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Spieker et al. Vessel Plus 2020;4:29 I http://dx.doi.org/10.20517/2574-1209.2020.28 Page 5 of 11

Table 1. Baseline patient characteristics
All patients Moderate MR Dynamic severe MR Severe MR at rest
n = 221 n = 10 n = 44 n = 167 P-value
Age (years) 75 ± 10 77 ± 8 77 ± 9 75 ± 11 0.696
Gender, female, n (%) 80 (36%) 6 (60%) 21 (48%) 53 (32%) 0.040
Hypertension, n (%) 183 (83%) 9 (90%) 35 (80%) 142 (85%) 0.594
Diabetes, n (%) 57 (26%) 4 (40%) 12 (27%) 41 (25%) 0.541
Previous cardiac history
ICM, n (%) 151 (68%) 9 (90%) 28 (64%) 114 (68%) 0.290
DCM, n (%) 38 (17%) 1 (10%) 11 (25%) 26 (16%) 0.107
Previous CABG, n (%) 73 (33%) 5 (50%) 12 (27%) 56 (34%) 0.403
Previous VS, n (%) 40 (18%) 4 (40%) 5 (11%) 31 (19%) 0.117
Atrial fibrillation, n (%) 121 (55%) 4 (40%) 27 (61%) 90 (54%) 0.430
Logistic EuroSCORE (%) 22 ± 15 17 ± 7 18 ± 12 24 ± 16* 0.037
NYHA functional class 0.425
NYHA II, n (%) 24 (11%) 1 (10%) 6 (14%) 17 (10%)
NYHA III, n (%) 156 (71%) 7 (70%) 33 (75%) 116 (69%)
NYHA IV, n (%) 40 (18%) 2 (20%) 4 (9%) 34 (20%)
Labaratory assessment
Hemoglobin (mg/dL) 12.1 ± 1.9 11.2 ± 2.4 12.4 ± 1.8 12.1 ± 1.9 0.185
2
eGFR (mL/min/1.73 m ) 51 ± 23 50 ± 17 56 ± 17 51 ± 24 0.853
NT-proBNP (pg/mL) 4499 ± 6499 2077 ± 1917 2161 ± 1555 5158 ± 7048* 0.015
P < 0.05 vs. moderate MR; *P < 0.05 vs. dynamic severe MR by post hoc analysis. ICM: ischemic cardiomyopathy; DCM: dilated
cardiomyopathy; CABG: coronary artery bypass graft; eGFR: estimated glomerular filtration rate; MR: mitral regurgitation; NT-proBNP:
N-terminal pro-brain natriuretic peptide; NYHA: New York Heart Association; VS: valve surgery

Table 2. Echocardiographic parameters at rest
All patients Moderate MR Dynamic severe MR Severe MR at rest
n = 221 n = 10 n = 44 n = 167 P-value
DMR (%) 80 (36%) 5 (50%) 18 (41%) 57 (34%) 0.478
FMR (%) 141 (64%) 5 (50%) 26 (59%) 110 (66%) 0.478
LVEDD (mm) 56 ± 11 55 ± 8 55 ± 10 57 ± 10 0.106
2
LA area (cm ) 28 ± 9 26 ± 6 25 ± 7 29 ± 10* 0.024
LVEF (%) 43 ± 13 48 ± 13 46 ± 12 42 ± 13 0.053
RV diameter (mm) 30 ± 7 29 ± 3 29 ± 8 31 ± 7 0.548
TAPSE (mm) 18 ± 4 19 ± 4 19 ± 4 18 ± 4 0.888
VC width (mm) 6.4 ± 1.8 5.3 ± 1.2 5.3 ± 1.0 6.7 ± 1.9* 0.002
PISA radius (mm) 7.4 ± 3.1 5.9 ± 0.5 6.4 ± 1.0 7.8 ± 1.8 * < 0.001
#,
#,
RVol (mL) 43 ± 24 25 ± 5 30 ± 11 48 ± 20 * 0.001
#,
2
EROA (mm ) 28 ± 12 19 ± 7 20 ± 8 30 ± 17 * 0.007
MVPG (mmHg) 2.2 ± 1.0 1.5 ± 0.6 1.9 ± 0.8 2.3 ± 1.1 0.041
Moderate/severe TR, n (%) 76 (34%) 5 (50%) 16 (36%) 55 (31%) 0.515
SPAP (mmHg) 45 ± 14 50 ± 16 42 ± 12 47 ± 15 0.345
# P < 0.05 vs. Moderate MR; *P < 0.05 vs. Dynamic severe MR by post hoc analysis. LVEF: left ventricular ejection fraction; LVEDD:
left ventricular end diastolic diameter; LA: left atrium; DMR: degenerative mitral regurgitation; FMR: functional mitral regurgitation;
MVPG: mitral valve pressure gradient; RV diameter: right ventricular diameter; PISA: proximal iso-velocity surface area; EROA: effective
orifice regurgitant area; RVol: regurgitation volume; TAPSE: tricuspid annular plane systolic excursion; TR: tricuspid regurgitation; SPAP:
systolic pulmonary artery pressure

showed an increase from 8186 ± 2074 to 10735 ± 3043 mmHg*bpm (P < 0.001) during handgrip exercise.
No patient experienced chest pain, ischemic ECG changes or significant arrhythmias during exercise.

Exercise-induced changes of MR severity and SPAP
Handgrip exercise caused an increase in PISA radius, EROA and RVol (all P < 0.01) [Figure 2]. According
to established parameters, 44 patients (81%) with moderate MR at rest showed dynamic severe MR
during handgrip exercise. Stratified by MR etiology, 18 patients (78%) with moderate DMR at rest showed