Dynamic mitral regurgitation unmasked by handgrip exercise is linked with outcomes in (non-) dilated cardiomyopathy
Background: Recent studies suggest that secondary mitral regurgitation (MR) is a dynamic condition influenced by global and regional left ventricular (LV) remodeling as well as by mitral valvular deformation. Exercise testing is crucial in assessing the hemodynamic relevance of MR and is recommended...
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| Format: | Article |
| Language: | English |
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Elsevier
2025-08-01
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| Series: | International Journal of Cardiology: Heart & Vasculature |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352906725001186 |
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| author | Fabian Voß Niklas Guenther Lucas Christian Elric Zweck Jafer Haschemi Christian Schulze Ralf Westenfeld Patrick Horn Malte Kelm Amin Polzin Maximilian Spieker |
| author_facet | Fabian Voß Niklas Guenther Lucas Christian Elric Zweck Jafer Haschemi Christian Schulze Ralf Westenfeld Patrick Horn Malte Kelm Amin Polzin Maximilian Spieker |
| author_sort | Fabian Voß |
| collection | DOAJ |
| description | Background: Recent studies suggest that secondary mitral regurgitation (MR) is a dynamic condition influenced by global and regional left ventricular (LV) remodeling as well as by mitral valvular deformation. Exercise testing is crucial in assessing the hemodynamic relevance of MR and is recommended by current guidelines. However, data are still lacking on the prevalence and prognostic impact of dynamic MR in patients with non-ischemic cardiomyopathy. Aims: We aimed to assess the prevalence, hemodynamic consequences, and prognostic impact of exercise-induced changes in patients with MR and hypokinetic non-dilated and dilated cardiomyopathy. Methods: Patients with hypokinetic non-dilated and dilated cardiomyopathy and at least mild MR who underwent handgrip echocardiography at the University Hospital Duesseldorf between January 2018 and September 2021 were enrolled. Follow-up was performed at one year. Results: Fifty-eight patients were included (median age 73 [65;81] years; 41 % female; mean LVEF 37 ± 10 %). At rest, 28 patients (48 %) presented with mild MR and 30 patients with moderate MR (52 %). Fifteen patients (26 %) with non-severe MR at rest, developed severe MR during handgrip exercise. Patients with dynamic MR had larger left ventricular volumes, increased mitral annular diameter, and more advanced mitral valve tenting during exercise than those without dynamic MR. Patients with dynamic MR were more likely to undergo MV surgery/interventions (Chi2 23.19; log-rank test p < 0.001). Conclusion: The hemodynamic changes provoked by isometric exercise unmasked dynamic MR in a significant number of patients without 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-e82fb90d155e454e87a148cfbf2671af |
| institution | Kabale University |
| issn | 2352-9067 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Cardiology: Heart & Vasculature |
| spelling | doaj-art-e82fb90d155e454e87a148cfbf2671af2025-08-20T03:39:05ZengElsevierInternational Journal of Cardiology: Heart & Vasculature2352-90672025-08-015910171510.1016/j.ijcha.2025.101715Dynamic mitral regurgitation unmasked by handgrip exercise is linked with outcomes in (non-) dilated cardiomyopathyFabian Voß0Niklas Guenther1Lucas Christian2Elric Zweck3Jafer Haschemi4Christian Schulze5Ralf Westenfeld6Patrick Horn7Malte Kelm8Amin Polzin9Maximilian Spieker10Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Medical Faculty, Moorenstraße 5, 40225 Duesseldorf, GermanyDivision of Cardiology, Pulmonology and Vascular Medicine, University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Medical Faculty, Moorenstraße 5, 40225 Duesseldorf, GermanyDivision of Cardiology, Pulmonology and Vascular Medicine, University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Medical Faculty, Moorenstraße 5, 40225 Duesseldorf, GermanyDivision of Cardiology, Pulmonology and Vascular Medicine, University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Medical Faculty, Moorenstraße 5, 40225 Duesseldorf, GermanyDivision of Cardiology, Pulmonology and Vascular Medicine, University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Medical Faculty, Moorenstraße 5, 40225 Duesseldorf, GermanyDivision of Cardiology, Vascular Medicine and Intensive Care Medicine, University Hospital Jena, Medical Faculty, Am Klinikum 1, 07747 Jena, GermanyDivision of Cardiology, Pulmonology and Vascular Medicine, University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Medical Faculty, Moorenstraße 5, 40225 Duesseldorf, GermanyDivision of Cardiology, Pulmonology and Vascular Medicine, University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Medical Faculty, Moorenstraße 5, 40225 Duesseldorf, GermanyDivision of Cardiology, Pulmonology and Vascular Medicine, University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Medical Faculty, Moorenstraße 5, 40225 Duesseldorf, Germany; Cardiovascular Research Institute Duesseldorf, Medical Faculty, Heinrich-Heine University, Moorenstraße 5, 40225 Duesseldorf, GermanyDivision of Cardiology, Pulmonology and Vascular Medicine, University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Medical Faculty, Moorenstraße 5, 40225 Duesseldorf, GermanyDivision of Cardiology, Pulmonology and Vascular Medicine, University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Medical Faculty, Moorenstraße 5, 40225 Duesseldorf, Germany; Corresponding author at: Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University Duesseldorf, Medical Faculty, Moorenstraße 5, 40225 Duesseldorf, Germany.Background: Recent studies suggest that secondary mitral regurgitation (MR) is a dynamic condition influenced by global and regional left ventricular (LV) remodeling as well as by mitral valvular deformation. Exercise testing is crucial in assessing the hemodynamic relevance of MR and is recommended by current guidelines. However, data are still lacking on the prevalence and prognostic impact of dynamic MR in patients with non-ischemic cardiomyopathy. Aims: We aimed to assess the prevalence, hemodynamic consequences, and prognostic impact of exercise-induced changes in patients with MR and hypokinetic non-dilated and dilated cardiomyopathy. Methods: Patients with hypokinetic non-dilated and dilated cardiomyopathy and at least mild MR who underwent handgrip echocardiography at the University Hospital Duesseldorf between January 2018 and September 2021 were enrolled. Follow-up was performed at one year. Results: Fifty-eight patients were included (median age 73 [65;81] years; 41 % female; mean LVEF 37 ± 10 %). At rest, 28 patients (48 %) presented with mild MR and 30 patients with moderate MR (52 %). Fifteen patients (26 %) with non-severe MR at rest, developed severe MR during handgrip exercise. Patients with dynamic MR had larger left ventricular volumes, increased mitral annular diameter, and more advanced mitral valve tenting during exercise than those without dynamic MR. Patients with dynamic MR were more likely to undergo MV surgery/interventions (Chi2 23.19; log-rank test p < 0.001). Conclusion: The hemodynamic changes provoked by isometric exercise unmasked dynamic MR in a significant number of patients without severe MR at rest. These data may have implications for therapeutic decision-making in symptomatic patients with non-severe MR at rest.http://www.sciencedirect.com/science/article/pii/S2352906725001186 |
| spellingShingle | Fabian Voß Niklas Guenther Lucas Christian Elric Zweck Jafer Haschemi Christian Schulze Ralf Westenfeld Patrick Horn Malte Kelm Amin Polzin Maximilian Spieker Dynamic mitral regurgitation unmasked by handgrip exercise is linked with outcomes in (non-) dilated cardiomyopathy International Journal of Cardiology: Heart & Vasculature |
| title | Dynamic mitral regurgitation unmasked by handgrip exercise is linked with outcomes in (non-) dilated cardiomyopathy |
| title_full | Dynamic mitral regurgitation unmasked by handgrip exercise is linked with outcomes in (non-) dilated cardiomyopathy |
| title_fullStr | Dynamic mitral regurgitation unmasked by handgrip exercise is linked with outcomes in (non-) dilated cardiomyopathy |
| title_full_unstemmed | Dynamic mitral regurgitation unmasked by handgrip exercise is linked with outcomes in (non-) dilated cardiomyopathy |
| title_short | Dynamic mitral regurgitation unmasked by handgrip exercise is linked with outcomes in (non-) dilated cardiomyopathy |
| title_sort | dynamic mitral regurgitation unmasked by handgrip exercise is linked with outcomes in non dilated cardiomyopathy |
| url | http://www.sciencedirect.com/science/article/pii/S2352906725001186 |
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