A recent study has revealed that in patients with mitral regurgitation or MR, isometric handgrip exercise or IHE appears to alter mitral valve geometry, triggering MR exacerbation regardless of its etiology.
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There were 76 patients participated in the research,
with median age of 71 years where 63% were men, 40 of whom had functional MR
and 36 participants with median age of 68 years, 61% were men had degenerative
MR. All of the participants underwent 3D transesophageal echocardiography or
TEE combined with IHE, during which mitral valve geometry and the 3D vena contracta
area or VCA were measured, as well as at baseline.
Researchers had recorded significant impacts of IHE on
both hemodynamic factors and 3D MV geometry, which differed according to MR
etiology. For example, both functional mitral valve or FMR and degenerative mitral
valve or DMR groups saw significant elevations in systolic and diastolic blood
pressure, as well as in hear rate, following IHE; the diastolic BP changes were
stronger in the DMR group.
Regarding geometry, IHE triggered increases in tenting
height and tenting volume in the FMR group, while decreasing annular height and
tenting volume in DMR participants. Furthermore, IHE significantly exacerbated
3D VCA in both MR groups, but had a significantly stronger impact on FMR
patients.
With the utilization of multivariate analysis, it was
found that tenting height and baseline 3D VCA as significant associates of the
change in 3D VCA during IHE in the FMR group. For DMR patients, only flail
width had such a correlation.
Researchers said that the findings establish
determinants of exercise-induced MR differed between MR etiologies, and
highlight the importance for simultaneous assessment of MR severity and MV
geometry during exercise in heart failure patients with moderate or greater MR.
Source: Am J Cardiol 2021;151:78-85