G-sync Off, madVR hates Gsync
Smooth motion ON, this takes some GPU power but keeps everything smooth without perfectly tuned refresh rates.
Present Frame for every Vsync On, I have had better luck with this option.
Do you have power set to "Adaptive"? The drivers default to Optimal Powder, which is not good. Also, do you have the newest Nvidia drivers? The older ones had a bug that used a lot of CPU.
A test with D3D11 disabled and with windowed overlay enabled might be useful.
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