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