Rachel Bastiaenen1, Andrew T Cox2, Silvia Castelletti3, Yanushi D Wijeyeratne2, Nicholas Colbeck4, Nadia Pakroo4, Hammad Ahmed4, Nick Bunce4, Lisa Anderson2, James C Moon5, Sanjay Prasad6, Sanjay Sharma2, Elijah R Behr2. 1. Molecular and Clinical Sciences Research Institute, St. George's University of London, United Kingdom; Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom. Electronic address: rbastiae@sgul.ac.uk. 2. Molecular and Clinical Sciences Research Institute, St. George's University of London, United Kingdom; Cardiology Clinical Academic Group, St. George's University Hospitals NHS Foundation Trust, London, United Kingdom. 3. Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano "San Carlo." Milan, Italy. 4. Molecular and Clinical Sciences Research Institute, St. George's University of London, United Kingdom. 5. Bart's Heart Centre, St. Bartholomew's Hospital, London, United Kingdom. 6. Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.
Abstract
BACKGROUND: There is increasing evidence that the Brugada ECG pattern is a marker of subtle structural heart disease. OBJECTIVE: The purpose of this study was to characterize patients with Brugada syndrome (BrS) using cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE). METHODS: BrS was diagnosed according to international guidelines. Twenty-six percent of patients with BrS carried SCN5A mutations. CMR data from 78 patients with BrS were compared with 78 healthy controls (44 ± 15 vs 42 ± 14 years; P = .434; and 64% vs 64% male; P = 1). RESULTS: Right ventricular (RV) ejection fraction was slightly lower (61 ± 8% vs 64 ± 5%; P = .004) and RV end-systolic volume slightly greater (31 ± 10 mL/m2 vs 28 ± 6 mL/m2; P = .038) in BrS compared with controls. These values remained within the normal range. LGE was demonstrated in 8% of patients with BrS (left ventricular midwall LGE in 5%) but not in controls (P = .028). In patients with BrS with midwall LGE there were no other features of cardiomyopathy at the time of CMR, but genetic testing and follow-up revealed a desmoplakin mutation in 1 patient and evolution of T-wave inversion throughout all precordial ECG leads in another. Neither patient fulfils diagnostic criteria for arrhythmogenic right ventricular cardiomyopathy. CONCLUSION: Some patients with BrS have left ventricular midwall LGE consistent with an underlying cardiomyopathic process. Even cases without LGE show greater RV volumes and reduced RV function. These findings lend further support to the presence of subtle structural abnormalities in BrS. The BrS pattern with LGE may serve as early markers for evolution of a cardiomyopathic phenotype over time. CMR is a potentially useful adjunct investigation in the clinical evaluation of BrS.
BACKGROUND: There is increasing evidence that the Brugada ECG pattern is a marker of subtle structural heart disease. OBJECTIVE: The purpose of this study was to characterize patients with Brugada syndrome (BrS) using cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE). METHODS: BrS was diagnosed according to international guidelines. Twenty-six percent of patients with BrS carried SCN5A mutations. CMR data from 78 patients with BrS were compared with 78 healthy controls (44 ± 15 vs 42 ± 14 years; P = .434; and 64% vs 64% male; P = 1). RESULTS: Right ventricular (RV) ejection fraction was slightly lower (61 ± 8% vs 64 ± 5%; P = .004) and RV end-systolic volume slightly greater (31 ± 10 mL/m2 vs 28 ± 6 mL/m2; P = .038) in BrS compared with controls. These values remained within the normal range. LGE was demonstrated in 8% of patients with BrS (left ventricular midwall LGE in 5%) but not in controls (P = .028). In patients with BrS with midwall LGE there were no other features of cardiomyopathy at the time of CMR, but genetic testing and follow-up revealed a desmoplakin mutation in 1 patient and evolution of T-wave inversion throughout all precordial ECG leads in another. Neither patient fulfils diagnostic criteria for arrhythmogenic right ventricular cardiomyopathy. CONCLUSION: Some patients with BrS have left ventricular midwall LGE consistent with an underlying cardiomyopathic process. Even cases without LGE show greater RV volumes and reduced RV function. These findings lend further support to the presence of subtle structural abnormalities in BrS. The BrS pattern with LGE may serve as early markers for evolution of a cardiomyopathic phenotype over time. CMR is a potentially useful adjunct investigation in the clinical evaluation of BrS.
Authors: Belinda Gray; Ganesh Kumar Gnanappa; Richard D Bagnall; Giuseppe Femia; Laura Yeates; Jodie Ingles; Charlotte Burns; Rajesh Puranik; Stuart M Grieve; Christopher Semsarian; Raymond W Sy Journal: PLoS One Date: 2018-04-13 Impact factor: 3.240
Authors: Antonio Oliva; Simone Grassi; Vilma Pinchi; Francesca Cazzato; Mónica Coll; Mireia Alcalde; Marta Vallverdú-Prats; Alexandra Perez-Serra; Estefanía Martínez-Barrios; Sergi Cesar; Anna Iglesias; José Cruzalegui; Clara Hernández; Victoria Fiol; Elena Arbelo; Nuria Díez-Escuté; Vincenzo Arena; Josep Brugada; Georgia Sarquella-Brugada; Ramon Brugada; Oscar Campuzano Journal: J Clin Med Date: 2022-07-28 Impact factor: 4.964