Kujime Shingo, Sakurada Harumizu, Saito Naoki, Enomoto Yoshinari, Ito Naoshi, Nakamura Keijiro, Fukamizu Seiji, Tejima Tamotsu, Yambe Yuzuru, Nishizaki Mitsuhiro, Noro Mahito, Hiraoka Masayasu, Sugi Kaoru
Department of Cardiology, Yokohama General Hospital, Japan.
Intern Med. 2017;56(2):129-135. doi: 10.2169/internalmedicine.56.7307. Epub 2017 Jan 15.
Objective To evaluate the outcomes of patients with concomitant Brugada syndrome and coronary artery vasospasm. Methods Patients diagnosed with Brugada syndrome with an implantable cardiac defibrillator were retrospectively investigated, and the coexistence of vasospasm was evaluated. The clinical features and outcomes were evaluated, especially in patients with coexistent vasospasm. A provocation test using acetylcholine was performed in patients confirmed to have no organic stenosis on percutaneous coronary angiography to confirm the presence of vasospasm. Implantable cardiac defibrillator shock status was checked every three months. Statistical comparisons of the groups with and without vasospasm were performed. A univariate analysis was also performed, and the odds ratio for the risk of implantable cardiac defibrillator shock was calculated. Patients Thirty-five patients with Brugada syndrome, of whom six had coexistent vasospasm. Results There were no significant differences in the laboratory data, echocardiogram findings, disease, or the history of taking any drugs between patients with and without vasospasm. There were significant differences in the clinical features of Brugada syndrome, i.e. cardiac events such as resuscitation from ventricular fibrillation or appropriate implantable cardiac defibrillator shock. Four patients with vasospasm had cardiac events such as resuscitation from ventricular fibrillation and/or appropriate defibrillator shock; three of them had no cardiac events with calcium channel blocker therapy to prevent vasospasm. The coexistence of vasospasm was a potential risk factor for an appropriate implantable cardiac defibrillator shock (odds ratio: 13.5, confidence interval: 1.572-115.940, p value: 0.035) on a univariate analysis. Conclusion Coronary artery vasospasm could be a risk factor for cardiac events in patients with Brugada syndrome.
目的 评估合并Brugada综合征和冠状动脉痉挛患者的预后。方法 对诊断为Brugada综合征并植入植入式心脏除颤器的患者进行回顾性研究，评估是否存在痉挛并存情况。评估临床特征和预后，尤其是合并痉挛的患者。对经皮冠状动脉造影证实无器质性狭窄的患者进行乙酰胆碱激发试验，以确认是否存在痉挛。每三个月检查一次植入式心脏除颤器的电击状态。对有痉挛和无痉挛的组进行统计学比较。还进行了单因素分析，并计算了植入式心脏除颤器电击风险的比值比。患者 35例Brugada综合征患者，其中6例合并痉挛。结果 有痉挛和无痉挛的患者在实验室数据、超声心动图结果、疾病或服用任何药物的病史方面无显著差异。Brugada综合征的临床特征存在显著差异，即心脏事件，如室颤复苏或适当的植入式心脏除颤器电击。4例有痉挛的患者发生了心脏事件，如室颤复苏和/或适当的除颤器电击；其中3例在接受钙通道阻滞剂治疗以预防痉挛后未发生心脏事件。单因素分析显示，痉挛并存是适当的植入式心脏除颤器电击的潜在危险因素（比值比：13.5，置信区间：1.572 - 115.940，p值：0.035）。结论 冠状动脉痉挛可能是Brugada综合征患者发生心脏事件的危险因素。
