Cold Pressor Test Combined With Isometric Handgrip During Radionuclide Ventriculography in the Diagnosis of Coronary Disease

To assess the efficacy of cold pressor test combined with isometric handgrip in inducing ischemia detectable by radionuclide ventriculography (RVg), we used both tests to study 10 normal subjects and 20 patients with coronary artery disease (CAD). Mcan left ventricular ejection fraction (EF) decreased during the test in both groups, but the decrease in patients with CAD was more than in normal subjects (9.8±6.1 % vs 0.6±2.7 %, p<0.001). Considering a decrease of more than 4 % in EF an abnormal response, the sensitivity and the specificity of the test were found to be 80% and 100% respectively. Sixteen patients with CAD (80 %) showed new wall motion abnormalities during the test while no new wall motion abnormality was demonstrated in normal subjects. It is concluded that combination of cold stimulation and isometric handgrip test during RVg is a useful noninvasive test for the diagnosis and functional evaluation of CAD and may be used in subjects in whom adequate exercise cannot be accomplished.