Assessment of autonomic dysfunction and anxiety levels in patients with mitral valve prolapse

OBJECTIVES
This study aimed to assess autonomic dysfunction parameters and anxiety levels in patients with mitral valve prolapse (MVP).

STUDY DESIGN
We evaluated 33 patients (mean age 25±5 years) with MVP and 14 healthy subjects (mean age 25±4 years). The patients were divided into two groups according to the presence (anatomical MVP, n=11) or absence (MVP syndrome, n=22) of abnormal leaflet thickening (>5 mm). Spielberger’s Situational Anxiety Scale (SSAS) and Continuous Anxiety Scale (SCAS) were administered to all the subjects, and heart rates (HR) and arterial blood pressures (BP) were measured in the supine and standing positions.

RESULTS
Mid-systolic click and late systolic murmur were significantly more frequent in patients with anatomical MVP, while nonspecific symptoms such as dyspnea, vertigo, and atypical chest pain were more frequent in patients with MVP syndrome (p<0.05). Mitral insufficiency (mild) was significantly more frequent in patients with anatomical MVP (72.7% vs. 22.7%; p<0.009). Patients with MVP syndrome had significantly higher SSAS and SCAS scores (41.0±15.6 and 38.5±15.5) compared to patients with anatomical MVP (15.8±7.5 and 17.0±9.1) and controls (14.9±7.4 and 16.9±8.7, respectively; for both p<0.001). Orthostatic differences in BP and HR were significantly greater in patients with MVP syndrome than those having anatomical MVP (p<0.001 and p=0.032, respectively). Orthostatic HR differences showed a significant correlation with SSAS in both MVP groups (r=0.536, p=0.001) and a significant correlation with SCAS in patients with MVP syndrome (r=0.523, p=0.002). There was an inverse correlation between orthostatic BP differences and anxiety parameters in all MVP patients (r=-0.391, p=0.025 for SSAS, and r=-0.320, p=0.048 for SCAS).

CONCLUSION
Our data suggest that patients with MVP syndrome have increased autonomic dysfunction and anxiety scores compared to patients with anatomical MVP.