fig1

Figure 1. Consort diagram. Two hundred twenty-one patients with complete echocardiographic and follow-up data were included in retrospect. In 93 patients, handgrip echocardiography was performed prior to the procedure. Of those 93 patients, 44 patients presented with moderate MR at rest and dynamic severe MR during handgrip. Thirty-nine patients had severe MR already at rest. However, 10 patients showed moderate MR at rest and during exercise, but nevertheless underwent MitraClip implantation because of persistent severe symptoms. In addition, 128 patients with severe MR at rest were included, who did not undergo handgrip echocardiography. MR: mitral regurgitation