Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
J Am Coll Cardiol. 2010 Nov 2;56(19):1576-84. doi: 10.1016/j.jacc.2010.06.033.
The goal of this study was to evaluate the prevalence and the clinical significance of ST-segment elevation during recovery from exercise testing.
During recovery from exercise testing, ST-segment elevation is reported in some patients with Brugada syndrome (BrS).
Treadmill exercise testing was conducted for 93 patients (91 men), 46 ± 14 years of age, with BrS (22 documented ventricular fibrillation, 35 syncope alone, and 36 asymptomatic); and for 102 healthy control subjects (97 men), 46 ± 17 years of age. Patients were routinely followed up. The clinical end point was defined as the occurrence of sudden cardiac death, ventricular fibrillation, or sustained ventricular tachyarrhythmia.
Augmentation of ST-segment elevation ≥0.05 mV in V(1) to V(3) leads compared with baseline was observed at early recovery (1 to 4 min at recovery) in 34 BrS patients (37% [group 1]), but was not observed in the remaining 59 BrS patients (63% [group 2]) or in the 102 control subjects. During 76 ± 38 months of follow-up, ventricular fibrillation occurred more frequently in group 1 (15 of 34, 44%) than in group 2 (10 of 59, 17%; p = 0.004). Multivariate Cox regression analysis showed that in addition to previous episodes of ventricular fibrillation (p = 0.005), augmentation of ST-segment elevation at early recovery was a significant and independent predictor for cardiac events (p = 0.007), especially among patients with history of syncope alone (6 of 12 [50%] in group 1 vs. 3 of 23 [13%] in group 2) and among asymptomatic patients (3 of 15 [20%] in group 1 vs. 0 of 21 [0%] in group 2).
Augmentation of ST-segment elevation during recovery from exercise testing was specific in patients with BrS, and can be a predictor of poor prognosis, especially for patients with syncope alone and for asymptomatic patients.
本研究旨在评估运动试验恢复期出现 ST 段抬高的发生率及其临床意义。
在运动试验恢复期，有报道称一些 Brugada 综合征（BrS）患者出现 ST 段抬高。
对 93 例 BrS 患者（91 名男性，年龄 46±14 岁，其中 22 例有记录的心室颤动、35 例晕厥发作伴孤立性 ST 段抬高、36 例无症状）和 102 例健康对照者（97 名男性，年龄 46±17 岁）进行了踏车运动试验。对所有患者进行了常规随访。临床终点定义为心脏性猝死、心室颤动或持续性室性心动过速/心室颤动。
在 34 例 BrS 患者（37%[组 1]）中，在恢复期早期（恢复后 1-4 分钟）观察到 V1-V3 导联的 ST 段抬高较基线增加≥0.05 mV，但在其余 59 例 BrS 患者（63%[组 2]）或 102 例对照者中未观察到。在 76±38 个月的随访期间，组 1（34 例中的 15 例，44%）中室颤的发生率高于组 2（59 例中的 10 例，17%；p=0.004）。多变量 Cox 回归分析显示，除了先前发生过室颤（p=0.005）外，恢复期早期 ST 段抬高的增加也是心脏事件的一个显著且独立的预测因素（p=0.007），尤其是在有单纯晕厥史的患者中（组 1 中 12 例中的 6 例[50%]与组 2 中 23 例中的 3 例[13%]；在无症状患者中，组 1 中 15 例中的 3 例[20%]与组 2 中 21 例中的 0 例[0%]）。
运动试验恢复期 ST 段抬高的增加在 BrS 患者中具有特异性，可作为预后不良的预测因素，特别是对于单纯晕厥发作和无症状的患者。
