The use of isometric hand grasp exercise is a reasonable alternative to atropine to achieve study end point during dobutamine stress echocardiography

Dobutamine stress echocardiography (DSE) is an accurate and effective test for the diagnosis of coronary artery disease if 85% predicted maximal heart rate is achieved. The most commonly used method of achieving target heart rate currently is dobutamine with the addition of atropine, which is not without side effects. This retrospective study was designed to evaluate the use of repetitive hand grasp exercise in achieving a study end point as an alternative to atropine. The charts of 30 consecutive patients who had DSE performed using the hand grasp protocol were reviewed, specifically to asses how often an end point was achieved. The authors found that by using hand grasp exercise during DSE, 80% of patients reached a study end point. This compares favorably with what has been described in prior studies using atropine. The authors thus conclude that hand grasp exercise is a safe and reasonable alternative to atropine in improving the ability to achieve an end point during DSE and therefore should improve its sensitivity.