QT interval prolongation and increased plasma catecholamine levels in patients with mitral valve prolapse

https://doi.org/10.1016/0002-8703(83)90359-9Get rights and content

Abstract

The heart rate corrected QT interval (QTc) and plasma catecholamine (CA) and norepinephrine (NE) levels were measured in 15 symptomatic patients with idiopathic mitral valve prolapse (MVP) and in 19 control subjects. MVP patients showed longer mean QTc and were divided into two groups: group A normal QTc (> 440 msec) and group B prolonged QTc (< 440 msec). In supine resting conditions CA levels were as follows: group A 0.420 ± 0.035 ng/ml and group B 0.619 ± 0.104 ng/ml (p < 0.05); both were greater than control values (0.348 ± 0.017 ng/ml, p < 0.005). NE levels were as follows: group A 0.350 ± 0.031 ng/ml and group B 0.376 ± 0.052 ng/ml (NS); both were greater than control values (0.242 ± 0.025 ng/ml, (p < 0.05). When a standing position was assumed, CA and NE levels increased significantly in all groups but this was most marked in group B as compared to control levels (CA: 1.039 ± 0.123 ng/ml versus 0.625 ± 0.037 ng/ml; NE: 0.737 ± 0.076 ng/ml versus 0.504 ± 0.031 ng/ml) (p < 0.001 and p < 0.05, respectively). Thus the longest QTc was observed in patients with MVP who had the highest levels of CA and NE, in both supine and standing positions. These data may account, in part, for the occurrence of severe ventricular arrhythmias in some patients with MVP and may offer a rationale for adrenergic blockade in that subset of patients with MVP and markedly prolonged QTc.

References (63)

  • L Taran et al.

    The duration of QT interval in acute rheumatic carditis in children

    Am Heart J

    (1947)
  • AJ Moss et al.

    Sudden death and the idiopathic long QT syndrome (editorial)

    Am J Med

    (1979)
  • RM Doroghazi et al.

    Time-related changes in the QT interval in acute myocardial infarction: Possible relation to local hypocalcemia

    Am J Cardiol

    (1978)
  • PJ Schwartz et al.

    Electrical alternation of the T-wave: Clinical and experimental evidence of its relationship with the sympathetic nervous system and with the long QT syndrome

    Am Heart J

    (1975)
  • JA Abildskov

    Adrenergic effects on the QT interval of the electrocardiogram

    Am Heart J

    (1976)
  • PJ Schwartz et al.

    The long QT syndrome

    Am Heart J

    (1975)
  • RL Combs et al.

    Effects of induced psychological stress on click and rhythm in mitral valve prolapse

    Am Heart J

    (1980)
  • A Pasternac et al.

    The systolic click syndrome: an “ischemic” cardiomyopathy?

    Am J Cardiol

    (1976)
  • M Cleman et al.

    Myocardial blood flow as a determinant factor in the electrical stability of the myocardium

    Am Heart J

    (1980)
  • W Merx et al.

    The role of local disparity in conduction and recovery time on ventricular vulnerability to fibrillation

    Am Heart J

    (1977)
  • TD Schick et al.

    Nonuniform epicardial depolarizations during coronary occlusion in dogs

    J Electrocardiol

    (1980)
  • SS Seides et al.

    The electrophysiology of propranolol in man

    Am Heart J

    (1974)
  • C Wilhelmsson et al.

    Reduction of sudden deaths after myocardial infarction by treatment with alprenolol. Preliminary results

    Lancet

    (1974)
  • AJ Buda et al.

    Coronary artery spasm and mitral valve prolapse

    Am Heart J

    (1978)
  • DR Ricci et al.

    Altered adrenergic activity in coronary artery spasm: insight into mechanism based on study of coronary hemodynamics and the electrocardiogram

    Am J Cardiol

    (1979)
  • SD Shappell et al.

    Sudden death and the familial occurrence of mid-systolic click, late systolic murmur syndrome

    Circulation

    (1973)
  • RW Campbell et al.

    Ventricular arrhythmias in syndrome of balloon deformity of mitral valve. Definition of possible high risk group

    Br Heart J

    (1976)
  • AS Gooch et al.

    Prolapse of both mitral and tricuspid leaflets in systolic murmur-click syndrome

    N Engl J Med

    (1972)
  • AN De Maria et al.

    Arrhythmias in the mitral valve prolapse syndrome. Prevalence, nature, and frequency

    Ann Intern Med

    (1976)
  • A Pasternac et al.

    Les arythmies du syndrome du prolapsus mitral

    Med Hyg

    (1979)
  • S Benkheit et al.

    QT interval in idiopathic prolapsed mitral valve (abstr)

    Am J Cardiol

    (1978)
  • Cited by (54)

    • 2008 Focused Update Incorporated Into the ACC/AHA 2006 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 (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease)

      2008, Journal of the American College of Cardiology
      Citation Excerpt :

      The likely cause is a ventricular tachyarrhythmia, given the finding of increased incidence of complex ventricular ectopy on ambulatory ECG recordings in patients with MVP who had sudden death (512,513). Although infrequent, the highest incidence of sudden death has been reported in the familial form of MVP; some patients have also been noted to have QT prolongation (502,514). 1.

    • Arrhythmias in mitral valve prolapse

      2021, Mitral Valve Disease: Basic Sciences and Current Approaches to Management
    View all citing articles on Scopus

    Supported by the J. L. Lévesque Foundation, the Fonds de Recherche de I'lnstitut de Cardiologie de Montréal (FRICM) (Dr. Pasternac), the Arts Council of Canada (Dr. Puddu), and the Medical Research Council of Canada (Dr. de Champlain).

    View full text