{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T14:39:34Z","timestamp":1784385574152,"version":"3.55.0"},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2023,12,8]],"date-time":"2023-12-08T00:00:00Z","timestamp":1701993600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Medical Faculty of the Heinrich Heine University D\u00fcsseldorf","award":["2021-03"],"award-info":[{"award-number":["2021-03"]}]},{"name":"Clinician Scientist Track"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,4,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>In atrial functional mitral regurgitation (aFMR), a considerable proportion of patients displays a discrepancy between symptoms and echocardiographic findings at rest. Exercise testing plays a substantial role in assessing the haemodynamic relevance of mitral regurgitation (MR) and is recommended by current guidelines. Here, we aimed to assess the prevalence, extent, and prognostic impact of exercise-induced changes in patients with aFMR.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>Patients with at least mild MR who underwent handgrip exercise echocardiography at the University Hospital Duesseldorf between January 2019 and September 2021 were enrolled. Patients were followed up for 1 year to assess clinical outcomes. Eighty patients with aFMR were included [median age: 80 (77\u201383) years; 53.8% female]. The median N-terminal pro-brain natriuretic peptide level was 1756 (1034\u20133340) ng\/L. At rest, half of the patients (53.8%) had mild MR, 20 patients (25.0%) had moderate MR, and 17 patients (21.2%) had severe MR. In approximately every fifth patient (17.5%) with non-severe MR at rest, the MR became severe during exercise. Handgrip exercise led to a reclassification of MR severity in 28 patients (35.0%). At 1-year follow-up, adverse events occurred more often in patients with severe MR at rest (76.5%) and exercise-induced dynamic severe MR (66.7%) than in those with non-severe MR (28.6%; P &amp;lt; 0.001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Handgrip exercise during echocardiography revealed exercise-induced changes in aFMR in every third patient. These data may have implications for therapeutic decision-making in symptomatic patients with non-severe aFMR at rest.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjci\/jead336","type":"journal-article","created":{"date-parts":[[2023,12,9]],"date-time":"2023-12-09T04:25:22Z","timestamp":1702095922000},"page":"589-598","source":"Crossref","is-referenced-by-count":12,"title":["Prevalence and prognostic impact of dynamic atrial functional mitral regurgitation assessed by isometric handgrip exercise"],"prefix":"10.1093","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3570-8167","authenticated-orcid":false,"given":"Maximilian","family":"Spieker","sequence":"first","affiliation":[{"name":"Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Medical Faculty , Moorenstra\u00dfe 5, 40225 Duesseldorf , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Sidabras","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Medical Faculty , Moorenstra\u00dfe 5, 40225 Duesseldorf , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Lagarden","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Medical Faculty , Moorenstra\u00dfe 5, 40225 Duesseldorf , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas","family":"Christian","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Medical Faculty , Moorenstra\u00dfe 5, 40225 Duesseldorf , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Angendohr","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Medical Faculty , Moorenstra\u00dfe 5, 40225 Duesseldorf , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elric","family":"Zweck","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Medical Faculty , Moorenstra\u00dfe 5, 40225 Duesseldorf , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandru","family":"Bejinariu","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Medical Faculty , Moorenstra\u00dfe 5, 40225 Duesseldorf , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Verena","family":"Veulemanns","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Medical Faculty , Moorenstra\u00dfe 5, 40225 Duesseldorf , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Schulze","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Intensive Care Medicine and Vascular Medicine, University Hospital Jena , Am Klinikum 1, 07747 Jena , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amin","family":"Polzin","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Medical Faculty , Moorenstra\u00dfe 5, 40225 Duesseldorf , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Obaida","family":"Rana","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Medical Faculty , Moorenstra\u00dfe 5, 40225 Duesseldorf , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralf","family":"Westenfeld","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, Medical Faculty , Moorenstra\u00dfe 5, 40225 Duesseldorf , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0060-1052","authenticated-orcid":false,"given":"Malte","family":"Kelm","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Duesseldorf, 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