Augmented ST-Segment Elevation during Recovery from Exercise Predicts Cardiac Events in Patients with Brugada Syndrome

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概要

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• <B>Objectives:</B> The goal of this study was to evaluate the prevalence and the clinical significance of ST-segment elevation during recovery from exercise testing.<BR><B>Background:</B> During recovery from exercise testing, ST-segment elevation is reported in some patients with Brugada syndrome (BrS).<BR><B>Methods:</B> 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.<BR><B>Results:</B> 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).<BR><B>Conclusions:</B> 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.

著者

• Noda Takashi

  Division of Cardiology, National Cardiovascular Center

• Kurita Takashi

  Division Of Cardiology Department Of Internal Medicine National Cardiovascular Center

• Makimoto Hisaki

  Division Of Cardiology Deparitment Of Internal Medicine National Cardiovascular Center

• Nakagawa Eiichiro

  Department Of Cardiology Osaka City General Hospital

• Takaki Hiroshi

  Division Of Cardiology National Cardiovascular Center

• Shimizu Wataru

  Division Of Arrhythmia And Electrophysiology Department Of Cardiology National Cerebral And Cardiova

• Okamura Hideo

  Division Of Arrhythmia And Electrophysiology Department Of Cardiovascular Medicine National Cerebral

• Kamakura Shiro

  Division Of Arrhythmia And Electrophysiology Department Of Cardiovascular Medicine National Cerebral

• Yamada Yuko

  Division Of Arrhythmia And Electrophysiology Department Of Cardiovascular Medicine National Cerebral And Cardiovascular Center

• SATOMI Kazuhiro

  Division of Arrhythmias and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center

• Yamada Yuko

  Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center

• Suyama Kazuhiro

  Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center

• Aihara Naohiko

  Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center

• Makimoto Hisaki

  Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center

• Satomi Kazuhiro

  Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan

• Takaki Hiroshi

  Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center

• Kurita Takashi

  Division of Cardiology, Department of Internal Medicine, Kinki University School of Medicine

• Noda Takashi

  Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan

• Shimizu Wataru

  Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center

• Satomi Kazuhiro

  Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center

• Okamura Hideo

  Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center

• Kurita Takashi

  Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Japan

• Noda Takashi

  Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center

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