First Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Germany.
Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany.
Hellenic J Cardiol. 2021 Sep-Oct;62(5):329-338. doi: 10.1016/j.hjc.2021.05.003. Epub 2021 Jun 1.
This study evaluated the prognostic significance of cardiac magnetic resonance myocardial feature tracking (CMR-FT) in patients with Brugada syndrome (BrS) to detect subclinical alterations and predict major adverse events (MAE).
CMR was performed in 106 patients with BrS and 25 healthy controls. Biventricular global strain analysis was assessed using CMR-FT. Patients were followed over a median of 11.6 [8.8 ± 13.8] years.
The study cohort was subdivided according to the presence of a spontaneous type 1 ECG (sECG) into sBrS (BrS with sECG, n = 34 (32.1%)) and diBrS (BrS with drug-induced type 1 ECG, n = 72 (67.9%)). CMR-FT revealed morphological differences between sBrS and diBrS patients with regard to right ventricular (RV) strain (circumferential (%) (sBrS -7.9 ± 2.9 vs diBrS - 9.5 ± 3.1, p = 0.02) and radial (%) (sBrS 12.0 ± 4.3 vs diBrS 15.4 ± 5.4, p = 0.004)). During follow-up, MAE occurred in 11 patients (10.4%). Multivariable analysis was performed to identify independent predictors for the occurrence of events during follow-up. The strongest predictive value was found for RV circumferential strain (OR 3.2 (95% CI 1.4 - 6.9), p = 0.02) and RVOT/BSA (OR 3.1 (95% CI 1.0 - 7.0), p = 0.03).
Myocardial strain analysis detected early subclinical alterations, prior to apparent changes in myocardial function, in patients with BrS. While usual functional parameters were within the normal range, CMR-FT revealed pathological results in patients with an sECG. Moreover, RV circumferential strain and RVOT size provided additional prognostic information on the occurrence of MAE during follow-up, which reflects electrical vulnerability.
本研究评估心脏磁共振心肌特征追踪（CMR-FT）在 Brugada 综合征（BrS）患者中的预后意义，以检测亚临床改变并预测主要不良事件（MAE）。
对 106 例 BrS 患者和 25 例健康对照者进行 CMR 检查。使用 CMR-FT 评估双心室整体应变分析。中位随访时间为 11.6 [8.8 ± 13.8] 年。
该研究队列根据自发 1 型心电图（sECG）的存在分为 sBrS（伴有 sECG 的 BrS，n=34（32.1%））和 diBrS（伴有药物诱导 1 型 ECG 的 BrS，n=72（67.9%））。CMR-FT 显示 sBrS 和 diBrS 患者在右心室（RV）应变方面存在形态学差异，包括 RV 环向应变（%（sBrS-7.9 ± 2.9 与 diBrS-9.5 ± 3.1，p=0.02）和 RV 径向应变（%（sBrS 12.0 ± 4.3 与 diBrS 15.4 ± 5.4，p=0.004））。随访期间，11 例患者（10.4%）发生 MAE。进行多变量分析以确定随访期间发生事件的独立预测因子。RV 环向应变（OR 3.2（95%CI 1.4 - 6.9），p=0.02）和 RVOT/BSA（OR 3.1（95%CI 1.0 - 7.0），p=0.03）的预测值最强。
心肌应变分析在 BrS 患者出现明显心肌功能改变之前，即可检测到早期亚临床改变。虽然常规功能参数在正常范围内，但 CMR-FT 显示 sECG 患者存在病理性结果。此外，RV 环向应变和 RVOT 大小在随访期间提供了关于 MAE 发生的额外预后信息，反映了电脆弱性。
