Stress Echocardiography with Emotional Component in Diagnostics of Ischemic Heart Disease

Stress echocardiography has an important role in clinical practice for the early diagnosis and risk evaluation in patients with coronary artery disease (CAD). Conventional isometric stress echocardiography with hand-held dynamometer is not routinely used in patients with CAD because of a low sensitivity in diagnosis of coronary artery stenosis. In the study there was modified stress test using maximal isometric exercise (maximal isometric dominant hand grip force of expander during 3 minutes) combined with emotional component (the investigator inspired patient to maximal effort during the stress) and assessed its diagnostic value for detection of CAD. Purpose. To compare the diagnostic value of traditional method of isometric stress echocardiography and proposed combined maximal isometric handgrip and emotional stress echocardiography (MIHESE) in the diagnosis of CAD. Materials and methods. 138 men scheduled for stress echocardiography (mean age 54.8 ± 0.8 years) were examined. 108 patients underwent combined MIHESE, while 30 patients of group II had conventional isometric stress echocardiography. The diagnosis of CAD was verified with coronary angiography performed in all patients after stress test. Results. Echocardiography test was performed in all patients and no complications were detected. For detection of CAD conventional isometric stress echocardiography demonstrated sensitivity 62.5% and specificity 64.3% compared to sensitivity 87.5% and specificity 94.4% in the group of combined MIHESE. Conclusion. The proposed combined method of maximal isometric handgrip and emotional stress echocardiography showed a high diagnostic value in detection of ischemia and may be used as a novel approach for detection of CAD in clinical practice.

ишемическая болезнь сердца, эхокардиография, стресс-эхокардиография, изометрическая нагрузка, эмоциональная проба, coronary artery disease, echocardiography, stress echocardiography, isometric exercise, emotional stress test

1. Шальнова С.А., Деев А.Д., Оганов Р.Г. Факторы, влияющие на смертность от сердечно-сосудистых заболеваний в российской популяции. Кардиоваскулярная терапия и профилактика. 2005; 4(1): 4-8.

2. Оганов Р.Г., Шальнова С.А., Калинина А.М. Профилактика сердечно-сосудистых заболеваний: руководство М.: ГЭОТАР-Медиа, 2009. 216 с.

3. Клиническое руководство по ультразвуковой диагностике; Под ред. В.В. Митькова. В 5 томах. Т. 5. М.: Видар, 1998. 360 с.

4. Coronary artery disease: diagnostic and prognostic models for reducing patient risk. J. Cardiovasc. Nurs. 2006. 21(6, Suppl. 1): S2-S16.

5. The European Society of Cardiology (ESC) guidelines for percutaneous coronary interventions (PCI). Herz. 2006; 31 (9): 848 р.

6. Шиллер Н., Осипов М.А. Клиническая эхокардиография. 2-е изд. М.: Практика, 2005. 344 с.

7. Аронов Д.М., Лупанов В.П. Функциональные пробы в кардиологии. М.: МЕДпресс-информ, 2007. 328 с.

8. Кузнецов В.А., Антонов О.С., Анмут Т.П. и др. Сравнительная оценка нагрузочных и эхокардиографических проб в диагностике недостаточности коронарного кровообращения. Терапевтический архив. 1988; 9: 99-102.

9. Корнеев Н.В., Давыдова Т.В., Функциональные нагрузочные пробы в кардиологии. М.: Медика, 2010. 128 с.

10. Galiuto L., Badana L., Fox K. et al. The EAE Textbook of Echocardiography. New York: Oxford University Press Inc., 2011.477р.

11. ACC/AHA Guidelines for Exercise Testing: Executive Summary. A Report of the American College of Cardiology. American Heart Association Task Force on Practice Guidelines. Circulation; 1997; 96: 345-354.

12. Sicari R., Nihoyannopoulos P., Evangelista A. et al. Stress Echocardiography Expert Consensus Statement - Executive Summary: European Association of Echocardiography (EAE) (a registered branch of the ESC). Eur. Heart J. 2009; 30 (3): 278-289.

13. Ramadan R., Sheps D., Esteves F. et al. Myocardial ischemia during mental stress: role of coronary artery disease burden and vasomotion. J. Am. Heart Assoc. 2013; 2(5): e000321.

14. Mitamura H., Ogawa S., Hori S. et al. Two dimensional echocardiographic analysis of wall motion abnormalities during handgrip exercise in patients with coronary artery disease. Am. J. Cardiol. 1981; 48 (4): 711-719.

15. Loimaala A., Groundstroem K., Pasanen M. et al. Comparison of bicycle, heavy isometric, dipyridamole-atropine and dobutamine stress echocardiography for diagnosis of myocardial ischemia. Am. J. Cardiol. 1999; 84 (12): 1396-1400.

16. Peter C.A., Jones R.H. Effects of isometric handgrip and dynamic exercise on left-ventricular function. J. Nucl. Med. 1980; 21 (12): 1131-1138.

17. Strike P.C., Steptoe A. Systematic review of mental stress-induced myocardial ischaemia. Eur. Heart J. 2003; 24: 690-703.

18. Кузнецов В.А., Криночкин Д.В., Пушкарев Г.С. и др. Способ диагностики ИБС методом стресс-эхокардиографии с комбинированной изометрической и психоэмоциональной нагрузкой. Патент на изобретение N 2525510 от 20.06.2014.

19. Медик В.А., Токмачев М.С. Математическая статистика в медицине. М.: Финансы и статистика, 2007. 800 с.

20. Шабалин А.В. Информативность психоэмоциональной нагрузочной пробы “математический счет” и ручной дозированной изометрической нагрузки в диагностике стресс-зависимости у больных эссенциальной артериальной гипертензии. Артериальная гипертензия. 2003; 3: 98-101.

21. Rozanski A., Bairey C.N., Karantz D.S. et al. Mental stress and the induction of silent myocardial ischemia in patients with coronary artery disease. N. Eng. J. Med. 1988; 318: 1005-1011.

22. Jain D., Shaker S.M., Burg W. et al. Effects of mental stress on left-ventricular and peripheral vascular performance in patients with coronary artery disease. J. Am. Call. Cardial. 1998; 31: 1314-1322.

23. Arrighi J.A., Burg M., Cahen I.S., et al. Myocardial blood-flow response during mental stress in patients with coronary artery disease. Lancet. 2000; 356: 310-311.

24. Yelung A.C., Vecshtein V.I., Krants D.S. et al. The effect of Atherosclerosis on the vasomotor response of coronary arteries to mental stress. N. Eng. J. Med. 1991; 325: 1551-1556.