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P-Wave Dispersion and Heart Rate Variability in Children with Mitral Valve Prolapse

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Abstract

Previous studies have reported that patients with mitral valve prolapse (MVP) may display autonomic dysfunction. Measurement of heart rate variability (HRV) and P-wave dispersion (PWD) may provide insights into the functional state of the autonomic nervous system. Heart rate variability (HRV) has been used as a noninvasive marker of autonomic activity. However, to the authors’ knowledge, PWD has not been studied in the context of MVP. This study aimed to examine HRV and PWD in patients with MVP and to determine whether differences exist between symptomatic and asymptomatic patients. The study population consisted of 54 healthy children (17 boys and 37 girls) ages 6–18 years and 76 patients with MVP (20 boys and 56 girls) ages 6–18 years. The duration and dispersion of the P-wave were measured by surface 12-lead electrocardiograms (ECGs). Heart rate variability was quantified using both time-domain and frequency-domain analyses of Holter ECGs. The minimum duration of the P-wave was significantly lower in the MVP patients (42.4 ± 10.0 ms) than in the control subjects (54.4 ± 12.8 ms) (p < 0.01), and the PWD was significantly increased in the MVP group (42.7 ± 10.8 ms) compared with the control subjects (31.8 ± 10.9 ms) (p < 0.01). However, no significant differences were found between the symptomatic and asymptomatic patients. In addition, the HRV parameters were not statistically different between the two groups. In conclusion, although HRV parameters were not significantly different between the MVP and control groups, the findings show that PWD was increased for the children with MVP. However, no relationship could be established between PWD and clinical symptoms.

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References

  1. American College of Cardiology/American Heart Association (1998) ACC/AHA guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Valvular Heart Disease). J Am Coll Cardiol 32:1486–1588

    Article  Google Scholar 

  2. Boudoulas H, Reynolds JC, Mazzaferri E, Wooley CF (1980) Metabolic studies in mitral valve prolapse syndrome: a neuroendocrine–cardiovascular process. Circulation 61:1200–1205

    PubMed  CAS  Google Scholar 

  3. Boudoulas H, Reynolds JC, Mazzaferri E, Wooley CF (1983) Mitral valve prolapse syndrome: the effect of adrenergic stimulation. J Am Coll Cardiol 2:638–644

    Article  PubMed  CAS  Google Scholar 

  4. Cheema AN, Ahmed MW, Kadish AH, Goldberger JJ (1995) Effects of autonomic stimulation and blockade on signal-averaged P-wave duration. J Am Coll Cardiol 26:497–502

    Article  PubMed  CAS  Google Scholar 

  5. Davies AO, Mares A, Pool JL, Taylor AA (1987) Mitral valve prolapse with symptoms of beta-adrenergic hypersensitivity: beta 2-adrenergic receptor supercoupling with desensitization on isoproterenol exposure. Am J Med 82:193–201

    Article  PubMed  CAS  Google Scholar 

  6. Devereux RB, Jones EC, Roman MJ, Howard BV, Fabsitz RR, Liu JE, Palmieri V, Welty TK, Lee ET (2001) Prevalence and correlates of mitral valve prolapse in a population-based sample of American Indians: the strong heart study. Am J Med 111:679–685

    Article  PubMed  CAS  Google Scholar 

  7. Digeos-Hasnier S, Copie X, Paziaud O, Abergel E, Guize L, Diebold B, Jeunemaître X, Berrebi A, Piot O, Lavergne T, Le Heuzey JY (2005) Abnormalities of ventricular repolarization in mitral valve prolapse. Ann Noninvasive Electrocardiol 10:297–304

    Article  PubMed  Google Scholar 

  8. Dilaveris PE, Gialafos EJ, Sideris SK, Theopistou AM, Andrikopoulos GK, Kyriakidis M, Gialafos JE, Toutouzas PK (1998) Simple electrocardiographic markers for the prediction of paroxysmal idiopathic atrial fibrillation. Am Heart J 135:733–738

    Article  PubMed  CAS  Google Scholar 

  9. Freed LA, Levy D, Levine RA, Larson MG, Evans JC, Fuller DL, Lehman B, Benjamin EJ (1999) Prevalence and clinical outcome of mitral valve prolapse. N Engl J Med 341:1–7

    Article  PubMed  CAS  Google Scholar 

  10. Frisinghelli A, Turiel M, Milletich A, Crema C, Malliani A (1992) The role of mitral regurgitation in the neurovegetative regulation of mitral valve prolapse. Cardiologia 37:781–783

    PubMed  CAS  Google Scholar 

  11. Gaffney FA, Karlsson ES, Campbell W, Schutte JE, Nixon JV, Willerson JT, Blomqvist CG (1979) Autonomic dysfunction in women with mitral valve prolapse syndrome. Circulation 59:894–901

    PubMed  CAS  Google Scholar 

  12. Gaffney FA, Bastian BC, Lane LB, Taylor WF, Horton J, Schutte JE, Graham RM, Pettinger W, Blomqvist CG (1983) Abnormal cardiovascular regulation in the mitral valve prolapse syndrome. Am J Cardiol 52:316–320

    Article  PubMed  CAS  Google Scholar 

  13. Gunduz H, Arinc H, Kayardi M, Akdemir R, Ozyildirim S, Uyan C (2006) Heart rate turbulence and heart rate variability in patients with mitral valve prolapse. Europace 8:515–520

    Article  PubMed  Google Scholar 

  14. Han L, Ho TF, Yip WC, Chan KY (2000) Heart rate variability of children with mitral valve prolapse. J Electrocardiol 33:219–224

    Article  PubMed  CAS  Google Scholar 

  15. Helmcke F, Nanda NC, Hsiung MC, Soto B, Adey CK, Goyal RG, Gatewood RP Jr (1987) Color Doppler assessment of mitral regurgitation with orthogonal planes. Circulation 75:175–183

    PubMed  CAS  Google Scholar 

  16. Josephson ME, Kastor JA, Morganroth J (1977) Electrocardiographic left atrial enlargement: electrophysiologic, echocardiographic, and hemodynamic correlates. Am J Cardiol 39:967–971

    Article  PubMed  CAS  Google Scholar 

  17. Kochiadakis GE, Parthenakis FI, Zuridakis EG, Rombola AT, Chrysostomakis SI, Vardas PE (1996) Is there increased sympathetic activity in patients with mitral valve prolapse? Pacing Clin Electrophysiol 19:1872–1876

    Article  PubMed  CAS  Google Scholar 

  18. Leier CV, Jewell GM, Magorien RD, Wepsic RA, Schaal SF (1979) Interatrial conduction (activation) times. Am J Cardiol 44:442–446

    Article  PubMed  CAS  Google Scholar 

  19. Levine RA, Stathogiannis E, Newell JB, Harrigan P, Weyman AE (1988) Reconsideration of echocardiographic standards for mitral valve prolapse: lack of association between leaflet displacement isolated to the apical four-chamber view and independent echocardiographic evidence of abnormality. J Am Coll Cardiol 11:1010–1019

    Article  PubMed  CAS  Google Scholar 

  20. Marks AR, Choong CY, Sanfilippo AJ, Ferré M, Weyman AE (1989) Identification of high-risk and low-risk subgroups of patients with mitral valve prolapse. N Engl J Med 320:1031–1036

    Article  PubMed  CAS  Google Scholar 

  21. Michelucci A, Bagliani G, Colella A, Pieragnoli P, Porciani MC, Gensini G, Padeletti L (2002) P-wave assessment: state of the art update. Card Electrophysiol Rev 6:215–220

    Article  PubMed  Google Scholar 

  22. Nishimura RA, McGoon MD, Shub C, Miller FA Jr, Ilstrup DM, Tajik AJ (1985) Echocardiographically documented mitral valve prolapse: long-term follow-up of 237 patients. N Engl J Med 313:1305–1309

    Article  PubMed  CAS  Google Scholar 

  23. Pasternac A, Tubau JF, Puddu PE, Król RB, de Champlain J (1982) Increased plasma catecholamine levels in patients with symptomatic mitral valve prolapse. Am J Med 73:783–789

    Article  PubMed  CAS  Google Scholar 

  24. Rubler S, Shah NN, Moallem A (1976) Comparison of left atrial size and pulmonary capillary pressure with P-wave of electrocardiogram. Am Heart J 92:73–78

    Article  PubMed  CAS  Google Scholar 

  25. Taçoy G, Balcioğlu AS, Arslan U, Durakoğlugil E, Erdem G, Ozdemir M, Cengel A (2007) Effect of metoprolol on heart rate variability in symptomatic patients with mitral valve prolapse. Am J Cardiol 99:1568–1570

    Article  PubMed  Google Scholar 

  26. Terechtchenko L, Doronina SA, Pochinok EM, Riftine A (2003) Autonomic tone in patients with supraventricular arrhythmia associated with mitral valve prolapse in young men. Pacing Clin Electrophysiol 26:444–446

    Article  PubMed  Google Scholar 

  27. Tükek T, Akkaya V, Atilgan D, Demirel E, Ozcan M, Güven O, Korkut F (2001) Effect of left atrial size and function on P-wave dispersion: a study in patients with paroxysmal atrial fibrillation. Clin Cardiol 24:676–680

    Article  PubMed  Google Scholar 

  28. Waggoner AD, Adyanthaya AV, Quinones MA, Alexander JK (1976) Left atrial enlargement. Echocardiographic assessment of electrocardiographic criteria. Circulation 54:553–557

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatric Cardiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey

    Kadir Babaoglu, Gürkan Altun & Köksal Binnetoğlu

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  1. Kadir Babaoglu
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  2. Gürkan Altun
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  3. Köksal Binnetoğlu
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Correspondence to Kadir Babaoglu.

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Babaoglu, K., Altun, G. & Binnetoğlu, K. P-Wave Dispersion and Heart Rate Variability in Children with Mitral Valve Prolapse. Pediatr Cardiol 32, 449–454 (2011). https://doi.org/10.1007/s00246-011-9892-0

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  • DOI: https://doi.org/10.1007/s00246-011-9892-0

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