Mitral Valve Prolapse More Prevalent in Patients With Panic Disorder, Study Finds

Mitral valve prolapse (MVP), which occurs when the valve between the left upper and lower chambers of the heart does not close properly, is significantly more common in patients with panic disorder/agoraphobia, according to a meta-analysis in Psychosomatics (The Journal of Consultation-Liaison Psychiatry). The findings confirm longstanding speculation that the two conditions are linked.

"This highlights the need of a careful cardiac examination in patients with [panic disorder], many of which also suffer from MVP,” wrote Umit Tural, M.D., and Dan V. Iosifescu, M.D., M.Sc., of The Nathan S. Kline Institute for Psychiatric Research at NYU Langone Health.

Also known as “click-murmur syndrome” because it creates a murmur in the heartbeat, MVP is not life threatening in most cases and typically does not require treatment. However, severe cases of MVP can lead to serious complications such as stroke and have been linked to sudden cardiac arrest.

The meta-analysis included 14 studies comprising 1,146 participants. To be included in the analysis, the study must have included patients diagnosed with either panic disorder or agoraphobia (PD/A) and healthy controls and must have reported the prevalence of MVP in the PD/A groups. (PD and agoraphobia were considered together because the two conditions, as described in DSM, often overlap and share common symptoms.)

Based on the analysis, prevalence of MVP was nearly three times higher in patients with panic disorder or agoraphobia compared with healthy controls: 27.2% versus 9.2%, respectively. Patients with PD/A had more than twice the risk of MVP compared with controls. Age did not significantly modify the risk, according to the study.

Beyond the immediate clinical implications, the findings raise a host of questions for further research about biological explanations for the strong association between MVP and panic disorder, whether the association is causal, and how MVP may modify the course of panic disorder or affect response to treatment.

“Clinicians treating patients with [panic disorder] should be aware of the high prevalence of MVP and of its possible consequences,” Tural and Iosifescu concluded. “However, more studies are needed to explore the biologic shared mechanisms between MVP and PD/A.”

For related information, see the Psychiatric News article “Cardioprotective Treatments After Heart Attack Can Help Patients With Schizophrenia Live Longer.”

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