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Spieker et al. Vessel Plus 2020;4:29 Vessel Plus
DOI: 10.20517/2574-1209.2020.28

Original Article Open Access

Percutaneous mitral valve repair with the MitraClip
in patients with handgrip exercise-induced dynamic

mitral regurgitation

Maximilian Spieker , Katharina Hellhammer , Jens Spießhoefer , Tobias Zeus , Patrick Horn , Malte
1
1
1
2
1
Kelm , Ralf Westenfeld 1
1,3
1 Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Heinrich Heine University
Düsseldorf, Düsseldorf 40225, Germany.
2 Institute of Life Sciences, Scuola Superiore Sant’Anna, Pisa 56127, Italy.
3 CARID, Cardiovascular Research Institute Düsseldorf, Düsseldorf 40225, Germany.
Correspondence to: Dr. Ralf Westenfeld, Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital
Düsseldorf, Heinrich Heine University Düsseldorf, Medical Faculty, Moorenstraße 5, Düsseldorf 40225, Germany.
E-mail: ralf.westenfeld@med.uni-duesseldorf.de
How to cite this article: Spieker M, Hellhammer K, Spießhoefer J, Zeus T, Horn P, Kelm M, Westenfeld R. Percutaneous mitral
valve repair with the MitraClip in patients with handgrip exercise-induced dynamic mitral regurgitation. Vessel Plus 2020;4:29.
http://dx.doi.org/10.20517/2574-1209.2020.28

Received: First Decision: Revised: Accepted: Published: x Received: 7 Jul 2020 First Decision: 13 Jul 2020 Revised: 6 Sep 2020 Accepted: 8 Sep 2020 Published: 29 Sep 2020

Science Editor: Copy Editor: Production Editor: Jing Yu Academic Editor: Manel Sabate Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract
Aim: To investigate whether patients with symptomatic heart failure and exercise-induced dynamic severe mitral
regurgitation (MR) benefit from percutaneous mitral valve repair (PMVR).

Methods: We included patients who underwent PMVR with the MitraClip system in an all-comers observational
study. Handgrip echocardiography was performed in patients with a discrepancy between symptoms and
echocardiographic findings at rest, giving rise to the suspicion of an exercise-induced increase in MR severity.
The primary endpoint of the study was a composite of all-cause mortality or admission for heart failure at 1-year
follow-up. The secondary endpoint was the reduction in NYHA functional class.

Results: Two hundred twenty-one patients who underwent MitraClip implantation were included. Ninety-three
patients with moderate to severe MR at rest received handgrip echocardiography prior to PMVR. The remaining
128 patients presented with severe MR at rest, making exercise echocardiography unnecessary. Handgrip exercise
led to an increase in MR severity in 81% of patients with moderate MR at rest, irrespective of the subtype of MR.
Following PMVR, patients with dynamic severe MR experienced comparable clinical improvement as patients

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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