Weissman N J, Shear M K, Kramer-Fox R, Devereux R B
Am J Med. 1987 May;82(5):880-8. doi: 10.1016/0002-9343(87)90148-3.
Both mitral valve prolapse (MVP) and panic attacks have been reported to be associated with autonomic dysfunction, but previous studies have been limited by the lack of clear separation between patients with MVP and those with panic attacks and the use of noncomparable control subjects. Accordingly, heart rate and blood pressure responses to deep breathing, five minutes' quiet standing, and the Valsalva maneuver were studied in age- and cardiac symptom-matched groups of 33 control subjects, 66 patients with MVP, 20 patients with panic attacks, and 17 patients with both MVP and panic attacks. Compared with control subjects, patients with MVP exhibited more syncope (13 of 66, or 20 percent, versus none of 33, or 0 percent; p less than 0.01), more orthostatic hypotension during quiet standing (11 of 66, or 17 percent, versus one of 33, or 3 percent; p less than 0.01), loss of the normal decrease with age in vagally-mediated heart rate variability during deep breathing (r = 0.13, p = NS versus r = -0.44, p = 0.01), and lower 24-hour epinephrine excretion (6.1 +/- 0.7 versus 11.0 +/- 2.7 micrograms; p less than 0.01). In contrast, patients with panic attacks had greater increases than control subjects or patients with MVP without panic attacks in heart rate, mean blood pressure, and the product of heart rate and mean blood pressure during each minute of quiet standing and during the early strain phase of the Valsalva maneuver. These findings indicate that autonomic dysfunction occurs both in patients with MVP and in those with panic attacks in comparison with symptomatic control subjects, but that the patterns of abnormality differ. Patients with MVP exhibit decreased effectiveness of responses to orthostatic stress, reduced epinephrine excretion, and abnormal vagal tone, whereas patients with panic attacks have heightened cardiovascular responses to postural and positive intrathoracic pressure stresses.
二尖瓣脱垂（MVP）和惊恐发作均被报道与自主神经功能障碍有关，但既往研究因未能清晰区分MVP患者与惊恐发作患者，且使用了不可比的对照对象而受到限制。因此，我们对33名对照对象、66名MVP患者、20名惊恐发作患者以及17名同时患有MVP和惊恐发作的患者进行了分组研究，这些分组在年龄和心脏症状方面相互匹配，研究内容为深呼吸、安静站立5分钟以及瓦尔萨尔瓦动作对心率和血压的影响。与对照对象相比，MVP患者出现更多晕厥（66例中有13例，即20%，而33例对照对象中无一例出现，即0%；p<0.01），安静站立时更多出现体位性低血压（66例中有11例，即17%，而33例对照对象中有1例，即3%；p<0.01），深呼吸时随着年龄增长由迷走神经介导的心率变异性正常下降消失（r = 0.13，p无统计学意义，而对照对象r = -0.44，p = 0.01），24小时肾上腺素排泄量更低（6.1±0.7对11.0±2.7微克；p<0.01）。相比之下，惊恐发作患者在安静站立的每分钟以及瓦尔萨尔瓦动作早期用力阶段，心率、平均血压以及心率与平均血压乘积的升高幅度大于对照对象或无惊恐发作的MVP患者。这些发现表明，与有症状的对照对象相比，自主神经功能障碍在MVP患者和惊恐发作患者中均存在，但异常模式不同。MVP患者对体位性应激的反应有效性降低、肾上腺素排泄减少以及迷走神经张力异常，而惊恐发作患者对体位和胸腔内正压应激的心血管反应增强。
