1st Department of Medicine, University Medical Centre Mannheim, Germany.
Heart Rhythm. 2010 Dec;7(12):1790-6. doi: 10.1016/j.hrthm.2010.09.004. Epub 2010 Sep 7.
Patients with Brugada syndrome (BrS) and a spontaneous type 1 ECG are considered to be at greater increased risk for sudden cardiac death than are patients with an abnormal ECG only after administration of sodium channel blockers and therefore represent a more severe phenotype. Thus, it can be hypothesized that in the presence of a more severe electrical phenotype, structural and functional changes are more likely expected because electrical changes can play a causal role in producing structural changes.
The purpose of this study was to investigate whether the different ECG manifestations in patients with BrS are associated with structural changes detected by cardiovascular magnetic resonance imaging.
Cardiovascular magnetic resonance imaging was performed on 69 consecutive patients with proven BrS and 30 healthy controls. Twenty-six patients had a spontaneous diagnostic type 1 BrS ECG; the remainder had a type 1 response to ajmaline provocation. Left and right ventricular volumes and dimensions were assessed and compared with respect to ECG pattern.
The right ventricular outflow tract area was significantly enlarged in patients with a spontaneous type 1 ECG compared to patients with a nondiagnostic resting ECG or controls (11 cm(2), 9 cm(2), and 9 cm(2), respectively, P < .05). Patients with a spontaneous type 1 BrS ECG revealed significantly lower left ventricular ejection fraction than did patients with a nondiagnostic resting ECG and controls (56 ± 5 vs 59 ± 5 vs 60 ± 4, respectively, P < .05) and significantly lower right ventricular ejection fraction (54 ± 5 vs 59 ± 5, P = .001) as well as end-systolic volumes compared to controls (34 ± 9 mL/m(2) vs 28 ± 79 mL/m(2), P = .02).
Patients with a spontaneous type 1 BrS ECG reveal significantly functional and morphological alterations in both the left and right ventricles compared to patients with basal nondiagnostic ECG or controls.
与仅心电图异常的患者相比，自发性 1 型心电图的 Brugada 综合征（BrS）患者发生心源性猝死的风险更高，被认为是更严重的表型。因此，可以假设，在更严重的电表型存在的情况下，更可能预期到结构和功能的变化，因为电变化可以在产生结构变化中起因果作用。
本研究旨在探讨 BrS 患者不同的心电图表现是否与心血管磁共振成像检测到的结构变化相关。
对 69 例经证实的 BrS 患者和 30 例健康对照者进行心血管磁共振成像检查。26 例患者存在自发性诊断 1 型 BrS 心电图；其余患者对胺碘酮激发有 1 型反应。评估并比较左、右心室容积和大小与心电图模式的关系。
与无诊断意义的静息心电图或对照组相比，自发性 1 型心电图患者的右心室流出道面积明显增大（分别为 11cm2、9cm2 和 9cm2，P <.05）。自发性 1 型 BrS 心电图患者的左心室射血分数明显低于无诊断意义的静息心电图和对照组（分别为 56 ± 5%、59 ± 5%和 60 ± 4%，P <.05），右心室射血分数（分别为 54 ± 5%、59 ± 5%，P =.001）和收缩末期容积明显低于对照组（分别为 34 ± 9ml/m2、28 ± 79ml/m2，P =.02）。
与基础无诊断意义的心电图或对照组相比，自发性 1 型 BrS 心电图患者的左、右心室均表现出明显的功能和形态改变。
