Diagnostic Value of Stress Right Heart Catheterization for Dynamic Mitral Regurgitation in Atrial Fibrillation

Figures

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  Visual Summary. Clinical Utility of Stress Right Heart Catheterization With Handgrip Exercise The upper panel shows the insertion of Swan-Gantz catheter via the right internal jugular vein, with isometric handgrip exercise using the patient's left hand. Stress right heart catheterization with handgrip exercise can provide valuable diagnostic information in cases where noninvasive findings are inconclusive. The left panel shows the elevation of mean PCWP to 28 mm Hg during handgrip stress before MitraClip. The right panel demonstrates a marked reduction in PCWP to 11 mm Hg after MitraClip therapy, indicating substantial hemodynamic improvement and therapeutic efficacy. BP = blood pressure; MR = mitral regurgitation; PCWP = pulmonary capillary wedge pressure.

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  Figure 1. Challenges in the Assessment of MR Due to Atrial Fibrillation (A) A relatively small mitral regurgitation (MR) jet observed during resting transthoracic echocardiography. (B) A markedly larger MR jet observed during resting echocardiographic examination. (C) A small MR jet visualized during stress echocardiography with handgrip exercise, suggesting underestimation of severity. (D) A significantly larger MR jet observed during stress echocardiography with handgrip.

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  Figure 2. Changes in PCWP During Stress Right Heart Catheterization With Handgrip Exercise The left panel shows PCWP measured at rest, and the right panel demonstrates PCWP after isometric handgrip stress, revealing an increase in both mean PCWP and the amplitude of the V-wave. BP = blood pressure; PCWP = pulmonary capillary wedge pressure.

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  Figure 3. TEE Images of MR Before and After MitraClip, and 3D Mitral Valve Imaging Post-MitraClip (A) Transesophageal echocardiography (TEE) image showing severe mitral regurgitation (MR) before MitraClip. (B) Significant reduction in MR observed on TEE after MitraClip. (C) Three-dimensional (3D) mitral valve imaging demonstrating successful implantation of the MitraClip G4 XTW device at the central-medial position of the A2-P2 scallops (surgeon's view).

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  Figure 4. PCWP During Stress Right Heart Catheterization With Handgrip Exercise After MitraClip The left panel shows PCWP measured at rest, and the right panel demonstrates PCWP after isometric handgrip stress, revealing a mild increase in both mean PCWP and the amplitude of the V-wave, despite an elevation in systemic BP. Abbreviations as in Figure 2.