PhD Scientific Days 2026

Cardiovascular Medicine and Research 2.

Characterization of Arrhythmic Mitral Valve Prolapse by Echocardiography and Cardiopulmonary Exercise Testing

Name of the presenter

Szabó, Kamilla Zsuzsanna

Institute/workplace of the presenter

Heart and Vascular Centre, Semmelweis University

Authors

Kamilla Zsuzsanna Szabó¹, Dr. Emese Csulak¹, Dr. Edit Tanai¹, Dr. Csilla Czimbalmos¹, Dr. Luca Kata Bátai¹, Dr. Szilvia Herczeg¹, Petra Márton¹, Dr. Tímea Kováts¹, Prof. Dr. Hajnalka Vágó¹, Prof. Dr. Béla Merkely¹, Dr. Andrea Nagy¹, Dr. Nóra Sydó¹
1: Heart and Vascular Centre, Semmelweis University

Text of the abstract

Introduction: Exercise testing is currently not part of the diagnostic process for patients with arrhythmic mitral valve prolapse (AMVP). However, cardiopulmonary exercise testing (CPET) enables not only the detection of exercise-induced arrhythmias but also an objective assessment of exercise capacity.
Aims: The aim of our study was to compare the echocardiographic and CPET parameters of AMVP patients to a healthy, asymptomatic control group and to characterise the structural and functional cardiac markers of the AMVP group.
Method: Patients diagnosed with AMVP via echocardiography underwent CPET testing. Echocardiographic and CPET parameters were compared to a healthy age and sexed matched control group.
Results: A total of 50 AMVP patients (12 males, mean age 40.5±11.7 years) and 50 controls (15 males, mean age 36.8±9.2 years) were included. AMVP patients were physically less active (1.7±2.3 vs 4.4±3.0 hours/week; p<0.001), most of them had symptoms of palpitation while the control did not (64% vs 6%; p<0.001). However, smoking was less common compared to the control group (12% vs 30%, p=0.027). More than half of the AMVP patients took cardiovascular medication, mostly beta blocker while only 2 control patients used such medication (60% vs. 4%; p<0.001). Echocardiography revealed larger cardiac chambers in AMVP patients compared to controls (RV: 34.2±4.4 vs. 30.1±4.1 mm; RA: 47.0±6.3 vs. 42.1±6.7 mm; LA: 50.6±5.1 vs. 43.4±7.4 mm; LVEDD: 52.7±5.5 vs. 44.1±5.9 mm; all p<0.0001), whereas ejection fraction did not differ (62.16±5.57 vs. 61.22±3.48%; p=0.327). Complex ventricular arrhythmias occurred in 31 AMVP patients (60%) during exercise, whereas only premature ventricular contractions (PVCs) were observed in 8 control subjects. The AMVP group demonstrated reduced maximal aerobic capacity (VO₂max: 31.3±7.3 vs. 38.5±5.2 ml/kg/min; p<0.001) and lower O₂-pulse (12.9±3.3 vs. 15.2±4.1 ml; p=0.0027). The AMVP group also had decreased ventilation (83.9±24.7 vs. 104.5±21.7 L/min; p<0.001) and peak heart rates (169.7±19.1 vs. 181.1±11.7 /min; p<0.001).
Conclusion: AMVP patients have bigger cardiac chamber sizes and reduced exercise capacity compared to healthy controls. These results suggest that patients with AMVP have structural cardiac abnormalities which may contribute to the development of their arrhythmias.