Scientific publications

Validation of multiparametric approaches for the prediction of sudden cardiac death in patients with Brugada syndrome and electrophysiological study

Aug 31, 2021 | Magazine: Revista Española de Cardiología

Moisés Rodríguez-Mañero  1 , Aurora Baluja  2 , Jaime Hernández  3 , Carmen Muñoz  4 , David Calvo  5 , Juan Fernández-Armenta  6 , Amaya García-Fernández  7 , Esther Zorio  8 , Álvaro Arce-León  9 , Juan Miguel Sánchez-Gómez  10 , Ignacio Mosquera-Pérez  11 , Miguel Á Arias  12 , Ernesto Díaz-Infante  13 , Víctor Expósito  14 , Víctor Jiménez-Ramos  15 , Elvis Teijeira  16 , María Victoria Cañadas-Godoy  17 , José María Guerra-Ramos  18 , Teresa Oloriz  19 , Nuria Basterra  20 , Pedro Sousa  21 , Juliana Elices-Teja  22 , Ignacio García-Bolao  23 , José Ramón González-Juanatey  24 , Ramón Brugada  25 , Juan Ramón Gimeno  26 , Josep Brugada  3 , Elena Arbelo  3


Introduction and objectives: Multiparametric scores have been designed for better risk stratification in Brugada syndrome (BrS). We aimed to validate 3 multiparametric approaches (the Delise score, Sieira score and the Shanghai BrS Score) in a cohort with Brugada syndrome and electrophysiological study (EPS).

Methods: We included patients diagnosed with BrS and previous EPS between 1998 and 2019 in 23 hospitals. C-statistic analysis and Cox proportional hazard regression models were used.

Results: A total of 831 patients were included (mean age, 42.8±13.1; 623 [75%] men; 386 [46.5%] had a type 1 electrocardiogram (ECG) pattern, 677 [81.5%] were asymptomatic, and 319 [38.4%] had an implantable cardioverter-defibrillator). During a follow-up of 10.2±4.7 years, 47 (5.7%) experienced a cardiovascular event. In the global cohort, a type 1 ECG and syncope were predictive of arrhythmic events. All risk scores were significantly associated with events. The discriminatory abilities of the 3 scores were modest (particularly when these scores were evaluated in asymptomatic patients). Evaluation of the Delise and Sieira scores with different numbers of extra stimuli (1 or 2 vs 3) did not substantially improve the event prediction c-index.

Conclusions: In BrS, classic risk factors such as ECG pattern and previous syncope predict arrhythmic events. The predictive capabilities of the EPS are affected by the number of extra stimuli required to induce ventricular arrhythmias. Scores combining clinical risk factors with EPS help to identify the populations at highest risk, although their predictive abilities remain modest in the general BrS population and in asymptomatic patients.

CITATION  Rev Esp Cardiol (Engl Ed). 2021 Aug 31;S1885-5857(21)00223-1. doi: 10.1016/j.rec.2021.07.007. 

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