二尖瓣脱垂患者自主神经功能障碍和焦虑水平的评估。

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

作者信息

Orhan Ahmet L, Sayar Nurten, Nurkalem Zekeriya, Uslu Nevzat, Erdem Ismail, Erdem Emine C, Erer Hatice B, Soylu Ozer, Emre Ayşe, Sayar Kemal, Eren Mehmet

机构信息

Department of Cardiology, Siyami Ersek Cardiovascular Surgery Center, Istanbul, Turkey.

出版信息

Turk Kardiyol Dern Ars. 2009 Jun;37(4):226-33.

PMID:19717954

Abstract

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.

摘要

目的

本研究旨在评估二尖瓣脱垂（MVP）患者的自主神经功能障碍参数和焦虑水平。

研究设计

我们评估了33例MVP患者（平均年龄25±5岁）和14名健康受试者（平均年龄25±4岁）。根据有无异常瓣叶增厚（>5mm）将患者分为两组，即存在异常瓣叶增厚的解剖性MVP组（n = 11）和不存在异常瓣叶增厚的MVP综合征组（n = 22）。对所有受试者进行斯皮尔伯格状态焦虑量表（SSAS）和持续焦虑量表（SCAS）评估，并测量仰卧位和站立位的心率（HR）和动脉血压（BP）。

结果

解剖性MVP患者中收缩中期喀喇音和收缩晚期杂音明显更常见，而MVP综合征患者中呼吸困难、眩晕和非典型胸痛等非特异性症状更常见（p<0.05）。解剖性MVP患者中二尖瓣关闭不全（轻度）明显更常见（72.7%对22.7%；p<0.009）。与解剖性MVP患者（15.8±7.5和17.0±9.1）及对照组（分别为14.9±7.4和16.9±8.7）相比，MVP综合征患者的SSAS和SCAS评分显著更高（41.0±15.6和38.5±15.5；两者p<0.001）。MVP综合征患者的血压和心率直立位差异明显大于解剖性MVP患者（分别为p<0.001和p = 0.032）。直立位心率差异在两个MVP组中均与SSAS呈显著正相关（r = 0.536，p = 0.001），在MVP综合征患者中与SCAS呈显著正相关（r = 0.523，p = 0.002）。在所有MVP患者中，直立位血压差异与焦虑参数呈负相关（SSAS的r = -0.391，p = 0.025；SCAS的r = -0.320，p = 0.048）。