Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy.
Cardiology Unit, Department of Emergency and Critical Care, Hospital S. Croce e Carle, 12100 Cuneo, Italy.
Sensors (Basel). 2023 Mar 16;23(6):3159. doi: 10.3390/s23063159.
A diagnosis of Brugada syndrome (BrS) is based on the presence of a type 1 electrocardiogram (ECG) pattern, either spontaneously or after a Sodium Channel Blocker Provocation Test (SCBPT). Several ECG criteria have been evaluated as predictors of a positive SCBPT, such as the β-angle, the α-angle, the duration of the base of the triangle at 5 mm from the r'-wave (DBT- 5 mm), the duration of the base of the triangle at the isoelectric line (DBT- iso), and the triangle base/height ratio. The aim of our study was to test all previously proposed ECG criteria in a large cohort study and to evaluate an r'-wave algorithm for predicting a BrS diagnosis after an SCBPT. We enrolled all patients who consecutively underwent SCBPT using flecainide from January 2010 to December 2015 in the test cohort and from January 2016 to December 2021 in the validation cohort. We included the ECG criteria with the best diagnostic accuracy in relation to the test cohort in the development of the r'-wave algorithm (β-angle, α-angle, DBT- 5 mm, and DBT- iso.) Of the total of 395 patients enrolled, 72.4% were male and the average age was 44.7 ± 13.5 years. Following the SCBPTs, 24.1% of patients (n = 95) were positive and 75.9% (n = 300) were negative. ROC analysis of the validation cohort showed that the AUC of the r'-wave algorithm (AUC: 0.92; CI 0.85-0.99) was significantly better than the AUC of the β-angle (AUC: 0.82; 95% CI 0.71-0.92), the α-angle (AUC: 0.77; 95% CI 0.66-0.90), the DBT- 5 mm (AUC: 0.75; 95% CI 0.64-0.87), the DBT- iso (AUC: 0.79; 95% CI 0.67-0.91), and the triangle base/height (AUC: 0.61; 95% CI 0.48-0.75) ( < 0.001), making it the best predictor of a BrS diagnosis after an SCBPT. The r'-wave algorithm with a cut-off value of ≥2 showed a sensitivity of 90% and a specificity of 83%. In our study, the r'-wave algorithm was proved to have the best diagnostic accuracy, compared with single electrocardiographic criteria, in predicting the diagnosis of BrS after provocative testing with flecainide.
Brugada 综合征（BrS）的诊断基于 1 型心电图（ECG）模式的存在，无论是自发出现还是在钠离子通道阻滞剂激发试验（SCBPT）后出现。已经评估了几种 ECG 标准作为阳性 SCBPT 的预测因子，例如β角、α角、r'波处距三角基线 5 毫米的持续时间（DBT-5 毫米）、等电线上三角基线的持续时间（DBT-iso）以及三角基线/高度比。我们研究的目的是在大型队列研究中测试所有先前提出的 ECG 标准，并评估 r'波算法在 SCBPT 后预测 BrS 诊断的作用。我们在测试队列中纳入了 2010 年 1 月至 2015 年 12 月期间连续接受氟卡尼 SCBPT 的所有患者，在验证队列中纳入了 2016 年 1 月至 2021 年 12 月期间连续接受氟卡尼 SCBPT 的所有患者。我们将与测试队列相关的最佳诊断准确性的 ECG 标准纳入 r'波算法的开发中（β角、α角、DBT-5 毫米和 DBT-iso）。在总共纳入的 395 名患者中，72.4%为男性，平均年龄为 44.7±13.5 岁。进行 SCBPT 后，24.1%的患者（n=95）为阳性，75.9%（n=300）为阴性。验证队列的 ROC 分析显示，r'波算法的 AUC（AUC：0.92；95%CI 0.85-0.99）明显优于β角（AUC：0.82；95%CI 0.71-0.92）、α角（AUC：0.77；95%CI 0.66-0.90）、DBT-5 毫米（AUC：0.75；95%CI 0.64-0.87）、DBT-iso（AUC：0.79；95%CI 0.67-0.91）和三角基线/高度（AUC：0.61；95%CI 0.48-0.75）（<0.001），使其成为 SCBPT 后预测 BrS 诊断的最佳指标。r'波算法的截断值≥2 时，灵敏度为 90%，特异性为 83%。在我们的研究中，与单一心电图标准相比，r'波算法在预测氟卡尼激发试验后 BrS 诊断方面被证明具有最佳的诊断准确性。
