{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T12:21:21Z","timestamp":1785414081685,"version":"3.56.0"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"vor","delay-in-days":394,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,1,20]],"date-time":"2025-01-20T00:00:00Z","timestamp":1737331200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Forschungskommission of the Medical Faculty of the Heinrich Heine University D\u00fcsseldorf","award":["2021-03"],"award-info":[{"award-number":["2021-03"]}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Ischaemic mitral regurgitation (MR) is a dynamic condition influenced by global and regional left ventricular remodelling as well as mitral valvular deformation. Exercise testing plays a substantial role in assessing the haemodynamic relevance of MR and is recommended by current guidelines. We aimed to assess the prevalence, haemodynamic consequences, and prognostic impact of dynamic MR using isometric handgrip exercise.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Heart failure patients with ischaemic cardiomyopathy and at least mild MR who underwent handgrip echocardiography at the University Hospital Duesseldorf between January 2018 and September 2021 were enrolled. Patients were followed-up for 1 year to assess a combined endpoint including all-cause mortality, heart failure hospitalization, mitral valve surgery\/interventions, ventricular assist device implantation and heart transplantation. One hundred thirty-three patients with ischaemic cardiomyopathy were included (age 75 \u00b1 10 years; 21% female; LVEF 35 \u00b1 9%). At rest, 70 patients (53%) presented with mild MR, 54 patients had moderate MR (41%), and 9 patients (7%) showed severe MR. Twenty-five patients (20%) with non-severe MR at rest, developed severe MR during handgrip exercise. Patients with dynamic MR had larger left atrial dimensions, increased wall motion score index and larger tenting area at rest. Multivariate analysis identified MR severity during exercise [HR 1.998 (1.367\u20132.938)] and exercise TAPSE [HR 0.913 (0.853\u20130.973)] as predictors of the combined endpoint.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The haemodynamic changes provoked by isometric exercise unmasked dynamic severe MR in a significant number of patients with non-severe MR at rest. These data may have implications for therapeutic decision-making in symptomatic patients with non-severe MR at rest.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ehf2.15195","type":"journal-article","created":{"date-parts":[[2025,1,20]],"date-time":"2025-01-20T04:51:24Z","timestamp":1737348684000},"page":"1883-1892","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Exercise-Induced Dynamic Mitral Regurgitation is Associated with Outcomes in Patients with Ischaemic Cardiomyopathy"],"prefix":"10.1093","volume":"12","author":[{"given":"Maximilian","family":"Spieker","sequence":"first","affiliation":[{"name":"Department of Cardiology, Pulmonology and Vascular Medicine, University Hospital Duesseldorf , Duesseldorf ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Sidabras","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Pulmonology and Vascular Medicine, University Hospital Duesseldorf , Duesseldorf ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Lagarden","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Pulmonology and Vascular Medicine, University Hospital Duesseldorf , Duesseldorf ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas","family":"Christian","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Pulmonology and Vascular Medicine, University Hospital Duesseldorf , Duesseldorf ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niklas","family":"G\u00fcnther","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Pulmonology and Vascular Medicine, University Hospital Duesseldorf , Duesseldorf ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Angendohr","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Pulmonology and Vascular Medicine, University Hospital Duesseldorf , Duesseldorf ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandru","family":"Bejinariu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Pulmonology and Vascular Medicine, University Hospital Duesseldorf , Duesseldorf ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P. Christian","family":"Schulze","sequence":"additional","affiliation":[{"name":"Deparmtent of Cardiology, Angiology and Intensive Care Medicine, University Hospital Jena , Jena ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roman","family":"Pfister","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne , Cologne ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Can","family":"\u00d6zt\u00fcrk","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Heart Center Bonn, Medical Faculty, University Hospital Bonn , Bonn ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralf","family":"Westenfeld","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Pulmonology and Vascular Medicine, University Hospital Duesseldorf , Duesseldorf ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Horn","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Pulmonology and Vascular Medicine, University Hospital Duesseldorf , Duesseldorf ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amin","family":"Polzin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Pulmonology and Vascular Medicine, University Hospital Duesseldorf , Duesseldorf ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malte","family":"Kelm","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Pulmonology and Vascular Medicine, University Hospital Duesseldorf , Duesseldorf ,","place":["Germany"]},{"name":"Cardiovascular Research Institute Duesseldorf, Medical Faculty, Heinrich-Heine University , Duesseldorf 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the prognostic value of Doppler echocardiography in patients with left ventricular systolic dysfunction and functional mitral regurgitation at rest","volume":"155","author":"Ennezat","year":"2008","journal-title":"Am Heart J"}],"container-title":["ESC Heart 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