Öz
Objective: The aim of this study was to evaluate heart rate variability (HRV) parameters and ventricular repolarization abnormalities in children with mitral valve prolapse (MVP) compared with healthy controls.
Materials and Methods: This retrospective single-center study included 78 children with MVP and 92 healthy controls with similar age and gender distributions. Demographic characteristics, 24-hour Holter-derived HRV parameters, and electrocardiographic measurements were analyzed. HRV indices included SDNN, SDANN, SDANNi, rMSSD, pNN50, total power, VLF, LF, HF, LF/HF ratio, and triangular index. Multiple comparisons were adjusted using the Benjamini–Hochberg false discovery rate (FDR) method. Multivariable linear regression analyses adjusted for age and sex were performed for selected representative variables.
Results: Children with MVP demonstrated significantly lower SDANNi, rMSSD, total power, LF, HF, and triangular index values compared with controls after FDR correction. Maximum QTc values were significantly higher in the MVP group. In multivariable regression analysis, MVP remained independently associated with lower HF and rMSSD values and higher maximum QTc values after adjustment for age and gender. No significant differences were observed for LF/HF ratio, SDNN, SDANN, or pNN50 after FDR correction.
Conclusion: Children with MVP exhibit reduced parasympathetic modulation together with prolonged ventricular repolarization independently of age and gender. These findings suggest that pediatric MVP may be associated with autonomic and electrophysiological alterations.
Kaynakça
- Boudoulas H, Kolibash Jr AJ, Baker P, King BD, Wooley CF. Mitral valve prolapse and the mitral valve prolapse syndrome: a diagnostic classification and pathogenesis of symptoms. American heart journal. 1989;118:796-818. https://doi.org/10.1016/0002-8703(89)90594-2
- Freed LA, Levy D, Levine RA, Larson MG, Evans JC, Fuller DL, et al. Prevalence and clinical outcome of mitral-valve prolapse. New England Journal of Medicine. 1999;341:1-7. https://doi.org/10.1056/NEJM199907013410101
- Franchitto N, Bounes V, Telmon N, Rougé D. Mitral valve prolapse and out-of-hospital sudden death: a case report and literature review. Medicine, Science and the Law. 2010;50:164-7. https://doi.org/10.1258/msl.2010.1000
- Narayanan K, Uy-Evanado A, Teodorescu C, Reinier K, Nichols GA, Gunson K, et al. Mitral valve prolapse and sudden cardiac arrest in the community. Heart Rhythm. 2016;13:498-503.
- Bindal A, Deveci M. Evaluation Of Cardiac Autonomic Dysfunction And The Risk Of Arrhythmia In Children With Mitral Valve Prolapse. Acta Medica Nicomedia. 2023;6:290-6. https://doi.org/10.53446/actamednicomedia.1292677
- Ahmadi M, Ghahremani B, Habibi D, Sadrnia S, Ghandi Y. Effects of mitral valve prolapse on heart rate variability and the autonomic nervous system in children. The Journal of Tehran University Heart Center. 2022;17:140. https://doi.org/10.18502/jthc.v17i3.10847
- Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology.. Circulation. 1996;93:1043-65. https://doi.org/10.1161/01.CIR.93.5.104
- Shaffer F, Ginsberg JP. An Overview of Heart Rate Variability Metrics and Norms. Front Public Health. 2017;5:258. https://doi.org/10.3389/fpubh.2017.00258
- Amekran Y, Damoun N, El Hangouche AJ. A focus on the assessment of the autonomic function using heart rate variability. Global Cardiology Science & Practice. 2025;2025:e202512.
- Shaffer F, McCraty R, Zerr CL. A healthy heart is not a metronome: an integrative review of the heart’s anatomy and heart rate variability. Frontiers in psychology. 2014;5:1040. https://doi.org/10.3389/fpsyg.2014.01040
- Chang C-J, Chen Y-C, Lee C-H, Yang F, Yang T-F. Posture and gender differentially affect heart rate variability of symptomatic mitral valve prolapse and normal adults. Acta Cardiologica Sinica. 2016;32:467.
- Han L, Ho TF, Yip WC, Chan KY. Heart rate variability of children with mitral valve prolapse. Journal of electrocardiology. 2000;33:219-24. https://doi.org/10.1054/jelc.2000.7661
- Beyazal M, Ozgur S, Sayici IU, Celebi SK. Assessment of Heart Rate Variability in Children with Mitral Valve Prolapse. Pediatric Cardiology. 2025;46:648-57. https://doi.org/10.1007/s00246-024-03481-1
- İmamoğlu EY, Eroğlu AG. QT dispersion and ventricular arrhythmias in children with primary mitral valve prolapse. Turkish Archives of Pediatrics/Türk Pediatri Arşivi. 2016;51:135. https://doi.org/10.5152/TurkPediatriArs.2016.4094
- Guven B, Eroglu AG, Babaoglu K, Demir T, Güzeltas A, Oztunc F, et al. QT dispersion and diastolic functions in differential diagnosis of primary mitral valve prolapse and rheumatic mitral valve prolapse. Pediatric cardiology. 2008;29:352-8. https://doi.org/10.1007/s00246-007-9095-x
- Goldenberg I, Moss AJ, Zareba W. QT interval: how to measure it and what is “normal”. Journal of cardiovascular electrophysiology. 2006;17. https://doi.org/10.1111/j.1540-8167.2006.00408.x
- Robison LB, Brady WJ, Robison RA, Charlton N. QT interval prolongation and the risk of malignant ventricular dysrhythmia and/or cardiac arrest: Systematic search and narrative review of risk related to the magnitude of QT interval length. The American Journal of Emergency Medicine. 2021;49:40-7.
- Harteveld LM, Nederend I, Ten Harkel AD, Schutte NM, De Rooij SR, Vrijkotte TG, et al. Maturation of the cardiac autonomic nervous system activity in children and adolescents. Journal of the American Heart Association. 2021;10:e017405. https://doi.org/10.1161/JAHA.120.017405
- Koenig J, Rash JA, Campbell TS, Thayer JF, Kaess M. A meta-analysis on gender differences in resting-state vagal activity in children and adolescents. Front. Physiol. 2017;8:582.
- Huang J-K, Huang S-Y, Lee C-h, Yang I-F, Yang T-F, Wang Y-M. Effect of age on heart rate variability in patients with mitral valve prolapse: an observational study. Journal of Clinical Medicine. 2022;12:165. https://doi.org/10.3390/jcm12010165
- Kochiadakis GE, Parthenakis FI, Zuridakis EG, Rombola AT, Chrysostomakis SI, Vardas PE. Is there increased sympathetic activity in patients with mitral valve prolapse? Pacing and clinical electrophysiology. 1996;19:1872-6. https://doi.org/10.1111/j.1540-8159.1996.tb03243.x
Telif hakkı ve lisans
Telif hakkı © 2026 Yazar(lar). Açık erişimli bu makale, orijinal çalışmaya uygun şekilde atıfta bulunulması koşuluyla, herhangi bir ortamda veya formatta sınırsız kullanım, dağıtım ve çoğaltmaya izin veren Creative Commons Atıf Lisansı (CC BY) altında dağıtılmıştır.