Department of Cardiology, National Hospital Organization Kyoto Medical Center, Japan.
Intern Med. 2022 Jun 15;61(12):1817-1822. doi: 10.2169/internalmedicine.8505-21. Epub 2021 Nov 13.
Objective The severity of mitral regurgitation (MR) dynamically changes during a stress test. Isometric handgrip is a readily-available stress test in daily practice; however, little is known regarding the response to isometric handgrip in MR patients during right heart catheterization. We aimed to evaluate this issue from our case-series study. Methods We retrospectively investigated consecutive MR patients using the isometric handgrip stress test during right heart catheterization at our institution between October 2019 and April 2021. After resting measurements were obtained, sustained maximum-effort hand dynamometer grasping was maintained for about 2-3 minutes. We investigated the differences in right heart catheterization data between at rest and during handgrip, and evaluated the individual response to the isometric handgrip stress test. Results We investigated a total of 15 patients (mean age: 75±6 years, moderate/severe MR: 7/8, primary/secondary MR: 8/7, mean left ventricular ejection fraction: 56±16%, exertional dyspnea: 10). During the handgrip test, the pulmonary capillary wedge pressure (PCWP) significantly increased [9 (8, 13) mmHg at rest to 20 (15, 27) mmHg during handgrip; p<0.001]. PCWP changes varied among individuals (range 2-22 mmHg) and were not correlated with patients' backgrounds including age, the natriuretic peptide levels, left ventricular ejection fraction, left atrial diameter or E/e' (all p>0.05). Patients with PCWP ≥25 mmHg during handgrip had a higher prevalence of exertional dyspnea than those without [6 (100%) vs. 4 (44%); p=0.04]. Conclusion We observed dynamic and varied hemodynamic changes during isometric handgrip in MR patients, suggesting that further research is needed to evaluate the clinical value of this maneuver.
二尖瓣反流（MR）在应激试验期间严重程度会发生动态变化。等长握力是日常实践中一种易于进行的应激试验；然而，对于 MR 患者在右心导管检查期间进行等长握力的反应知之甚少。我们旨在从我们的病例系列研究中评估这个问题。
我们回顾性调查了 2019 年 10 月至 2021 年 4 月期间在我们机构使用等长握力应激试验进行右心导管检查的连续 MR 患者。在获得休息时的测量值后，持续进行最大努力手测力计抓握约 2-3 分钟。我们研究了休息时和握力时右心导管检查数据的差异，并评估了个体对等长握力应激试验的反应。
我们共调查了 15 名患者（平均年龄：75±6 岁，中/重度 MR：7/8，原发性/继发性 MR：8/7，平均左心室射血分数：56±16%，运动性呼吸困难：10）。在握力试验期间，肺毛细血管楔压（PCWP）显著升高[休息时 9（8，13）mmHg 至握力时 20（15，27）mmHg；p<0.001]。个体之间的 PCWP 变化（范围 2-22mmHg）差异很大，与患者的背景无关，包括年龄、利钠肽水平、左心室射血分数、左心房直径或 E/e'（均 p>0.05）。在握力时 PCWP≥25mmHg 的患者比没有的患者更常出现运动性呼吸困难[6（100%）与 4（44%）；p=0.04]。
我们观察到 MR 患者在等长握力期间存在动态和变化的血流动力学变化，这表明需要进一步研究来评估该操作的临床价值。
