Augmentation of ST-segment elevation during early recovery from exercise testing predicted a higher rate of ventricular fibrillation in Brugada syndrome patients (44% vs 17%; p=0.004).
Cohort (n=195)
Does augmentation of ST-segment elevation during recovery from exercise testing predict cardiac events in patients with Brugada syndrome?
Augmentation of ST-segment elevation during early recovery from exercise testing is a specific and independent predictor of poor prognosis in patients with Brugada syndrome, particularly those who are asymptomatic or have only experienced syncope.
Absolute Event Rate: 44% vs 17%
p-value: p=0.004
OBJECTIVES: The goal of this study was to evaluate the prevalence and the clinical significance of ST-segment elevation during recovery from exercise testing. BACKGROUND: During recovery from exercise testing, ST-segment elevation is reported in some patients with Brugada syndrome (BrS). METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
Makimoto et al. (Wed,) conducted a cohort in Brugada syndrome (n=195). Augmentation of ST-segment elevation during recovery from exercise testing vs. No augmentation of ST-segment elevation was evaluated on Occurrence of sudden cardiac death, ventricular fibrillation, or sustained ventricular tachyarrhythmia (p=0.004). Augmentation of ST-segment elevation during early recovery from exercise testing predicted a higher rate of ventricular fibrillation in Brugada syndrome patients (44% vs 17%; p=0.004).