Key result
Exercise-induced dynamic severe MR linked to ~133% greater 1-year adverse event risk versus non-severe MR.
Why the study?
In atrial functional mitral regurgitation, patients often show discrepancies between symptoms and resting echocardiographic findings, prompting evaluation of the prevalence and prognostic impact of exercise-induced changes.
Does isometric handgrip exercise echocardiography identify dynamic changes in MR severity that predict adverse events in patients with atrial functional mitral regurgitation?
Cohort (n=80)
No
Does isometric handgrip exercise echocardiography identify dynamic changes in MR severity that predict adverse events in patients with atrial functional mitral regurgitation?
Isometric handgrip exercise during echocardiography reveals dynamic worsening of atrial functional mitral regurgitation in one-third of patients, which is associated with a higher rate of adverse events at 1 year.
Answers are grounded in this paper and cite their sources.
Exercise echo may refine risk stratification in atrial functional MR; leaves open need for prospective trials before guiding decisions.
AIMS: In atrial functional mitral regurgitation (aFMR), a considerable proportion of patients displays a discrepancy between symptoms and echocardiographic findings at rest. Exercise testing plays a substantial role in assessing the haemodynamic relevance of mitral regurgitation (MR) and is recommended by current guidelines. Here, we aimed to assess the prevalence, extent, and prognostic impact of exercise-induced changes in patients with aFMR. METHODS AND RESULTS: Patients with at least mild MR who underwent handgrip exercise echocardiography at the University Hospital Duesseldorf between January 2019 and September 2021 were enrolled. Patients were followed up for 1 year to assess clinical outcomes. Eighty patients with aFMR were included [median age: 80 (77-83) years; 53.8% female]. The median N-terminal pro-brain natriuretic peptide level was 1756 (1034-3340) ng/L. At rest, half of the patients (53.8%) had mild MR, 20 patients (25.0%) had moderate MR, and 17 patients (21.2%) had severe MR. In approximately every fifth patient (17.5%) with non-severe MR at rest, the MR became severe during exercise. Handgrip exercise led to a reclassification of MR severity in 28 patients (35.0%). At 1-year follow-up, adverse events occurred more often in patients with severe MR at rest (76.5%) and exercise-induced dynamic severe MR (66.7%) than in those with non-severe MR (28.6%; P < 0.001). CONCLUSION: Handgrip exercise during echocardiography revealed exercise-induced changes in aFMR in every third patient. These data may have implications for therapeutic decision-making in symptomatic patients with non-severe aFMR at rest.
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Spieker et al. (2023) conducted a cohort in atrial functional mitral regurgitation (aFMR) (n=80). Exercise-induced dynamic severe MR vs. Non-severe MR was evaluated on Adverse events at 1-year follow-up (p=<0.001). Exercise-induced dynamic severe mitral regurgitation was associated with a higher 1-year rate of adverse events compared to non-severe MR (66.7% vs 28.6%; P<0.001).
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