Handgrip Test for Heart Function Assessment in Adults

Overseen By Rasha Hamzeh, RN

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Calgary

Must not be taking: Inotropes, Pressors

Disqualifiers: Unable to consent, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

100 Participants Needed

Trial Summary

What is the purpose of this trial?

Background There are significant limitations in the current approaches to assessing 2 important areas of cardiovascular physiology - the systemic circulation and left ventricular (LV) performance. The investigators' have repurposed the concepts of "systemic vascular conductance" to assess systemic circulation, and the "head capacity principle" to assess LV performance. The investigators' now seek to test these concepts in human adults, with heart failure and without heart failure, using non-invasive methods. Hypothesis There will be a depressed head-capacity curve and reduced power among patients with heart failure which will indicate compromised left ventricular pump function. Methods The research study will involve a single outpatient visit per subject. The study will take place with the subject supine on a bed/table. The subjects will be instrumented with EKG electrodes and finger blood pressure cuffs. The continuous finger BP device performs a waveform analysis in real-time to determine the non-invasive stroke volume, cardiac output, and blood pressure. The patient will be supine for at least 5 minutes to collect baseline data before being handed a dynamometer device. The subject will then be asked to squeeze the dynamometer with maximum force for a minimum of 2 minutes while only engaging their forearm and remaining relaxed in the rest of their body. The subject will then release the dynamometer and remain supine, in recovery, for a minimum of 5 minutes. Following the handgrip test, the instrumentation will be removed and the patient's participation in the study will be complete. The study duration should be about 20 min.

Will I have to stop taking my current medications?

The trial protocol does not specify whether you need to stop taking your current medications. However, if you are on intravenous medications to support your heart function, you cannot participate in the trial.

What data supports the effectiveness of the handgrip test treatment for heart function assessment in adults?

Research shows that the handgrip test can help evaluate heart function in patients with heart conditions like coronary artery disease and after a heart attack. It is a simple and safe method that can reveal changes in heart performance, making it useful for assessing heart health. ^{1 2 3 4 5}

Is the handgrip test safe for assessing heart function in adults?

The handgrip test is generally considered safe for assessing heart function in adults, as it is a simple and low-cost method that can be used across a wide range of ages. However, in patients with severe heart conditions, the test may cause increased heart stress, so it should be used with caution in these cases. ^{3 4 5 6 7}

How does the handgrip test differ from other treatments for heart function assessment?

The handgrip test is unique because it is a simple, non-invasive stress test that can be used to assess heart function by measuring changes in blood pressure and heart rate during isometric exercise (muscle contraction without movement). Unlike other treatments, it does not involve medication or complex procedures, making it accessible and safe for a wide range of patients. ^{2 3 4 5 6}

Research Team

Satish R Raj, MD MSCI

Principal Investigator

University of Calgary

Eligibility Criteria

This trial is for adults over 18 with heart failure, as well as those without it. Participants must be able to give informed consent and not be on IV medications like inotropes or pressors that help maintain heart function.

Inclusion Criteria

I have heart failure or I do not have heart failure, depending on the study group I am in.

I am 18 years old or older.

Exclusion Criteria

I am on IV medication to support my heart function.

I cannot or do not want to give permission for treatment.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Single Outpatient Visit

Participants undergo non-invasive cardiovascular assessments including EKG and blood pressure monitoring, followed by a handgrip test

20 minutes

1 visit (in-person)

Follow-up

Participants are monitored for safety and effectiveness after the single visit

1 week

Treatment Details

Interventions

• Handgrip Test

Trial Overview The study tests new non-invasive methods to assess systemic circulation and left ventricular performance using a handgrip test. It involves one outpatient visit where subjects perform the grip test while monitored with EKG electrodes and blood pressure cuffs.

Participant Groups

Group I: HFrEF Experimental Treatment 1 Intervention

patients with heart failure with reduced ejection fraction

Group II: HFpEF Experimental Treatment 1 Intervention

heart failure with preserved ejection fraction

Group III: Control Active Control 1 Intervention

healthy (no heart failure) control participants

Who Is Running the Clinical Trial?

University of Calgary

Lead Sponsor

Trials

827

Recruited

902,000+

Findings from Research

In a study of 14 patients recovering from their first heart attack, isometric handgrip exercise revealed differing cardiac responses, indicating potential underlying heart function issues.

While some patients showed normal heart responses during exercise, others exhibited increased peripheral resistance and a smaller rise in cardiac output, suggesting that standard recovery may not fully reflect heart health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Haemodynamic effects of isometric handgrip exercise in patients convalescent from myocardial infarction. Baccelli, G., Valentini, R., Gregorini, L., et al.[2019]

In a study of 20 patients with coronary artery disease, handgrip exercise was used to evaluate left ventricular contractile function, revealing that 8 patients had a normal increase in contractile indices with minimal changes in pressure.

After administering nitroglycerin to 12 patients with abnormal responses, 8 normalized their reaction to handgrip, indicating that this test can help identify patients with greater contractile reserve and improve assessment of heart function.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[An evaluation of ventricular function in coronary artery disease patients using the isometric (handgrip) test (author's transl)]. Specchia, G., De Servi, S., Angoli, L., et al.[2013]

In a case study of a 70-year-old woman with functional mitral regurgitation (MR) and acute heart failure, isometric handgrip stress testing revealed a significant deterioration of MR from moderate to severe, demonstrating the test's utility in evaluating dynamic changes in MR during acute heart failure.

After stabilization and a transcatheter mitral repair, the patient's MR remained moderate, and she did not experience rehospitalization for acute heart failure, indicating that timely intervention can lead to improved outcomes in patients with functional MR.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Differential response to isometric handgrip depending on the heart failure condition in patients with functional mitral regurgitation: a case report. Hamatani, Y., Ide, Y., Watanabe, H., et al.[2023]

In a study of 35 patients with stable angina pectoris, combining isometric handgrip stress testing with longitudinal speckle-tracking strain measurements significantly improved the detection of coronary artery disease (CAD), showing an 80% sensitivity for identifying significant coronary stenosis.

After percutaneous coronary intervention (PCI), the longitudinal strain in stenotic segments improved, indicating that this method can predict the recovery of heart function post-treatment, making it a valuable tool for assessing ischemic heart conditions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of longitudinal speckle tracking strain in conjunction with isometric handgrip stress test for detection of ischemic myocardial segments. Ryo, K., Tanaka, H., Kaneko, A., et al.[2016]

The handgrip exercise test effectively assesses left ventricular responses in patients with ischemic heart disease, showing significant changes in left ventricular contractility and Tl defect scores, particularly in patients with reduced global ejection fraction.

This test is low-cost, safe, and suitable for a wide range of ages, making it a practical tool for evaluating heart function in clinical settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Evaluation of cardiovascular responses to handgrip tests in patients with ischemic heart disease by radionuclide method]. Morishita, T., Kawamura, Y., Muto, T., et al.[2019]

In a study involving normal subjects aged 20 to 63, a standardized maximal isometric handgrip test led to a significant increase in blood pressure and heart rate by about 25%, but did not negatively affect left ventricular (LV) systolic function.

The test improved LV diastolic function, indicating that isometric handgrip can be an effective exercise test to assess cardiac function, potentially enhancing the detection of mild LV dysfunction.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Left ventricular diastolic and systolic function during isometric exercise: an echocardiographic study. Bryhn, M., Castenfors, J.[2019]

In a study of 37 patients with various heart conditions, a simple hand grip test effectively categorized patients based on their left ventricular pressure responses, helping to identify those with normal heart function versus those at higher risk of complications.

Patients in Group 1, with normal left ventricular function, had no deaths during an average follow-up of 33.8 months, while Group 3, with severely impaired function, had a 50% mortality rate over a shorter follow-up of 21.4 months, highlighting the importance of the hand grip test in assessing patient prognosis and management needs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The grip test: a simple method for the assessment of left ventricular performance. Vecht, RJ.[2012]

References

1. Australia pubmed.ncbi.nlm.nih.gov

Haemodynamic effects of isometric handgrip exercise in patients convalescent from myocardial infarction. [2019]

2. Italy pubmed.ncbi.nlm.nih.gov

[An evaluation of ventricular function in coronary artery disease patients using the isometric (handgrip) test (author's transl)]. [2013]

3. England pubmed.ncbi.nlm.nih.gov

Differential response to isometric handgrip depending on the heart failure condition in patients with functional mitral regurgitation: a case report. [2023]

4. United States pubmed.ncbi.nlm.nih.gov

Efficacy of longitudinal speckle tracking strain in conjunction with isometric handgrip stress test for detection of ischemic myocardial segments. [2016]

5. Japan pubmed.ncbi.nlm.nih.gov

[Evaluation of cardiovascular responses to handgrip tests in patients with ischemic heart disease by radionuclide method]. [2019]

6. United States pubmed.ncbi.nlm.nih.gov

Left ventricular diastolic and systolic function during isometric exercise: an echocardiographic study. [2019]

7. Netherlands pubmed.ncbi.nlm.nih.gov

The grip test: a simple method for the assessment of left ventricular performance. [2012]