{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T22:58:01Z","timestamp":1788217081976,"version":"build-2803163510"},"reference-count":56,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,1,21]],"date-time":"2023-01-21T00:00:00Z","timestamp":1674259200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Patients with mitral valve prolapse (MVP) have been reported to have exercise intolerance. However, the underlying pathophysiological mechanisms and their physical fitness remain unclear. We aimed to determine the exercise capacity of patients with MVP through the cardiopulmonary exercise test (CPET). We retrospectively collected the data of 45 patients with a diagnosis of MVP. Their CPET and echocardiogram results were compared with 76 healthy individuals as primary outcomes. No significant differences regarding the patient\u2019s baseline characteristics and echocardiographic data were found between the two groups, except for the lower body mass index (BMI) of the MVP group. Patients in the MVP group demonstrated a similar peak metabolic equivalent (MET), but a significantly lower peak rate pressure product (PRPP) (p = 0.048). Patients with MVP possessed similar exercise capacity to healthy individuals. The reduced PRPP may indicate compromised coronary perfusion and subtle left ventricular function impairment.<\/jats:p>","DOI":"10.3390\/life13020302","type":"journal-article","created":{"date-parts":[[2023,1,23]],"date-time":"2023-01-23T03:26:41Z","timestamp":1674444401000},"page":"302","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Comparison of the Results of Cardiopulmonary Exercise Testing between Healthy Peers and Pediatric Patients with Different Echocardiographic Severity of Mitral Valve Prolapse"],"prefix":"10.3390","volume":"13","author":[{"given":"Ming-Hsuan","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Road, Kaohsiung 81362, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6951-1712","authenticated-orcid":false,"given":"Sheng-Hui","family":"Tuan","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung 842, Taiwan"},{"name":"Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun-Jeng","family":"Tsai","sequence":"additional","affiliation":[{"name":"Jia Huan Rehabilitation Clinic, Kaohsiung 830, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei-Chun","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine and Cardiology Center, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan"},{"name":"School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ta-Cheng","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shin-Tsu","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Road, Kaohsiung 81362, Taiwan"},{"name":"School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ko-Long","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Road, Kaohsiung 81362, Taiwan"},{"name":"School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan"},{"name":"School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan"},{"name":"Department of Post-Baccalaureate Medicine, National Sun Yat-sen University, Kaohsiung 804, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1161\/CIRCULATIONAHA.118.034075","article-title":"Mitral Valve Prolapse, Ventricular Arrhythmias, and Sudden Death","volume":"140","author":"Basso","year":"2019","journal-title":"Circulation"},{"key":"ref_2","first-page":"511","article-title":"Prevalence of mitral valve prolapse in ethnic groups","volume":"20","author":"Theal","year":"2004","journal-title":"Can. J. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1080\/14779072.2019.1553619","article-title":"Mitral valve prolapse","volume":"17","author":"Althunayyan","year":"2019","journal-title":"Expert Rev. Cardiovasc. Ther."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1016\/0002-8703(83)90704-4","article-title":"Mitral valve prolapse in the general population. 1. Epidemiologic features: The Framingham Study","volume":"106","author":"Savage","year":"1983","journal-title":"Am. Heart J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1161\/CIRCULATIONAHA.118.033488","article-title":"Common Phenotype in Patients With Mitral Valve Prolapse Who Experienced Sudden Cardiac Death","volume":"138","author":"Hourdain","year":"2018","journal-title":"Circulation"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.1016\/S0002-9149(99)80718-8","article-title":"Natural history of mitral valve prolapse","volume":"75","author":"Zuppiroli","year":"1995","journal-title":"Am. J. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/0735-1097(88)90164-7","article-title":"Long-term follow-up of idiopathic mitral valve prolapse in 300 patients: A prospective study","volume":"11","author":"Duren","year":"1988","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1016\/0002-9343(86)90339-6","article-title":"Complications of mitral valve prolapse. Disproportionate occurrence in men and older patients","volume":"81","author":"Devereux","year":"1986","journal-title":"Am. J. Med."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Kukavica, D., Guglielmo, M., Baggiano, A., Muscogiuri, G., Fusini, L., Muratori, M., Tamborini, G., Mantegazza, V., Trancuccio, A., and Arn\u00f2, C. (2021). Arrhythmic Mitral Valve Prolapse: Introducing an Era of Multimodality Imaging-Based Diagnosis and Risk Stratification. Diagnostics, 11.","DOI":"10.3390\/diagnostics11030467"},{"key":"ref_10","unstructured":"Shah, S.N., Gangwani, M.K., and Oliver, T.I. (2021). Mitral Valve Prolapse, StatPearls."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1161\/CIRCULATIONAHA.115.016291","article-title":"Arrhythmic Mitral Valve Prolapse and Sudden Cardiac Death","volume":"132","author":"Basso","year":"2015","journal-title":"Circulation"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"305","DOI":"10.7326\/0003-4819-111-4-305","article-title":"Mitral valve prolapse: Causes, clinical manifestations, and management","volume":"111","author":"Devereux","year":"1989","journal-title":"Ann. Intern. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1056\/NEJM199907013410101","article-title":"Prevalence and clinical outcome of mitral-valve prolapse","volume":"341","author":"Freed","year":"1999","journal-title":"N. Engl. J. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1016\/0735-1097(88)91523-9","article-title":"Postural exercise abnormalities in symptomatic patients with mitral valve prolapse","volume":"11","author":"Bashore","year":"1988","journal-title":"J. Am. Col.l Cardiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"4307","DOI":"10.1016\/j.ijcard.2013.04.187","article-title":"High prevalence of \u2019mitral valve prolapse syndrome\u2019 (MVPS) among older children and adolescents in a contained population","volume":"168","author":"Gokhale","year":"2013","journal-title":"Int. J. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1111\/j.1745-7599.1994.tb00888.x","article-title":"The phenomenon of dysautonomia and mitral valve prolapse","volume":"6","author":"Styres","year":"1994","journal-title":"J. Am. Acad. Nurse Pract."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1016\/0002-9149(91)90620-Z","article-title":"Effects of aerobic exercise training on symptomatic women with mitral valve prolapse","volume":"67","author":"Scordo","year":"1991","journal-title":"Am. J. Cardiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1515\/JPEM.2004.17.9.1211","article-title":"Reversible mitral valve prolapse and mitral regurgitation in children with Graves\u2019 disease","volume":"17","author":"Liu","year":"2004","journal-title":"J. Pediatr. Endocrinol. Metab."},{"key":"ref_19","first-page":"249","article-title":"Mitral valve prolapse syndrome: Neuro-endocrinological aspects","volume":"13","author":"Boudoulas","year":"1988","journal-title":"Herz"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1378\/chest.120.3.816","article-title":"Cardiopulmonary exercise testing in children with heart failure secondary to idiopathic dilated cardiomyopathy","volume":"120","author":"Guimaraes","year":"2001","journal-title":"Chest"},{"key":"ref_21","first-page":"1","article-title":"Establishing a prediction model of maximal oxygen uptake for young adults in Taiwan","volume":"19","author":"Wu","year":"2002","journal-title":"J. Chin. Inst. Ind. Eng."},{"key":"ref_22","first-page":"368","article-title":"Effect of mitral valve repair on cardiopulmonary exercise testing variables in patients with chronic mitral regurgitation","volume":"100","author":"Togna","year":"2013","journal-title":"Arq. Bras. Cardiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1177\/0267659112436631","article-title":"The association of rate pressure product (RPP) and myocardial perfusion imaging (MPI) findings: A preliminary study","volume":"27","author":"Ansari","year":"2012","journal-title":"Perfusion"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1016\/S0002-8703(96)90432-9","article-title":"Relationship between severity of mitral regurgitation and prognosis of mitral valve prolapse: Echocardiographic follow-up study","volume":"132","author":"Kim","year":"1996","journal-title":"Am. Heart J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.echo.2017.01.007","article-title":"Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance","volume":"30","author":"Zoghbi","year":"2017","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1413","DOI":"10.1016\/j.echo.2006.09.001","article-title":"Guidelines and standards for performance of a pediatric echocardiogram: A report from the Task Force of the Pediatric Council of the American Society of Echocardiography","volume":"19","author":"Lai","year":"2006","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"395","DOI":"10.2143\/AC.63.3.1020318","article-title":"Risk of vasovagal syncope and cardiac arrhythmias in children with mitral valve prolapse","volume":"63","author":"Cetinkaya","year":"2008","journal-title":"Acta Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"541781","DOI":"10.4061\/2010\/541781","article-title":"ST-Segment Depression in Hyperventilation Indicates a False Positive Exercise Test in Patients with Mitral Valve Prolapse","volume":"2010","author":"Michaelides","year":"2010","journal-title":"Cardiol. Res. Pract."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1016\/0002-8703(79)90468-X","article-title":"The nature and prevalence of the abnormal exercise electrocardiogram in mitral valve prolapse","volume":"98","author":"Engel","year":"1979","journal-title":"Am. Heart J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1097\/00149831-200410000-00013","article-title":"Non-invasive cardiac electrophysiological indices in soccer players with mitral valve prolapse","volume":"11","author":"Koutlianos","year":"2004","journal-title":"Eur. J. Cardiovasc. Prev. Rehabil."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1017\/S1047951107000108","article-title":"Mitral valvar prolapse is significantly associated with low body mass index in addition to mitral and tricuspid regurgitation","volume":"17","author":"Movahed","year":"2007","journal-title":"Cardiol. Young"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1016\/S0002-8703(99)70151-1","article-title":"Anthropometric and physiologic correlates of mitral valve prolapse in a biethnic cohort of young adults: The CARDIA study","volume":"138","author":"Flack","year":"1999","journal-title":"Am. Heart J."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2719","DOI":"10.1038\/s41598-021-81648-z","article-title":"Prevalence and characteristics of mitral valve prolapse in military young adults in Taiwan of the CHIEF Heart Study","volume":"11","author":"Liu","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"6838921","DOI":"10.1155\/2017\/6838921","article-title":"Identification of Patients Affected by Mitral Valve Prolapse with Severe Regurgitation: A Multivariable Regression Model","volume":"2017","author":"Songia","year":"2017","journal-title":"Oxid. Med. Cell Longev."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"S31","DOI":"10.1016\/j.ahj.2009.07.016","article-title":"The relationship between body mass index and cardiopulmonary exercise testing in chronic systolic heart failure","volume":"158","author":"Horwich","year":"2009","journal-title":"Am. Heart J."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"895A","DOI":"10.1378\/chest.2275004","article-title":"Impact of Body Mass Index on Cardiopulmonary Exercise Test Variables","volume":"148","author":"Mangardich","year":"2015","journal-title":"Chest"},{"key":"ref_37","first-page":"179","article-title":"Influence of body mass on risk prediction during cardiopulmonary exercise testing in patients with chronic heart failure","volume":"17","author":"Ingle","year":"2012","journal-title":"Exp. Clin. Cardiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1136\/thx.37.10.751","article-title":"Relation between severity of mitral valve disease and results of routine lung function tests in non-smokers","volume":"37","author":"Rhodes","year":"1982","journal-title":"Thorax"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1378\/chest.07-0593","article-title":"Differences in cardiopulmonary exercise test results by American Thoracic Society\/European Respiratory Society-Global Initiative for Chronic Obstructive Lung Disease stage categories and gender","volume":"132","author":"Vassaux","year":"2007","journal-title":"Chest"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1730","DOI":"10.1378\/chest.106.6.1730","article-title":"Differing effects of airway obstruction on physical work capacity and ventilation in men and women with COPD","volume":"106","author":"Carter","year":"1994","journal-title":"Chest"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Ostolin, T., Gonze, B.B., Sperandio, E.F., Arantes, R.L., Romiti, M., and Dourado, V.Z. (2022). Mediator Effect of Cardiorespiratory Fitness on the Association between Physical Activity and Lung Function in Adults: Cross-Sectional Results from the Epimov Study. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19159377"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1161\/01.CIR.50.6.1179","article-title":"Hemodynamic predictors of myocardial oxygen consumption during static and dynamic exercise","volume":"50","author":"Nelson","year":"1974","journal-title":"Circulation"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1161\/01.CIR.57.3.549","article-title":"The rate-pressure product as an index of myocardial oxygen consumption during exercise in patients with angina pectoris","volume":"57","author":"Gobel","year":"1978","journal-title":"Circulation"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.jpeds.2018.05.036","article-title":"Analysis of Exercise Capacity of Children with Kawasaki Disease by a Coronary Artery z Score Model (ZSP Version 4) Derived by the Lambda-Mu-Sigma Method","volume":"201","author":"Tuan","year":"2018","journal-title":"J. Pediatr."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"203","DOI":"10.2147\/COPD.S285812","article-title":"Eccentric Left Ventricular Hypertrophy and Left and Right Cardiac Function in Chronic Heart Failure with or without Coexisting COPD: Impact on Exercise Performance","volume":"16","author":"Roscani","year":"2021","journal-title":"Int. J. Chronic Obstr. Pulm. Dis."},{"key":"ref_46","first-page":"279","article-title":"Effect of exercise on rate pressure product in premenopausal and postmenopausal women with coronary artery disease","volume":"51","author":"Nagpal","year":"2007","journal-title":"Indian J. Physiol. Pharmacol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1016\/j.ijcard.2017.03.002","article-title":"Hypertension, left ventricular hypertrophy, and sudden cardiac death","volume":"237","author":"Shenasa","year":"2017","journal-title":"Int. J. Cardiol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"478","DOI":"10.20452\/pamw.462","article-title":"Mitral valve regurgitation is a powerful factor of left ventricular hypertrophy","volume":"118","author":"Szymczyk","year":"2008","journal-title":"Pol. Arch. Med. Wewn."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.1016\/S0140-6736(09)60692-9","article-title":"Mitral regurgitation","volume":"373","author":"Akins","year":"2009","journal-title":"Lancet"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1136\/heartjnl-2020-318086","article-title":"Ventricular arrhythmias in mitral valve prolapse: New explanations for an old problem","volume":"107","author":"Cipriani","year":"2021","journal-title":"Heart"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1186\/s12968-021-00800-w","article-title":"Mitral valve prolapse morphofunctional features by cardiovascular magnetic resonance: More than just a valvular disease","volume":"23","author":"Chokshi","year":"2021","journal-title":"J. Cardiovasc. Magn. Reson."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1159\/000351094","article-title":"Floppy mitral valve (FMV)\/mitral valve prolapse (MVP) and the FMV\/MVP syndrome: Pathophysiologic mechanisms and pathogenesis of symptoms","volume":"126","author":"Boudoulas","year":"2013","journal-title":"Cardiology"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1161\/01.CIR.54.1.3","article-title":"Mitral valve prolapse","volume":"54","author":"Devereux","year":"1976","journal-title":"Circulation"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1159\/000096952","article-title":"Changes of serum beta-endorphin by programmed exercise training are correlated with improvement of clinical symptoms and quality of life in female mitral valve prolapse syndrome","volume":"108","author":"Hung","year":"2007","journal-title":"Cardiology"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"e018553","DOI":"10.1161\/JAHA.120.018553","article-title":"Optimal Quantification of Functional Mitral Regurgitation: Comparison of Volumetric and Proximal Isovelocity Surface Area Methods to Predict Outcome","volume":"10","author":"Igata","year":"2021","journal-title":"J. Am. Heart Assoc."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1186\/s12968-021-00783-8","article-title":"Quantification of regurgitation in mitral valve prolapse with four-dimensional flow cardiovascular magnetic resonance","volume":"23","author":"Spampinato","year":"2021","journal-title":"J. Cardiovasc. Magn. Reson."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/13\/2\/302\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:12:56Z","timestamp":1760119976000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/13\/2\/302"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,21]]},"references-count":56,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["life13020302"],"URL":"https:\/\/doi.org\/10.3390\/life13020302","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,21]]}}}