A Novel Role of Sympathetic Activity in Regulating Mitral Valve Prolapse

Hu, Xiang; Wang, Hao-Zhe; Li, Jun; An-qin, Chen; Ye, Xiaofeng; Zhao, Qiang

doi:10.1253/circj.cj-13-1222

Cited by 10 publications

(6 citation statements)

References 20 publications

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“…Similar to previous discussions above, if characteristic of parasympathetic innervation, this fits with the current understanding [8]. Additionally, mitral valve prolapse specifically, often a contributory factor in heart failure, is influenced by the same autonomic dysregulation of the heart tied to heart failure, namely sympathetic hyper-innervation with parasympathetic attenuation [33,34].…”

Section: Discussionsupporting

confidence: 86%

Sihler’s stain visualization of myelinated cardiac plexus fiber attenuation in the AV node and the mitral valve as a result of heart failure

Hilton¹,

Jorgensen²,

Gardiner³

et al. 2018

Cardiovasc Disord Med

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A whole organ staining of myelinated cardiac plexus nerve fibers was conducted to visualize the cardiac innervation pathways in relation to heart failure. This visualization could better inform treatment for heart failure and contributory conditions, including arrhythmia, valve disease, and coronary artery disease. Two pathology-free human cadaveric heart specimens and one acute heart failure human cadaveric heart specimen were acquired as opportunity samples. One pathologyfree specimen was sectioned into three transverse slabs prior to staining, while the remaining pathology free specimen and the acute heart failure specimen were stained whole. Sihler's stain rendered the myocardium semi-translucent red-pink to purple, while the myelinated cardiac plexus fibers were stained a deep violet. Definitive nerve density was found in three major locations: along the coronary vessels, at the mitral valve, and in the ascending aorta, including the aortic valve. The Sihler's nonspecific staining of myelin indicates the presence of sympathetic and/or parasympathetic fibers. The pathology-free and diseased specimens were compared to determine what effect heart failure had on innervation patterns. Notable differences were found in the left anterior descending coronary artery, the atrioventricular (AV) node, the left ventricle, the mitral valve, and the pulmonary trunk. The diseased heart showed attenuated nerve staining in both the AV node and mitral valve, supporting the relationship between parasympathetic withdrawal and heart failure.

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Section: Discussionsupporting

confidence: 86%

Sihler’s stain visualization of myelinated cardiac plexus fiber attenuation in the AV node and the mitral valve as a result of heart failure

Hilton¹,

Jorgensen²,

Gardiner³

et al. 2018

Cardiovasc Disord Med

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“…It was previously shown that beta-II blockers improve LV function in MVP and Mitral regurgitation ( 23 ). It was previously shown that adrenergic receptor upregulation exists in mitral valve prolapse, which results in autonomic dysregulation in MVP patients ( 12 , 24 ). The findings of this study were in line with the hypothesis of high sympathetic activity in MVP.…”

Section: Discussionmentioning

confidence: 99%

Effect of Fluoxetine Administration on Clinical and Echocardiographic Findings in Patients with Mitral Valve Prolapse and Generalized Anxiety Disorder: Randomized Clinical Trial

2017

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BackgroundMitral valve prolapse (MVP) is accompanied by mental disorders including anxiety, which has similar presentations as MVP. It is hypothesised that treatment of anxiety might reduce the symptoms of MVP.ObjectiveThe aim of this study was to assess the clinical and echocardiographic effects of fluoxetine administration in patients with MVP and anxiety.MethodsThis randomized clinical trial was conducted on patients with documented MVP and generalised anxiety disorder (GAD) who were referred to Mashhad University of Medical Sciences cardiology clinics, Mashhad, Iran in 2015. Subjects were randomly assigned to intervention group who received propranolol and fluoxetine (both at 10 mg/day) and control group who received 10 mg/day propranolol. Assessments included echocardiography and GAD-7 questionnaire and rating of chest pain, that were performed at baseline and then weekly for 4 weeks. Analysis was performed using the Mann-Whitney U test and Two-way Repeated Measures Analysis of Variance (ANOVA).ResultsSixty patients (25 male/ 35 female) with a mean age of 22.9 ± 2.5 years were studied in two groups of intervention (n = 30) and control (n = 30). GAD score was significantly higher in the intervention group (17.37 ± 1.61) compared with the control group (14.17 ± 0.83) (p<0.001). No significant difference was observed for changes in left atrium diameter, mitral annular diameter, left ventricular diameter or ejection fraction (p>0.05). Pain severity was reduced significantly more in control group (3.27 ± 1.26) compared to intervention group (2.80 ± 0.85) after treatment (p<0.001).ConclusionsThis study revealed that the co-administration of fluoxetine and propranolol may not only have no effective in improving echocardiographic changes of MVP but may also aggravate subjective findings of patients with MVP and GAD.Trial registrationThe trial is registered at the Iranian Clinical Trial Registry (IRCT.ir) with the IRCT identification number IRCT2014102819721N1.FundingThis research has been financially supported by Research Council of Sabzevar University of Medical Sciences.

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“…17,18 All of the above could lead to neuroendocrine-autonomic nervous system dysfunction with high and excessive adrenergic activity or response. 20 Also, recent studies propose that low levels of magnesium may cause some dysautonomia. 21 Acute chest pain in children with connective tissue disorders may be considered a warning sign, and they should be carefully studied to discard severe complications such as myocardial ischemia or aortic or coronary dissection, especially when ischemic-like ECG abnormalities are observed.…”

Section: Discussionmentioning

confidence: 99%

Chest Pain in Children With Suspected Type I Fibrillinopathy: A Case Report

et al. 2015

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Chest pain is the second most common reason for referral to a pediatric cardiologist, because cardiovascular-related disorders are a major concern for children and their families when seeking medical attention. On the rare occasions when pediatric chest pain is a result of severe heart disease, it is usually associated with well-known cardiovascular risk factors such as fibrillinopathies. Type 1 fibrillinopathies are heritable disorders caused by mutations in the fibrillin genes that lead to a broad spectrum of connective tissue phenotypes ranging from Marfan syndrome, at the most severe end, to patients displaying mild marfanoid features, or milder Marfan (MM). We report the case of an adolescent patient with MM and suspected acute coronary syndrome, with chest pain and electrocardiographic changes suggestive of myocardial ischemia. Despite the low risk of coronary or aortic dissection/aneurysm in MM, these possibilities should be tested. Once they are ruled out, mitral valve prolapse should be considered as the main cause of chest pain with ischemic-like changes in the inferior electrocardiogram leads. We emphasize that clinical and echocardiographic follow-up over years is warranted in the pediatric population to ensure that the aortic root does not show progressive dilatation or a tendency to dissect. Finally, genotyping is clinically indicated for early and complete diagnosis in patients with MM as well as de novo Marfan syndrome to take advantage of educational and clinical programs for young carriers of the mutation.

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A Novel Role of Sympathetic Activity in Regulating Mitral Valve Prolapse

Cited by 10 publications

References 20 publications

Sihler’s stain visualization of myelinated cardiac plexus fiber attenuation in the AV node and the mitral valve as a result of heart failure

Sihler’s stain visualization of myelinated cardiac plexus fiber attenuation in the AV node and the mitral valve as a result of heart failure

Effect of Fluoxetine Administration on Clinical and Echocardiographic Findings in Patients with Mitral Valve Prolapse and Generalized Anxiety Disorder: Randomized Clinical Trial

Chest Pain in Children With Suspected Type I Fibrillinopathy: A Case Report

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