Hamatani Yasuhiro, Ide Yuya, Watanabe Hirotoshi, Akao Masaharu
Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan.
Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan.
Eur Heart J Case Rep. 2022 Dec 27;7(3):ytac489. doi: 10.1093/ehjcr/ytac489. eCollection 2023 Mar.
Functional mitral regurgitation (MR) changes dynamically depending on the loading conditions and can cause acute heart failure (HF). Isometric handgrip is a simple stress test and can be performed during early phase of acute HF for the evaluation of MR.
A 70-year-old woman with a prior myocardial infarction four months before, and with history of recurrent HF admission with functional MR, who received optimal HF medications, was hospitalized for acute HF. On the following day of the admission, isometric handgrip stress echocardiography was performed to evaluate functional MR. During the handgrip, MR deteriorated from moderate to severe and the tricuspid regurgitation pressure gradient increased from 45 to 60 mmHg. After HF stabilization 2 weeks after admission, repeat handgrip stress echocardiography showed that the degree of MR did not significantly change being moderate and the tricuspid regurgitation pressure gradient was only mildly elevated from 25 to 30 mmHg. She underwent transcatheter edge-to-edge mitral repair, and thereafter she has not experienced the rehospitalization for acute HF.
Exercise stress test is recommended for the evaluation of functional MR in HF patients; however, exercise tests are difficult to perform during the early phase of acute HF. In this regard, handgrip test is an option to investigate the exacerbating impact of functional MR during early-phase acute HF. This case indicated that response to isometric handgrip can vary depending on HF condition, highlighting the importance of taking into account the timing of the handgrip procedure in patients with functional MR and HF.
功能性二尖瓣反流（MR）会根据负荷情况动态变化，并可导致急性心力衰竭（HF）。等长握力试验是一种简单的应激试验，可在急性HF的早期进行，用于评估MR。
一名70岁女性，4个月前有过心肌梗死病史，有因功能性MR反复住院治疗HF的病史，接受了最佳的HF药物治疗，因急性HF住院。入院次日，进行等长握力应激超声心动图检查以评估功能性MR。在握力试验期间，MR从中度恶化为重度，三尖瓣反流压力梯度从45 mmHg增加到60 mmHg。入院2周后HF病情稳定后，重复进行握力应激超声心动图检查显示，MR程度无明显变化，仍为中度，三尖瓣反流压力梯度仅从25 mmHg轻度升高至30 mmHg。她接受了经导管二尖瓣缘对缘修复术，此后未因急性HF再次住院。
推荐进行运动应激试验以评估HF患者的功能性MR；然而，在急性HF的早期很难进行运动试验。在这方面，握力试验是研究急性HF早期功能性MR加重影响的一种选择。该病例表明，对等长握力的反应可能因HF病情而异，突出了在功能性MR和HF患者中考虑握力检查时机的重要性。
