Brugada syndrome in Hong Kong: long term outcome prediction through machine learning

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Brugada syndrome (BrS) is an ion channelopathy that predisposes affected patients to spontaneous ventricular tachycardia/fibrillation (VT/VF) and sudden cardiac death (SCD). Despite its greater prevalence in Asia and epidemiological heterogeneity in disease manifestation, the majority of the conducted cohort studies available in current literature are based in Western countries. Purpose The aim of this study is to examine the clinical and electrocardiographic predictive factors of spontaneous VT/VF for Asian BrS patients. Methods This was a territory-wide retrospective cohort study of patients diagnosed with BrS between 1997 and 2019. The primary outcome was spontaneous VT/VF detected either during hospital admission or by implantable-cardioverter defibrillator (ICD) data. Cox regression was used to identify significant clinical and electrocardiographic risk predictors. Non-linear interactions between variables (latent patterns) were extracted using non-negative matrix factorization (NMF) and used as inputs into the random survival forest (RSF) model. Results This study included 516 consecutive BrS patients (mean age of initial presentation= 50 ± 16 years, male= 92%) with a median follow-up of 86 (interquartile range: 45-118) months. The cohort was divided into subgroups based on initial disease manifestation: asymptomatic (n = 314), syncope (n = 159) or VT/VF (n = 41). Annualized event rates per person-year were 1.70%, 0.05% and 0.01% for the VT/VF, syncope and asymptomatic subgroups, respectively. Multivariate Cox regression analysis revealed initial presentation of VT/VF (HR = 24.0, 95% CI = [1.21, 479] , P= 0.037) and standard deviation of P-wave duration (HR = 1.07, 95% CI = [1.00, 1.13], P = 0.044) were significant predictors. The NMF-RSF showed the best predictive performance compared to RSF and Cox regression models (precision: 0.87 v.s. 0.83 v.s. 0.76, recall: 0.89 v.s. 0.85 v.s. 0.73, F1-score: 0.88 v.s. 0.84 v.s. 0.74). Conclusions This is one of the largest territory-wide cohort studies on BrS and the largest study in Asia published to date, with an extensive median follow-up duration of 7 years. Clinical history, electrocardiographic markers and investigation results provide important information for risk stratification. Machine learning techniques using NMF and RSF significantly improves overall risk stratification performance.

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Territory-wide cohort study of Brugada syndrome in Hong Kong: predictors of long-term outcomes using random survival forests and non-negative matrix factorisation

Open Heart ◽

10.1136/openhrt-2020-001505 ◽

2021 ◽

Vol 8 (1) ◽

pp. e001505

Author(s):

Sharen Lee ◽

Jiandong Zhou ◽

Ka Hou Christien Li ◽

Keith Sai Kit Leung ◽

Ishan Lakhani ◽

...

Keyword(s):

Cohort Study ◽

Risk Stratification ◽

Brugada Syndrome ◽

Cox Regression ◽

Significant Risk ◽

Initial Presentation ◽

P Wave ◽

Machine Learning Techniques ◽

Cox Regression Analysis ◽

Matrix Factorisation

ObjectivesBrugada syndrome (BrS) is an ion channelopathy that predisposes affected patients to spontaneous ventricular tachycardia/fibrillation (VT/VF) and sudden cardiac death. The aim of this study is to examine the predictive factors of spontaneous VT/VF.MethodsThis was a territory-wide retrospective cohort study of patients diagnosed with BrS between 1997 and 2019. The primary outcome was spontaneous VT/VF. Cox regression was used to identify significant risk predictors. Non-linear interactions between variables (latent patterns) were extracted using non-negative matrix factorisation (NMF) and used as inputs into the random survival forest (RSF) model.ResultsThis study included 516 consecutive BrS patients (mean age of initial presentation=50±16 years, male=92%) with a median follow-up of 86 (IQR: 45–118) months. The cohort was divided into subgroups based on initial disease manifestation: asymptomatic (n=314), syncope (n=159) or VT/VF (n=41). Annualised event rates per person-year were 1.70%, 0.05% and 0.01% for the VT/VF, syncope and asymptomatic subgroups, respectively. Multivariate Cox regression analysis revealed initial presentation of VT/VF (HR=24.0, 95% CI=1.21 to 479, p=0.037) and SD of P-wave duration (HR=1.07, 95% CI=1.00 to 1.13, p=0.044) were significant predictors. The NMF-RSF showed the best predictive performance compared with RSF and Cox regression models (precision: 0.87 vs 0.83 vs. 0.76, recall: 0.89 vs. 0.85 vs 0.73, F1-score: 0.88 vs 0.84 vs 0.74).ConclusionsClinical history, electrocardiographic markers and investigation results provide important information for risk stratification. Machine learning techniques using NMF and RSF significantly improves overall risk stratification performance.

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Ventricular Tachyarrhythmia Risk in Paediatric/Young vs. Adult Brugada Syndrome Patients: A Territory-Wide Study

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.671666 ◽

2021 ◽

Vol 8 ◽

Author(s):

Sharen Lee ◽

Wing Tak Wong ◽

Ian Chi Kei Wong ◽

Chloe Mak ◽

Ngai Shing Mok ◽

...

Keyword(s):

Brugada Syndrome ◽

Adult Population ◽

Ventricular Tachyarrhythmia ◽

Management Strategies ◽

Public Hospitals ◽

Initial Presentation ◽

P Wave ◽

The Mean

Introduction: Brugada syndrome (BrS) is a cardiac ion channelopathy with a higher prevalence in Asia compared to the Western populations. The present study compared the differences in clinical and electrocardiographic (ECG) presentation between paediatric/young (≤25 years old) and adult (>25 years) BrS patients.Method: This was a territory-wide retrospective cohort study of consecutive BrS patients presenting to public hospitals in Hong Kong. The primary outcome was spontaneous ventricular tachycardia/ventricular fibrillation (VT/VF).Results: The cohort consists of 550 consecutive patients (median age of initial presentation = 51 ± 23 years; female = 7.3%; follow-up period = 83 ± 80 months), divided into adult (n = 505, mean age of initial presentation = 52 ± 19 years; female = 6.7%; mean follow-up period = 83 ± 80 months) and paediatric/young subgroups (n = 45, mean age of initial presentation = 21 ± 5 years, female = 13.3%, mean follow-up period = 73 ± 83 months). The mean annual VT/VF incidence rate were 17 and 25 cases per 1,000 patient-year, respectively. Multivariate analysis showed that initial presentation of type 1 pattern (HR = 1.80, 95% CI = [1.02, 3.15], p = 0.041), initial asymptomatic presentation (HR = 0.26, 95% CI = [0.07, 0.94], p = 0.040) and increased P-wave axis (HR = 0.98, 95% CI = [0.96, 1.00], p = 0.036) were significant predictors of VT/VF for the adult subgroup. Only initial presentation of VT/VF was predictive (HR = 29.30, 95% CI = [1.75, 492.00], p = 0.019) in the paediatric/young subgroup.Conclusion: Clinical and ECG presentation of BrS vary between the paediatric/young and adult population in BrS. Risk stratification and management strategies for younger patients should take into consideration and adopt an individualised approach.

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Abstract 19123: Elevated Growth and Differentiation Factor 15 (GDF15) Levels Predict Outcome in Patients With Severe Aortic Stenosis Undergoing Tavi

Circulation ◽

10.1161/circ.130.suppl_2.19123 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Nora Krau ◽

Sandra Freitag-Wolf ◽

Doreen Brehm ◽

Rainer Petzina ◽

Georg Lutter ◽

...

Keyword(s):

Regression Analysis ◽

Aortic Valve ◽

Risk Stratification ◽

Transforming Growth Factor ◽

Cox Regression ◽

Severe Aortic Stenosis ◽

Statistical Significance ◽

Cox Regression Analysis ◽

Negative Outcome

Background: GDF15 belongs to the transforming growth factor superfamily and has a significant role in regulating inflammatory and apoptotic pathways. GDF15 is an emerging biomarker for risk stratification in cardiovascular disease. Here we analyze its prognostic value in patients with severe symptomatic aortic valve stenosis undergoing transcatheter aortic valve implantation (TAVI). Methods and Results: We prospectively enrolled 217 patients undergoing TAVI (using Edwards Sapien XT prostheses) at our institution over a continuous period of 35 month (2/2011-12/2013). All patients were available for complete follow up. Clinical parameters were determined before the procedure, biomarkers (GDF15 & NTproBNP) were measured before, 3 and 7 days after TAVI. The primary endpoint was survival time, all available prognostic factors were studied by Cox regression analysis with backward selection based on the likelihood ratio criteria. At median follow-up of 349 d (Q1-Q3 106-660d), a total of n=66 deaths occurred. 30d mortality was 6.9%. Mean age was 81.8 years (± 6.0 y) and 55.8% were females. Mean log. Euroscore (ES) was 25.4% (± 17.2%). Median preprocedural GDF15 values were 2256 pg/ml (Q1-Q3 1585.5-3082.0). In univariate analyses, increased GDF15 levels (upper quartile compared to lower three quartiles) revealed a HR of 2.4 (CI 1.5-3.9, p<0.001) for adverse outcome. In addition, also log. ES (p= 0.001), log. ES II (p=0.018), STS-Score (p=0.019), NTproBNP (p=0.037) and atrial fibrillation (p=0.02) demonstrated statistical significance for negative outcome. A multivariate Cox regression analysis including these factors and postprocedural aortic regurgitation, demonstrated that elevated GDF15 had a HR of 2.104 (CI 1.3-3.5; p=0.003) for negative outcome in patients undergoing TAVI, while elevated NTproBNP had HR of 1.412 (CI 0.8-2.4; p=0.212). Moreover, this analysis also revealed the log. ES as an independent risk factor (HR of 2.211, CI 1.3-3.7; p= 0.002). Conclusion: Increased GDF15 levels are associated with a poor prognosis in patients undergoing TAVI. Furthermore, GDF15 showed to be superior to the established biomarker NTproBNP in risk stratification of patients undergoing TAVI providing additional prognostic information.

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Brain Arteriovenous Malformation Recurrence After Apparent Microsurgical Cure

Stroke ◽

10.1161/strokeaha.120.030135 ◽

2020 ◽

Vol 51 (10) ◽

pp. 2990-2996

Author(s):

Alexander Copelan ◽

Gerald Drocton ◽

M. Travis Caton ◽

Eric R. Smith ◽

Daniel L. Cooke ◽

...

Keyword(s):

Arteriovenous Malformation ◽

Recurrence Rate ◽

Surgical Resection ◽

Intracranial Hemorrhage ◽

Cox Regression ◽

Initial Presentation ◽

High Rate ◽

Brain Arteriovenous Malformation ◽

Increased Risk

Background and Purpose: Do children have an increased risk for brain arteriovenous malformation (AVM) recurrence compared with adults and does this risk vary depending on initial presentation with AVM rupture? Methods: We retrospectively studied 115 patients initially presenting with brain AVM under age 25 years who underwent complete surgical resection of the AVM as documented by digital subtraction angiography (DSA) and had delayed follow-up DSA to evaluate for AVM recurrence after apparent initial cure. Results: The mean time from baseline DSA to follow-up DSA was 2.3 years, ranging from 0 to 15 years. Twelve patients (10.4% of the 115 patient cohort and 16.7% of 72 patients with hemorrhage at initial presentation) demonstrated AVM recurrence on follow-up DSA. All patients with recurrence initially presented with intracranial hemorrhage, and intracranial hemorrhage was a significant predictor of recurrence (log rank P =0.037). Among patients with initial hemorrhage, the 5-year recurrence rate was 17.8% (95% CI, 8.3%–35.7%). All recurrences occurred in patients who were children at the time of their initial presentation; the oldest was 15 years of age at the time of initial AVM surgery. The 5-year recurrence rate for children (0–18 years of age) with an initial presentation of hemorrhage was 21.4% (95% CI, 10.1%–41.9%). Using Cox regression, we found the risk of AVM recurrence decreased by 14% per each year increase in age at the time of initial surgical resection (hazard ratio=0.86 [95% CI, 0.75–0.99]; P =0.031). Conclusions: There is a high rate of recurrence of apparently cured brain AVMs in children who initially present with AVM rupture. Imaging follow-up is warranted to prevent re-rupture.

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A Four-Pseudogene Classifier Identified by Machine Learning Serves as a Novel Prognostic Marker for Survival of Osteosarcoma

Genes ◽

10.3390/genes10060414 ◽

2019 ◽

Vol 10 (6) ◽

pp. 414 ◽

Cited By ~ 10

Author(s):

Feng Liu ◽

Lu Xing ◽

Xiaoqian Zhang ◽

Xiaoqi Zhang

Keyword(s):

Machine Learning ◽

Expression Analysis ◽

Cox Regression ◽

High Sensitivity ◽

Rna Seq ◽

Cox Regression Analysis ◽

Potential Marker ◽

Risk Patients ◽

Common Malignancy

Osteosarcoma is a common malignancy with high mortality and poor prognosis due to lack of predictive markers. Increasing evidence has demonstrated that pseudogenes, a type of non-coding gene, play an important role in tumorigenesis. The aim of this study was to identify a prognostic pseudogene signature of osteosarcoma by machine learning. A sample of 94 osteosarcoma patients’ RNA-Seq data with clinical follow-up information was involved in the study. The survival-related pseudogenes were screened and related signature model was constructed by cox-regression analysis (univariate, lasso, and multivariate). The predictive value of the signature was further validated in different subgroups. The putative biological functions were determined by co-expression analysis. In total, 125 survival-related pseudogenes were identified and a four-pseudogene (RPL11-551L14.1, HR: 0.65 (95% CI: 0.44–0.95); RPL7AP28, HR: 0.32 (95% CI: 0.14–0.76); RP4-706A16.3, HR: 1.89 (95% CI: 1.35–2.65); RP11-326A19.5, HR: 0.52(95% CI: 0.37–0.74)) signature effectively distinguished the high- and low-risk patients, and predicted prognosis with high sensitivity and specificity (AUC: 0.878). Furthermore, the signature was applicable to patients of different genders, ages, and metastatic status. Co-expression analysis revealed the four pseudogenes are involved in regulating malignant phenotype, immune, and DNA/RNA editing. This four-pseudogene signature is not only a promising predictor of prognosis and survival, but also a potential marker for monitoring therapeutic schedule. Therefore, our findings may have potential clinical significance.

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Long-term outcome of extratemporal epilepsy surgery among 154 adult patients

Journal of Neurosurgery ◽

10.3171/jns/2008/108/4/0676 ◽

2008 ◽

Vol 108 (4) ◽

pp. 676-686 ◽

Cited By ~ 58

Author(s):

Alaa Eldin Elsharkawy ◽

Friedrich Behne ◽

Falk Oppel ◽

Heinz Pannek ◽

Reinhard Schulz ◽

...

Keyword(s):

Epilepsy Surgery ◽

Cox Regression ◽

Adult Patients ◽

Class I ◽

Seizure Outcome ◽

Term Outcome ◽

Long Term Outcome ◽

Factors Associated

Object The goal of this study was to evaluate the long-term outcome of patients who underwent extratemporal epilepsy surgery and to assess preoperative prognostic factors associated with seizure outcome. Methods This retrospective study included 154 consecutive adult patients who underwent epilepsy surgery at Bethel Epilepsy Centre, Bielefeld, Germany between 1991 and 2001. Seizure outcome was categorized based on the modified Engel classification. Survival statistics were calculated using Kaplan–Meier curves, life tables, and Cox regression models to evaluate the risk factors associated with outcomes. Results Sixty-one patients (39.6%) underwent frontal resections, 68 (44.1%) had posterior cortex resections, 15 (9.7%) multilobar resections, 6 (3.9%) parietal resections, and 4 (2.6%) occipital resections. The probability of an Engel Class I outcome for the overall patient group was 55.8% (95% confidence interval [CI] 52–58% at 0.5 years), 54.5% (95% CI 50–58%) at 1 year, and 51.1% (95% CI 48–54%) at 14 years. If a patient was in Class I at 2 years postoperatively, the probability of remaining in Class I for 14 years postoperatively was 88% (95% CI 78–98%). Factors predictive of poor long-term outcome after surgery were previous surgery (p = 0.04), tonic–clonic seizures (p = 0.02), and the presence of an auditory aura (p = 0.03). Factors predictive of good long-term outcome were surgery within 5 years after onset (p = 0.015) and preoperative invasive monitoring (p = 0.002). Conclusions Extratemporal epilepsy surgery is effective according to findings on long-term follow-up. The outcome at the first 2-year follow-up visit is a reliable predictor of long-term Engel Class I postoperative outcome.

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Sleep-related hypermotor epilepsy

Neurology ◽

10.1212/wnl.0000000000003459 ◽

2016 ◽

Vol 88 (1) ◽

pp. 70-77 ◽

Cited By ~ 22

Author(s):

Laura Licchetta ◽

Francesca Bisulli ◽

Luca Vignatelli ◽

Corrado Zenesini ◽

Lidia Di Vito ◽

...

Keyword(s):

Confidence Interval ◽

Cox Regression ◽

Univariate Analysis ◽

Age At Onset ◽

Hazard Ratio ◽

Seizure Freedom ◽

Brain Disorder ◽

Long Term Outcome

Objective:To assess the long-term outcome of sleep-related hypermotor epilepsy (SHE).Methods:We retrospectively reconstructed a representative cohort of patients diagnosed with SHE according to international diagnostic criteria, sleep-related seizures ≥75% and follow-up ≥5 years. Terminal remission (TR) was defined as a period of ≥5 consecutive years of seizure freedom at the last follow-up. We used Kaplan-Meier estimates to calculate the cumulative time-dependent probability of TR and to generate survival curves. Univariate and multivariate Cox regression analyses were performed.Results:We included 139 patients with a 16-year median follow-up (2,414 person-years). The mean age at onset was 13 ± 10 years. SHE was sporadic in 86% of cases and familial in 14%; 16% of patients had underlying brain abnormalities. Forty-five percent of patients had at least 1 seizure in wakefulness lifetime and 55% had seizures only in sleep (typical SHE). At the last assessment, 31 patients achieved TR (TR group, 22.3%), while 108 (NTR group, 77.7%) still had seizures or had been in remission for <5 years. The cumulative TR rate was 20.4%, 23.5%, and 28.4% by 10, 20, and 30 years from inclusion. At univariate analysis, any underlying brain disorder (any combination of intellectual disability, perinatal insult, pathologic neurologic examination, and brain structural abnormalities) and seizures in wakefulness were more frequent among the NTR group (p = 0.028; p = 0.043). Absence of any underlying brain disorder (hazard ratio 4.21, 95% confidence interval 1.26–14.05, p = 0.020) and typical SHE (hazard ratio 2.76, 95% confidence interval 1.31–5.85, p = 0.008) were associated with TR.Conclusions:Our data show a poor prognosis of SHE after a long-term follow-up. Its outcome is primarily a function of the underlying etiology.

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564 Controversial role of intracardiac eletrophysiology study in Brugada syndrome: analysis of a single-centre retrospective cohort study

European Heart Journal Supplements ◽

10.1093/eurheartj/suab127.014 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Claudio Licciardello ◽

Jacopo Marazzato ◽

Michele Golino ◽

Francesca Seganfreddo ◽

Federica Matteo ◽

...

Keyword(s):

High Risk ◽

Risk Stratification ◽

Right Ventricular ◽

Brugada Syndrome ◽

Type I ◽

Drug Induced ◽

Programmed Ventricular Stimulation ◽

Asymptomatic Patients ◽

Ventricular Stimulation

Abstract Aims According to European guidelines, aborted sudden cardiac death (SCD) in Brugada syndrome (BrS) is regarded as a I class recommendation for secondary prevention implantable cardioverter defibrillator (ICD). However, the risk stratification of BrS patients for primary prevention ICD still represents a clinical conundrum. Although intracardiac electrophysiology (EP) study proved useful for the selection of high-risk patients in this setting. Therefore, aim of this study was to assess all clinical and EP variables associated with the induction of VA at EP study and the rate of appropriate/inappropriate ICD interventions and/or clinical SCD events in these patients occurring at follow-up. Methods and results From 2001 to 2021, all EP studies performed in symptomatic/asymptomatic patients (46 ± 14 years, M 88%) with/without family history of SCD spontaneous/drug-induced type I pattern (TIP) on ECG and no spontaneous ventricular arrhythmias were retrospectively considered at our study centre. Clinical variables, BrS pattern, EP study data (including right ventricular site and type of stimulation protocol), and ICD interventions (DC-shocks or Anti-Tachycardia Pacing events, ATP) and/or SCD events occurring at follow-up were all evaluated. EP study was deemed positive for any polymorphic VA induced during programmed ventricular stimulation; non-sustained episodes included. ICD was routinely implanted in all patients with a positive EP study. Follow-up data were detected by the collection of medical and home-monitoring recordings at study-site level. Follow-up data were available in 50 patients (9 ± 6 years on average). Patients were generally young with few cardiovascular comorbidities. SCD history was known in 21 (42%) with a significant number of asymptomatic patients (48%). Br patterns were equally distributed in the investigated population (spontaneous and drug-induced TIP in 52% and 48%, respectively) and AF history was fairly common (16%). In the study population, EP study tested positive in 30 patients (60%): spontaneous TIP (P = 0.0518), few extrastimuli during programmed ventricular stimulation (P = 0.0015), and right ventricular stimulation at the apical site (P ≤ 0.0001) were the only variables to be clearly associated with a positive EP study in the appraised patients. At follow-up, appropriate ICD shocks were documented in 4 out of 30 implanted patients (13%) at generally 5 ± 7 years from EP study evaluation. Although three ICD interventions (75%) occurred in patients with spontaneous TIP, one patient with drug-induced TIP pattern and positive EP study referred to Emergency Department for unrelenting VT storm after roughly 13 years from ICD implantation. Inappropriate ICD interventions for fast rate AF were detected in 10% of cases. Finally, no SCD events were documented at follow up in patients with a negative EP study. Conclusions In a retrospective analysis, EP study proved useful in the risk stratification of SCD in BrS patients. A few ventricular extrastimuli delivered at the right ventricular apex seem sufficient to prompt the induction of life-threatening VA in high-risk BrS patients during EP study. Moreover, in this setting, a negative EP study seems protective against the development of VA/SCD events at follow-up. However, not only is spontaneous TIP associated with an increased risk of arrhythmic death, but a drug-induced TIP, generally regarded as a low-risk condition, might also be associated with a long-term hazard of SCD in these patients.

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Long term clinical impact of successful recanalization of chronic total occlusion in patients with and without type 2 diabetes mellitus

10.21203/rs.3.rs-28914/v1 ◽

2020 ◽

Author(s):

Chuan-Tsai Tsai ◽

Wei-Chieh Huang ◽

Hsin-I Teng ◽

Yi-Lin Tsai ◽

Tse-Min Lu

Keyword(s):

Diabetes Mellitus ◽

Cox Regression ◽

Total Occlusion ◽

Long Term Outcome ◽

Chronic Total Occlusions ◽

Cox Regression Analysis ◽

All Cause Mortality ◽

Diabetes Patients

Abstract Background Diabetes mellitus is one of the risk factors for coronary artery disease and frequently associated with multivessels disease and poor clinical outcomes. Long term outcome of successful revascularization of chronic total occlusions (CTO) in diabetes patients remains controversial. Methods and results From January 2005 to December 2015, 739 patients who underwent revascularization for CTO in Taipei Veterans General Hospital were included in this study, of which 313 (42%) patients were diabetes patients. Overall successful rate of revascularization was 619 (84%) patients whereas that in diabetics and non-diabetics were 265 (84%) and 354 (83%) respectively. Median follow up was 1095 days (median: 5 years, interquartile range: 1–10 years). During 3 years follow-up period, 59 (10%) in successful group and 18 (15%) patients in failure group died. Although successful revascularization of CTO was non-significantly associated with better outcome in total cohort (Hazard ratio (HR):0.593, 95% confidence interval (CI): 0.349–0.008, P:0.054), it might be associated with lower risk of all-cause mortality (HR: 0.307, 95% CI: 0.156–0.604, P: 0.001) and CV mortality (HR: 0.266, 95% CI: 0.095–0.748, P: 0.012) in diabetics (P: 0.512). In contrast, successful CTO revascularization didn’t improve outcomes in non-diabetics (all p > 0.05). In multivariate cox regression analysis, successful CTO revascularization remained an independent predictor for 3-years survival in diabetic subgroup (HR: 0.289, 95% CI: 0.125–0.667, P: 0.004). The multivariate analysis result was similar after propensity score matching (all-cause mortality, HR: 0.348, 95% CI: 0.142–0.851, P: 0.021). Conclusion Successful CTO revascularization was associated with reduced long term all-cause/cardiovascular mortality in diabetics but not in non-diabetic population.

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Abstract 2640: Clinical Characteristics and Risk Stratification in Symptomatic and Asymptomatic Patients with Brugada Syndrome - Multi-center Study in Japan-

Circulation ◽

10.1161/circ.116.suppl_16.ii_585-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Masahiko Takagi ◽

Yasuhiro Yokoyama ◽

Kazutaka Aonuma ◽

Naohiko Aihara ◽

Masayasu Hiraoka

Keyword(s):

Sudden Death ◽

Risk Stratification ◽

Brugada Syndrome ◽

Clinical Characteristics ◽

Low Risk ◽

Cardiac Events ◽

Asymptomatic Patients ◽

Risk Patients ◽

Qrs Duration

Background Neither the clinical characteristics nor risk stratification of symptomatic and asymptomatic patients with Brugada syndrome have been clearly determined. We compared clinical and ECG characteristics of symptomatic and asymptomatic patients with Brugada syndrome to identify new markers for distinguishing high- from low-risk patients. Methods A total of 216 consecutive individuals with Brugada syndrome (mean age 52±14 years, 197 males) were enrolled in the Japan Idiopathic Ventricular Fibrillation Study (J-IVFS). Clinical and ECG characteristics were compared among 3 groups of patients: VF group; patients with aborted sudden death and documented VF (N=34), Syncope (Sy) group; patients with syncope without documented VF (N=70), and Asymptomatic (As) group; subjects without symptoms (N=112). Comparisons were made among the 3 groups as well as between the symptomatic (VF/Sy) and asymptomatic (As) groups. Short-term prognosis was also compared among the 3 groups, and between the VF/Sy and As groups. Results 1) Clinical characteristics: incidence of past history of AF was significantly higher in the VF and Sy groups than in the AS group (26, 26, and 12 %, respectively; [p=0.04]), though no other clinical parameters differed among the groups. 2) On resting 12-lead ECG, r-J interval (interval from QRS onset to J point) in lead V2 and QRS duration in lead V6 were highest in the VF group (104, 98, and 92 msec in V2 [p<0.001]; 106, 103, and 94 msec in V6 [p<0.0001], respectively, VF vs. Sy vs. As). 3) Positive late potential and inducibility of VF by EPS did not differ in incidence among the 3 groups. 4) Clinical follow-up: during a mean follow-up of 36±16 months, incidence of cardiac events (sudden death and/or VF) was higher in the VF/Sy groups than in the As group (29, 8, and 0 %, respectively [p<0.001]). Multivariate analysis showed that the frequencies of r-J interval ≥ 90 msec in lead V2 and QRS duration ≥ 90 msec in lead V6 were significantly higher in patients with cardiac events (p=0.02, 0.02, respectively). Conclusions In symptomatic patients, prolonged ventricular depolarization in precordial leads of the ECG was prominent in the VF group, and this sign can be used to distinguish high- from low-risk patients with Brugada syndrome.

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