Li Xinye, Sacher Frédéric, Kusano Kengo F, Barajas-Martinez Hector, Liu Nian, Li Yanda, Gao Yonghong, Liu Tong, Shang Hongcai, Antzelevitch Charles, Hu Dan, Xing Yanwei
Guang'anmen Hospital, Chinese Academy of Chinese Medical Sciences, Beijing, China.
College of Acupuncture and Massage, Beijing University of Chinese Medicine, Beijing, China.
Front Physiol. 2019 Jan 31;9:1951. doi: 10.3389/fphys.2018.01951. eCollection 2018.
Risk stratification of patients with Brugada syndrome (BrS) is vital for accurate prognosis and therapeutic decisions. Spontaneous Type 1 ST segment elevation is generally considered to be an independent risk factor for arrhythmic events. Other risk factors include gender, syncope, sudden cardiac arrest (SCA), and positive electrophysiological study (EPS). However, the further risk stratification of spontaneous type 1 combined with the other risk factors remains unclear. The present study pooled data from 4 large trials aiming to systematically evaluate the risk of spontaneous Type-1 ECG when combined with one or more of these other recognized risk factors. We searched for related studies published from November 2, 2002 to February 10, 2018 in PubMed, EMBASE, Cochrane Library, MEDLINE, Chinese National Knowledge Infrastructure (CNKI), and Wanfang Databases. The pooled data were evaluated combining each risk factor with the presence of a spontaneous Type-1 ECG. All analyses were performed using Review Manager, version 5.0.12. Four eligible studies involving 1,338 patients (85% males, mean age: 48.1 ± 18.1 years) were enrolled. Spontaneous Type-1 ECG was associated with higher risk for ventricular tachycardia/fibrillation (VT/VF) than cases with non-Type 1 ECG in males (odds ratio: 95% CI: 1.84-5.17; < 0.0001), but not in females ( = 0.29). Among spontaneous Type-1 cases with syncope or with positive EPS, the difference was not statistically significant ( = 0.06 and 0.07, respectively). Patients with Type-1 ECGs and positive EPS were at higher risk than those with negative EPS (95% CI: 1.10-5.04; = 0.03). Pooled analysis showed an association of Spontaneous Type-1 ECG, Type-1 ECGs combined with male, and Type-1 ECGs combined with positive EPS between increased risk of arrhythmic events. Our results indicate that in BrS patients, a spontaneous Type-1 ECG is an independent risk factor for SCD in males, but not in females. A spontaneous Type-1 BrS is associated with a worse prognosis when combined with positive EPS.
布加综合征（BrS）患者的风险分层对于准确预后和治疗决策至关重要。自发性1型ST段抬高通常被认为是心律失常事件的独立危险因素。其他危险因素包括性别、晕厥、心脏骤停（SCA）和电生理检查（EPS）阳性。然而，自发性1型与其他危险因素相结合的进一步风险分层仍不明确。本研究汇总了4项大型试验的数据，旨在系统评估自发性1型心电图与这些其他公认危险因素中的一种或多种相结合时的风险。我们在PubMed、EMBASE、Cochrane图书馆、MEDLINE、中国知网（CNKI）和万方数据库中搜索了2002年11月2日至2018年2月10日发表的相关研究。将汇总数据与自发性1型心电图的存在情况相结合，对每个危险因素进行评估。所有分析均使用Review Manager 5.0.12版进行。纳入了4项符合条件的研究，涉及1338例患者（85%为男性，平均年龄：48.1±18.1岁）。在男性中，自发性1型心电图与室性心动过速/心室颤动（VT/VF）的风险高于非1型心电图患者（比值比：95%置信区间：1.84 - 5.17；P<0.0001），但在女性中并非如此（P = 0.29）。在伴有晕厥或EPS阳性的自发性1型病例中，差异无统计学意义（分别为P = 0.06和0.07）。EPS阳性的1型心电图患者比EPS阴性的患者风险更高（95%置信区间：1.10 - 5.04；P = 0.03）。汇总分析显示，自发性1型心电图、1型心电图与男性相结合以及1型心电图与EPS阳性相结合与心律失常事件风险增加之间存在关联。我们的结果表明，在BrS患者中，自发性1型心电图是男性心源性猝死的独立危险因素，但在女性中并非如此。自发性1型BrS与EPS阳性相结合时预后更差。
