Functional mitral regurgitation, a dynamic disease: lobbying for greater adoption of handgrip echocardiography!

This editorial refers to ‘Prevalence and prognostic impact of dynamic atrial functional mitral regurgitation assessed by isometric handgrip exercise’, by M. Spieker et al., https://doi.org/10.1093/ehjci/jead336. Mitral regurgitation (MR) is the most prevalent valvular heart disease and carries a poor prognosis if left untreated.1 Echocardiography is the cornerstone of MR evaluation and should be performed for diagnosis, risk stratification, and treatment guidance.2 Despite the morbidity, mortality, and symptomatic burden of MR, only 15% of patients with MR are referred for mitral valve surgery because of presumed high surgical risk.3 Consequently, mitral valve transcatheter edge-to-edge repair (M-TEER) has emerged as an important alternative for patients unsuitable for surgery. While initially approved for patients with primary MR, current guidelines now consider M-TEER a class IIa recommendation for patients with functional MR (FMR) who meet certain criteria.4 Although successful MR reduction via M-TEER has been shown to impact mortality and heart failure hospitalization rates, controversies regarding M-TEER in FMR still remain. FMR remains an opaque concept, and atrial FMR is hardly found as a clear entity in guidelines.5