Brugada综合征室性心律失常事件相关危险因素分析

Analysis of risk factors of ventricular arrhythmia in patients with Brugada syndrome

目的 初步分析Brugada综合征(BrS)患者发生室性心律失常的危险因素.方法 回顾性分析南京医科大学第一附属医院心脏科2003年3月至2016年12月收集的60例BrS患者的临床资料.患者确诊时年龄为0.6~83.0(43.2±13.1)岁,其中男性59例(98.3%),随访12~169(92±41)个月.采集并记录患者自发1型Brugada心电图或药物激发试验后出现的ST段抬高最明显的1型Brugada心电图资料以及其他临床资料.根据有无临床心室颤动/室性心动过速的发作将患者分为室性心律失常(VA)组(12例)和无VA组(48例).比较2组患者的一般资料和心电图资料,采用逐步logistic回归分析VA事件的独立危险因素.结果 2组年龄、性别比较差异无统计学意义(P均>0.05).与无VA组比较,VA组有家族猝死史的患者比例较高[7/12比22.9%(11/48),P<0.05],肢体导联有1型Brugada心电图患者的比例较高[6/12比16.67%(8/48),P<0.05],胸导联最大T波峰-末间期(Max-Tpe间期)延长[(144±53)ms比(110±16)ms,P<0.05]以及T波峰-末间期离散度(Tpe间期离散度)增大[(74±50)ms比(43±17)ms,P<0.05].Max-Tpe间期预测室性心律失常事件的受试者工作特征(ROC)曲线下面积为0.693,最佳切点值为Max-Tpe间期≥140 ms,其敏感度为50.0%,特异度为98.0%,阳性预测值为85.7%,阴性预测值为88.7%.Tpe间期离散度预测室性心律失常事件的ROC曲线下面积为0.775,最佳切点值为Tpe间期离散度≥45 ms,其敏感度为91.7%,特异度为64.6%,阳性预测值为39.3%,阴性预测值为96.9%.多因素logistic回归分析显示,Max-Tpe间期≥140 ms(OR=27.53,95%CI 1.07~706.77, P=0.045)和家族猝死史(OR=24.63,95%CI 2.05~295.38,P=0.011)为预测VA事件的独立危险因素.结论 Max-Tpe间期≥140 ms和家族猝死史为Brugada患者VA事件的独立危险因素.

Objective To investigate the risk factors of ventricular arrhythmias in patients with Brugada syndrome.Methods Clinical data of 60 Brugada syndrome patients admitted in the department of cardiology of the First Affiliated Hospital of Nanjing Medical University from March 2003 to December 2016 were collected and retrospectively analyzed.The age at diagnosis was (43.2±13.1)years (0.6-83.0 years), 98.3% were males (n=59),and the patients were followed up to (92±41)months (12-169 months).The 12-lead surface electrocardiogram (ECG)recorded at the time of diagnosis and showing the highest type 1 ST elevation,either spontaneously or after provocative drug test,was used for the analysis.Patients were divided into ventricular arrhythmia (VA,n=12)group and non-ventricular arrhythmia (non-VA,n=48)group depending on the presence or absence of clinical VA event.The demographic data and ECG data of the 2 groups were compared,and the independent risk factors of VA events were analyzed by stepwise logistic regression.Results Incidence of family history of sudden death (7/12 vs.22.9%(11/48))and percentage of type 1ST elevation in the peripheral ECG leads (6/12vs.16.67%(8/48))were significantly higher in VA group than in non-VA group (both P<0.05).Max Tpeak-Tend (Max-Tpe)interval ((144±53)ms vs.(110±16) ms)and dispersion of Tpe ((74±50)ms vs.(43±17)ms)were significantly higher in VA group than in non-VA group (both P<0.05).The area under receiver operating characteristic (ROC)curves for the Max-Tpe interval was 0.693 and Max-Tpe interval >1140 ms was determined as an optimized cutoff point with increased risk of VA event,which had a sensitivity of 50.0%,a specificity of 98.0%,a positive predictive value of 85.7%,and a negative predictive value of 88.7% for predicting VA event.The ROC curves for the dispersion of Tpe was 0.775 and dispersion of Tpe >145ms was determined as an optimized cutoff point for predicting VA event, which had a sensitivity of 91.7%,a specificity of 64.6%,a positive predictive value of 39.3%,and a negative predictive value of 96.9% for predicting VA event.In multivariate analysis,Max-Tpe interval≥140ms (OR= 27.53,95% CI 1.07-706.77,P=0.045)and family history of sudden death (OR=24.63,95%CI 2.05-295.38, P=0.011)were found to be the independent risk factors of arrhythmic events.Conclusions Max-Tpe interval >/140ms and family history of sudden death are risk factors of VA event in included patients with Brugada syndrome.