Left ventricular dynamics during handgrip.

The effect of isometric exercise by handgrip on the ejection dynamics of the left ventricle, especially the relation between left ventricular stroke work index and end-diastolic pressure, was studied in 25 patients. In the patients with normal or nearly normal left hearts (group i), the response to handgrip was characterized by a significant increase of left ventricular stroke work index at an essentially unchanged end-diastolic pressure. In the patients with definitely increased LV end- diastolic pressure at rest (group 3), handgrip led to a significant increase of LV end-diastolic pressure associated with only a small and insignificant increase of stroke work index. This re- sponse is indicative of depressed left ventricular function. Patients with volume or pressure loaded or coronary diseased left hearts with normal or only slightly raised LV end-diastolic pressure at rest (group 2) showed a response similar to that of group i. When comparison of the haemo- dynamic parameters was carried out at similar heart rates, group 2 elicited 'abnormal' left ventricular function characterized by both a significant increase of LV stroke work index and LV end-diastolic pressure. Whether this latter response represents an early sign of left ventricular depression remains open to question.