PMID- 33064244
OWN - NLM
STAT- MEDLINE
DCOM- 20210628
LR  - 20210628
IS  - 1875-8312 (Electronic)
IS  - 1569-5794 (Print)
IS  - 1569-5794 (Linking)
VI  - 37
IP  - 3
DP  - 2021 Mar
TI  - Dynamic handgrip exercise for the evaluation of mitral valve regurgitation: an 
      echocardiographic study to identify exertion induced severe mitral regurgitation.
PG  - 891-902
LID - 10.1007/s10554-020-02063-5 [doi]
AB  - Handgrip exercise (HG) has been occasionally used as a stress test in 
      echocardiography. The effect of HG on mitral regurgitation (MR) is not well 
      known. This study aims to evaluate this effect and the possible role of HG in the 
      echocardiographic evaluation of MR. 722 patients with MR were included (18% 
      primary, 82% secondary disease). We calculated effective regurgitant orifice area 
      (EROA) and regurgitant volume (RVOL) at rest and during dynamic HG. Increase in 
      MR was defined as any increase in EROA or RVOL. We analyzed the data to identify 
      possible associations between clinical or echocardiographic parameters and the 
      effect of HG on MR. MR increased during dynamic HG in 390 of 722 patients (54%) 
      (∆EROA = 25%, ∆RVOL = 27%). Increase of regurgitation occurred in 66 of 132 
      patients with primary MR (50%) and in 324 of 580 patients with secondary MR 
      (55%). This increase was associated with larger baseline EROA and RVOL, but it 
      was independent from other clinical or echocardiographic parameters. In secondary 
      MR, dynamic HG led to a reclassification of regurgitation severity from 
      non-severe at rest to severe MR during HG in 104 of 375 patients (28%). There was 
      a significant association between this upgrade in MR classification and higher 
      New York Heart Association (NYHA) class (OR 1.486, 95%-CI 1.138-1.940, 
      p = 0.004). Dynamic HG exercise increases MR in about half of patients 
      independent of the etiology. Dynamic HG may be used to identify symptomatic 
      patients with non-severe secondary MR at rest but severe MR during exercise.
FAU - Alachkar, Mhd Nawar
AU  - Alachkar MN
AUID- ORCID: 0000-0001-5883-2561
AD  - Department of Cardiology, Angiology and Intensive Care, University Hospital RWTH 
      Aachen, Aachen, Germany. nalachkar@ukaachen.de.
FAU - Kirschfink, Annemarie
AU  - Kirschfink A
AD  - Department of Cardiology, Angiology and Intensive Care, University Hospital RWTH 
      Aachen, Aachen, Germany.
FAU - Grebe, Julian
AU  - Grebe J
AD  - Department of Cardiology, Angiology and Intensive Care, University Hospital RWTH 
      Aachen, Aachen, Germany.
FAU - Almalla, Mohammad
AU  - Almalla M
AD  - Department of Cardiology, Angiology and Intensive Care, University Hospital RWTH 
      Aachen, Aachen, Germany.
FAU - Frick, Michael
AU  - Frick M
AD  - Department of Cardiology, Angiology and Intensive Care, University Hospital RWTH 
      Aachen, Aachen, Germany.
FAU - Milzi, Andrea
AU  - Milzi A
AD  - Department of Cardiology, Angiology and Intensive Care, University Hospital RWTH 
      Aachen, Aachen, Germany.
FAU - Moersen, Wiebke
AU  - Moersen W
AD  - Department of Cardiology, Nephrology and Intensive Care, Rhein-Maas Hospital, 
      Wuerselen, Aachen, Germany.
FAU - Becker, Michael
AU  - Becker M
AD  - Department of Cardiology, Nephrology and Intensive Care, Rhein-Maas Hospital, 
      Wuerselen, Aachen, Germany.
FAU - Marx, Nikolaus
AU  - Marx N
AD  - Department of Cardiology, Angiology and Intensive Care, University Hospital RWTH 
      Aachen, Aachen, Germany.
FAU - Altiok, Ertunc
AU  - Altiok E
AD  - Department of Cardiology, Angiology and Intensive Care, University Hospital RWTH 
      Aachen, Aachen, Germany.
LA  - eng
PT  - Journal Article
DEP - 20201016
PL  - United States
TA  - Int J Cardiovasc Imaging
JT  - The international journal of cardiovascular imaging
JID - 100969716
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - *Echocardiography, Stress
MH  - *Exercise Test
MH  - Female
MH  - *Hand Strength
MH  - *Hemodynamics
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve/*diagnostic imaging/physiopathology
MH  - Mitral Valve Insufficiency/*diagnostic imaging/physiopathology
MH  - Predictive Value of Tests
MH  - Severity of Illness Index
PMC - PMC7969558
OTO - NOTNLM
OT  - Echocardiography
OT  - Handgrip
OT  - Mitral valve regurgitation
COIS- The authors declare that they have no conflict of interest.
EDAT- 2020/10/17 06:00
MHDA- 2021/06/29 06:00
PMCR- 2020/10/16
CRDT- 2020/10/16 12:10
PHST- 2020/06/08 00:00 [received]
PHST- 2020/10/05 00:00 [accepted]
PHST- 2020/10/17 06:00 [pubmed]
PHST- 2021/06/29 06:00 [medline]
PHST- 2020/10/16 12:10 [entrez]
PHST- 2020/10/16 00:00 [pmc-release]
AID - 10.1007/s10554-020-02063-5 [pii]
AID - 2063 [pii]
AID - 10.1007/s10554-020-02063-5 [doi]
PST - ppublish
SO  - Int J Cardiovasc Imaging. 2021 Mar;37(3):891-902. doi: 
      10.1007/s10554-020-02063-5. Epub 2020 Oct 16.