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Mitral valve prolapse and autonomic function in panic disorder
T Hamada1, Y Koshino, T Misawa
1Department of Clinical and Laboratory Medicine, Fukui Medical School, Matsuoka, Japan.
Abstract:
We investigated the significance of mitral valve prolapse (MVP) and autonomic function in 121 patients diagnosed with panic disorder (PD). The incidence of MVP was higher in these patients (32.2%) than in the healthy controls (16.7%), but the difference was not significant. In the group with PD accompanied by depression, the MVP rate was 58.1%, significantly higher than the value of 25.7% observed in the PD patients without depression. The severity of MVP was mild; nearly all of the cases were silent, without cardiac murmur, and there was no problem with the left ventricular function. The coefficient of variation for R-R intervals on electrocardiograms (CV R-R) was smaller in patients with PD than in healthy controls. The CV R-R of PD patients was significantly lower in the group with MVP than in the group without MVP, suggesting a strong association with the parasympathetic nervous system. Since the CV R-R tended to decrease in the presence of depression, involvement of the parasympathetic nervous system was inferred.
Insights
Mitral valve prolapse (MVP) is more common in panic disorder (PD) patients, especially those with depression. Autonomic function, specifically parasympathetic activity, is impaired in PD patients with MVP.
Area of Science:
- Cardiology
- Psychiatry
- Autonomic Neuroscience
Background:
- Panic disorder (PD) is a condition often associated with physical symptoms.
- Autonomic dysfunction has been implicated in the pathophysiology of PD.
- The relationship between mitral valve prolapse (MVP) and PD requires further investigation.
Purpose of the Study:
- To investigate the prevalence of MVP in patients with PD.
- To assess autonomic function, particularly parasympathetic activity, in PD patients.
- To explore the association between MVP, autonomic function, and depression in PD.
Main Methods:
- Electrocardiogram (ECG) analysis, including the coefficient of variation for R-R intervals (CV R-R), was used to assess autonomic function.
- Patients diagnosed with PD were compared to healthy controls.
- Subgroup analysis was performed based on the presence of MVP and depression.
Main Results:
- The incidence of MVP was higher in PD patients (32.2%) than in controls (16.7%), though not statistically significant.
- MVP prevalence was significantly higher (58.1%) in PD patients with comorbid depression compared to those without (25.7%).
- PD patients exhibited lower CV R-R values, indicating reduced parasympathetic activity, which was more pronounced in those with MVP and depression.
Conclusions:
- MVP may be associated with PD, particularly when depression is present.
- Reduced parasympathetic nervous system activity, as indicated by lower CV R-R, is linked to PD and is further associated with MVP and depression.
- These findings suggest a potential role for autonomic dysfunction in the interplay between MVP, PD, and depression.