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Page 8 of 11 Spieker et al. Vessel Plus 2020;4:29 I http://dx.doi.org/10.20517/2574-1209.2020.28

Figure 4. Change in MR severity at rest and NYHA functional class pre-MitraClip implantation, at discharge and at 1-year follow-up in
patients with dynamic severe MR (n = 44) and severe MR at rest (n = 167). MR severity at rest and NYHA functional class improved
following MitraClip independent of the presence of dynamic MR. MR: mitral regurgitation; NYHA: New York Heart Association; PMVR:
percutaneous mitral valve repair

Table 3. Distribution of post-procedural outcome after 12 ± 4 months according to the grade of MR severity and to the
presence of dynamic MR at baseline
All patients Moderate MR Dynamic severe MR Severe MR at rest P-value
n = 221 n = 10 n = 44 n = 167
All-cause mortality, n (%) 37 (17) 4 (40) 4 (9) 29 (17) 0.244
Cardiac death, n (%) 18 (49) 2 (50) 2 (50) 14 (48) 0.532
Non-cardiac death, n (%) 10 (27) 1 (25) 1 (25) 8 (28) 0.689
Unknown, n (%) 9 (24) 1 (25) 1 (25) 7 (24) 0.999
HF-admission, n (%) 71 (32) 5 (50) 11 (25) 55 (33) 0.364
Mortality or HF-admission, n (%) 92 (42) 7 (70) 13 (30) 72 (43) 0.121
P-values represent differences in patients with dynamic severe MR vs. severe MR at rest. HF: heart failure; MR: mitral regurgitation

Eighty-five per cent of patients with dynamic severe MR showed MR grade ≤ 2+, and 85% of patients with
severe MR at rest did as well (P > 0.999) [Figure 4].

DISCUSSION
In the current study, we assessed the therapeutic benefit from PMVR with the MitraClip system in patients
with dynamic severe MR. We demonstrated that the symptomatic benefit following PMVR in patients with
dynamic severe MR, assessed during handgrip exercise, was similar compared to those patients presenting
with severe MR already at rest, irrespective of the etiology of MR (degenerative and functional MR).