Risk stratification of ventricular fibrillation in Brugada syndrome using noninvasive scoring methods

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• 作者：Hiroshi Kawazoe ; MD^⁎ ; Yukiko Nakano ; MD ; PhD^⁎ ; ^{nakanoy@hiroshima-u.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Hidenori Ochi ; MD ; PhD^&dagger ; ; Masahiko Takagi ; MD ; PhD^&Dagger ; ; Yusuke Hayashi ; MD ; PhD^&Dagger ; ; Yuko Uchimura ; MD ; PhD^⁎ ; Takehito Tokuyama ; MD ; PhD^⁎ ; Yoshikazu Watanabe ; MD ; PhD^⁎ ; Hiroya Matsumura ; MD^⁎ ; Shunsuke Tomomori ; MD^⁎ ; Akinori Sairaku ; MD^⁎ ; Kazuyoshi Suenari ; MD ; PhD^⁎ ; Akinori Awazu ; PhD^§ ; ; Yosuke Miwa ; MD ; PhD^¶ ; ; Kyoko Soejima ; MD ; PhD^¶ ; ; Kazuaki Chayama ; MD ; PhD^&dagger ; ; Yasuki Kihara ; MD ; PhD^⁎
• 关键词：Brugada syndrome ; Risk stratification ; Ventricular fibrillation ; Scoring method ; T-wave alternans
• 刊名：Heart Rhythm
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：13
• 期：10
• 页码：1947-1954
• 全文大小：779 K

文摘

Risk stratification for ventricular fibrillation (VF) in patients with Brugada syndrome (BrS) remains controversial.

Objective

The purpose of this study was to construct a novel prediction model for VF risk in BrS patients using noninvasive parameters.

Methods

A total of 143 Japanese BrS patients with VF (n = 35) and without VF (n = 108) were retrospectively enrolled. We built a logistic regression model predicting VF occurrence and evaluated it by cross-validation.

Results

Frequencies of history of syncope and spontaneous type 1 ECG, r–J interval in V₁, QRS duration in V₆, and LAS₄₀, Tpeak–Tend dispersion, and max T-wave alternans were significantly associated with VF occurrence in univariate analyses. The history of syncope, r–J interval in V₁, QRS duration in V₆, and Tpeak–Tend dispersion were identified as independent predictors by multivariate logistic regression analysis. The predictive model was constructed using all these parameters with good discrimination of VF occurrence (area under the curve 0.869 with 97.1% sensitivity and 65.7% specificity). The area under the curve based on leave-one-out cross-validation was 0.845, with 97.1% sensitivity and 63.0% specificity suggesting good performance of the model. Retrospective survival analysis revealed that the cumulative VF event rate was significantly higher in patients at high risk than in those with low risk using the log rank test (P = 2.97 × 10^–8). Notably, no BrS patient below the cutoff value developed a subsequent VF event.

Conclusion

This novel prediction method may effectively assesses VF risk in BrS patients, especially when determining implantable cardioverter-defibrillator placement for asymptomatic BrS patients.