Exercise‐induced dynamic mitral regurgitation is associated with outcomes in patients with ischaemic cardiomyopathy
Abstract Aims Ischaemic mitral regurgitation (MR) is a dynamic condition influenced by global and regional left ventricular remodelling as well as mitral valvular deformation. Exercise testing plays a substantial role in assessing the haemodynamic relevance of MR and is recommended by current guidel...
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Wiley
2025-06-01
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| Series: | ESC Heart Failure |
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| Online Access: | https://doi.org/10.1002/ehf2.15195 |
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| author | Maximilian Spieker Jonas Sidabras Hannah Lagarden Lucas Christian Niklas Günther Stephan Angendohr Alexandru Bejinariu P. Christian Schulze Roman Pfister Can Öztürk Ralf Westenfeld Patrick Horn Amin Polzin Malte Kelm Obaida Rana |
| author_facet | Maximilian Spieker Jonas Sidabras Hannah Lagarden Lucas Christian Niklas Günther Stephan Angendohr Alexandru Bejinariu P. Christian Schulze Roman Pfister Can Öztürk Ralf Westenfeld Patrick Horn Amin Polzin Malte Kelm Obaida Rana |
| author_sort | Maximilian Spieker |
| collection | DOAJ |
| description | Abstract Aims Ischaemic mitral regurgitation (MR) is a dynamic condition influenced by global and regional left ventricular remodelling as well as mitral valvular deformation. Exercise testing plays a substantial role in assessing the haemodynamic relevance of MR and is recommended by current guidelines. We aimed to assess the prevalence, haemodynamic consequences, and prognostic impact of dynamic MR using isometric handgrip exercise. Methods and results Heart failure patients with ischaemic cardiomyopathy and at least mild MR who underwent handgrip echocardiography at the University Hospital Duesseldorf between January 2018 and September 2021 were enrolled. Patients were followed‐up for 1 year to assess a combined endpoint including all‐cause mortality, heart failure hospitalization, mitral valve surgery/interventions, ventricular assist device implantation and heart transplantation. One hundred thirty‐three patients with ischaemic cardiomyopathy were included (age 75 ± 10 years; 21% female; LVEF 35 ± 9%). At rest, 70 patients (53%) presented with mild MR, 54 patients had moderate MR (41%), and 9 patients (7%) showed severe MR. Twenty‐five patients (20%) with non‐severe MR at rest, developed severe MR during handgrip exercise. Patients with dynamic MR had larger left atrial dimensions, increased wall motion score index and larger tenting area at rest. Multivariate analysis identified MR severity during exercise [HR 1.998 (1.367–2.938)] and exercise TAPSE [HR 0.913 (0.853–0.973)] as predictors of the combined endpoint. Conclusions The haemodynamic changes provoked by isometric exercise unmasked dynamic severe MR in a significant number of patients with non‐severe MR at rest. These data may have implications for therapeutic decision‐making in symptomatic patients with non‐severe MR at rest. |
| format | Article |
| id | doaj-art-9011971cb43844f595607fce3a5a6c2e |
| institution | Kabale University |
| issn | 2055-5822 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj-art-9011971cb43844f595607fce3a5a6c2e2025-08-20T03:53:16ZengWileyESC Heart Failure2055-58222025-06-011231883189210.1002/ehf2.15195Exercise‐induced dynamic mitral regurgitation is associated with outcomes in patients with ischaemic cardiomyopathyMaximilian Spieker0Jonas Sidabras1Hannah Lagarden2Lucas Christian3Niklas Günther4Stephan Angendohr5Alexandru Bejinariu6P. Christian Schulze7Roman Pfister8Can Öztürk9Ralf Westenfeld10Patrick Horn11Amin Polzin12Malte Kelm13Obaida Rana14Department of Cardiology, Pulmonology and Vascular Medicine University Hospital Duesseldorf Duesseldorf GermanyDepartment of Cardiology, Pulmonology and Vascular Medicine University Hospital Duesseldorf Duesseldorf GermanyDepartment of Cardiology, Pulmonology and Vascular Medicine University Hospital Duesseldorf Duesseldorf GermanyDepartment of Cardiology, Pulmonology and Vascular Medicine University Hospital Duesseldorf Duesseldorf GermanyDepartment of Cardiology, Pulmonology and Vascular Medicine University Hospital Duesseldorf Duesseldorf GermanyDepartment of Cardiology, Pulmonology and Vascular Medicine University Hospital Duesseldorf Duesseldorf GermanyDepartment of Cardiology, Pulmonology and Vascular Medicine University Hospital Duesseldorf Duesseldorf GermanyDeparmtent of Cardiology, Angiology and Intensive Care Medicine University Hospital Jena Jena GermanyFaculty of Medicine and University Hospital Cologne Clinic III for Internal Medicine, University of Cologne Cologne GermanyDepartment of Internal Medicine II, Heart Center Bonn, Medical Faculty University Hospital Bonn Bonn GermanyDepartment of Cardiology, Pulmonology and Vascular Medicine University Hospital Duesseldorf Duesseldorf GermanyDepartment of Cardiology, Pulmonology and Vascular Medicine University Hospital Duesseldorf Duesseldorf GermanyDepartment of Cardiology, Pulmonology and Vascular Medicine University Hospital Duesseldorf Duesseldorf GermanyDepartment of Cardiology, Pulmonology and Vascular Medicine University Hospital Duesseldorf Duesseldorf GermanyDepartment of Cardiology, Pulmonology and Vascular Medicine University Hospital Duesseldorf Duesseldorf GermanyAbstract Aims Ischaemic mitral regurgitation (MR) is a dynamic condition influenced by global and regional left ventricular remodelling as well as mitral valvular deformation. Exercise testing plays a substantial role in assessing the haemodynamic relevance of MR and is recommended by current guidelines. We aimed to assess the prevalence, haemodynamic consequences, and prognostic impact of dynamic MR using isometric handgrip exercise. Methods and results Heart failure patients with ischaemic cardiomyopathy and at least mild MR who underwent handgrip echocardiography at the University Hospital Duesseldorf between January 2018 and September 2021 were enrolled. Patients were followed‐up for 1 year to assess a combined endpoint including all‐cause mortality, heart failure hospitalization, mitral valve surgery/interventions, ventricular assist device implantation and heart transplantation. One hundred thirty‐three patients with ischaemic cardiomyopathy were included (age 75 ± 10 years; 21% female; LVEF 35 ± 9%). At rest, 70 patients (53%) presented with mild MR, 54 patients had moderate MR (41%), and 9 patients (7%) showed severe MR. Twenty‐five patients (20%) with non‐severe MR at rest, developed severe MR during handgrip exercise. Patients with dynamic MR had larger left atrial dimensions, increased wall motion score index and larger tenting area at rest. Multivariate analysis identified MR severity during exercise [HR 1.998 (1.367–2.938)] and exercise TAPSE [HR 0.913 (0.853–0.973)] as predictors of the combined endpoint. Conclusions The haemodynamic changes provoked by isometric exercise unmasked dynamic severe MR in a significant number of patients with non‐severe MR at rest. These data may have implications for therapeutic decision‐making in symptomatic patients with non‐severe MR at rest.https://doi.org/10.1002/ehf2.15195Exercise echocardiographyHandgrip exerciseIschaemic mitral regurgitation |
| spellingShingle | Maximilian Spieker Jonas Sidabras Hannah Lagarden Lucas Christian Niklas Günther Stephan Angendohr Alexandru Bejinariu P. Christian Schulze Roman Pfister Can Öztürk Ralf Westenfeld Patrick Horn Amin Polzin Malte Kelm Obaida Rana Exercise‐induced dynamic mitral regurgitation is associated with outcomes in patients with ischaemic cardiomyopathy ESC Heart Failure Exercise echocardiography Handgrip exercise Ischaemic mitral regurgitation |
| title | Exercise‐induced dynamic mitral regurgitation is associated with outcomes in patients with ischaemic cardiomyopathy |
| title_full | Exercise‐induced dynamic mitral regurgitation is associated with outcomes in patients with ischaemic cardiomyopathy |
| title_fullStr | Exercise‐induced dynamic mitral regurgitation is associated with outcomes in patients with ischaemic cardiomyopathy |
| title_full_unstemmed | Exercise‐induced dynamic mitral regurgitation is associated with outcomes in patients with ischaemic cardiomyopathy |
| title_short | Exercise‐induced dynamic mitral regurgitation is associated with outcomes in patients with ischaemic cardiomyopathy |
| title_sort | exercise induced dynamic mitral regurgitation is associated with outcomes in patients with ischaemic cardiomyopathy |
| topic | Exercise echocardiography Handgrip exercise Ischaemic mitral regurgitation |
| url | https://doi.org/10.1002/ehf2.15195 |
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