handgrip echocardiography test for detecting coronary artery disease

Dipyridamole-echocardiography testing has been proposed for the diagnosis of coronary artery disease (CAD). It is a feasible, safe, highly specific and relatively inexpensive diagnostic test. The major limitation of the dose used (0.56 mg/kg within 4 minutes) as a test is a relatively low sensitivity. 1 Several methods have been proposed to overcome this limitation, including combination with dynamic exercise 2 and the use of a higher dosage of dipyridamole. 3 Another attractive means of increasing the sensitivity of this test would be handgrip exercise, which is a weak Stressor when used alone. 4 Although handgrip exercise reportedly only slightly increased the sensitivity of the dipyridamoleechocardiography test 5 in a study that used a 25% maximal grip strength over 4 minutes, according to the protocol previously used for thallium testing, 6 a more strenuous handgrip stress can conceivably apply a greater ischemic challenge to the myocardium by inducing more profound hemodynamic changes. The aim of this study was to assess whether a strong handgrip stress (50% of predetermined maximal grip strength until exhaustion or up to 5 minutes) might increase the sensitivity of dipyridamole-echocardiography testing for CAD detection.