Abstract
BACKGROUND: Accurate evaluation of dynamic mitral regurgitation (MR) during stress echocardiography is challenging due to atrial fibrillation (AF), time constraints, and poor reproducibility. CASE PRESENTATION: An 85-year-old man with exertional dyspnea had moderate atrial functional MR on transthoracic echocardiography. Quantitative assessment during handgrip stress echocardiography was difficult due to AF. Stress right heart catheterization (RHC) with handgrip revealed increased mean pulmonary capillary wedge pressure and V-wave. The mitral transcatheter edge-to-edge repair markedly reduced MR. Postprocedural stress RHC demonstrated only slight increase in the mean pulmonary capillary wedge pressure and the V-wave. He remained free from heart failure hospitalization. DISCUSSION: AF increases the risk of atrial functional MR, making it common in clinical practice. Stress RHC with handgrip is a simple and reproducible invasive test even with AF. TAKE-HOME MASSAGE: Stress RHC with handgrip provides valuable diagnostic information when noninvasive results are inconclusive, especially in dynamic MR with AF.