Background: Handgrip (HG) maneuver is an established and easy to perform method to intensify murmurs in mitral valve regurgitation (MR) during auscultation as it increases afterload. Impact of HG maneuver as a diagnostic tool for isometric exercise in the evaluation of MR severity is not known.

Aim: This study evaluated the impact of HG exercise on MR severity as assessed by transthoracic echocardiography (TTE).

Methods: 137 patients (64±13 years) with MR were included. MR was classified as either primary (n=28) or secondary (functional) (n=109) MR. Effective regurgitant orifice area (EROA) and regurgitant volume (RVol) at rest and during HG exercise were measured by TTE.

Results: Baseline EROA and RVol were higher in patients with primary MR (21.9±13.0 mm² and 36±17 ml/beat, respectively) than in those with secondary MR (15.1±6.3 mm² and 25±10 ml/beat, respectively). After HG maneuver EROA increased by 27.4% and RVol by 28.1% in patients with primary MR. Concordantly, EROA increased by 26.5% and RVol by 27.6% in patients with secondary MR.
In primary MR increase of regurgitation severity during HG exercise was higher in patients with higher baseline values of EROA and RVol while in patients with secondary MR increase by HG exercise was independent of baseline regurgitation severity grade (Figure 1).

Conclusion: There was a markedly increase of regurgitation severity by HG exercise in patients with primary and secondary MR. In primary MR increase of regurgitation severity by HG exercise was higher in patients with higher regurgitation severity grades while in patients with secondary MR increase by HG exercise was independent of baseline regurgitation severity grade.