Risk stratification of individuals with the Brugada electrocardiogram: A meta-analysis
Risk stratification of individuals with the Brugada electrocardiogram: A meta-analysis
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DOI：
10.1111/j.1540-8167.2006.00455.x
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发表时间：
2006-06-01
影响因子：
2.7
通讯作者：
Mehta, Davendra
中科院分区：
文献类型：
--
作者：
Gehi, Anil K.;Duong, Truong D.;Mehta, Davendra
目的：我们对Brugada心电图患者的预后研究进行了荟萃分析，以评估事件的预测因素。背景：Brugada综合征是日益公认的特发性室颤的原因；然而，Brugada心电图患者的预后存在很大差异。方法和结果：我们检索了30项Brugada心电图患者的前瞻性研究，积累了1,545名患者的数据。使用随机效应模型对各种潜在预测因素的事件(心脏性猝死[SCD]、晕厥或内部除颤器休克)的相对风险(RR)进行汇总估计。平均随访32个月，总事件发生率为10.0%(95%可信区间8.5%，11.5%)。与钠通道阻滞剂诱导的I型Brugada心电图相比，有晕厥或SCD病史的患者(RR3.24[95%CI2.13，4.93])、男性患者(RR3.47[95%CI1.58，7.63])和自发性心脏病患者(RR4.65[95%CI2.25，9.58])事件的RR增加(P<；0.001)。有SCD家族史(P=0.97)或SCN5A基因突变(P=0.18)的患者发生事件的相对危险度(RR)无明显增加。电生理检查(EPS)可诱发的患者与非诱发的患者相比，事件的RR也没有显著增加(RR 1.88[95%CI 0.62，5.73]，P=0.27)；但纳入的研究存在显著的异质性。结论：我们的研究结果表明，晕厥或SCD病史、自发性I型Brugada心电图的存在以及男性性别预示着更恶性的自然病史。我们的发现不支持使用SCD家族史、SCN5A基因突变的存在或EPS来指导Brugada心电图患者的治疗。
Objectives: We performed a meta-analysis of prognostic studies of patients with a Brugada ECG to assess predictors of events.Background: The Brugada syndrome is an increasingly recognized cause of idiopathic ventricular fibrillation; however, there is wide variation in the prognosis of patients with the Brugada ECG.Methods and Results: We retrieved 30 prospective studies of patients with the Brugada ECG, accumulating data on 1,545 patients. Summary estimates of the relative risk (RR) of events (sudden cardiac death [SCD], syncope, or internal defibrillator shock) for a variety of potential predictors were made using a random-effects model. The overall event rate at an average of 32 months follow-up was 10.0% (95% CI 8.5%, 11.5%). The RR of an event was increased (P < 0.001) among patients with a history of syncope or SCD (RR 3.24 [95% CI 2.13, 4.93]), men compared with women (RR 3.47 [95% CI 1.58, 7.63]), and patients with a spontaneous compared with sodium-channel blocker induced Type I Brugada ECG (RR 4.65 [95% CI 2.25, 9.58]). The RR of events was not significantly increased in patients with a family history of SCD (P = 0.97) or a mutation of the SCN5A gene (P = 0.18). The RR of events was also not significantly increased in patients inducible compared with noninducible by electrophysiologic study (EPS) (RR 1.88 [95% CI 0.62, 5.73], P = 0.27); however, there was significant heterogeneity of the studies included.Conclusions: Our findings suggest that a history of syncope or SCD, the presence of a spontaneous Type I Brugada ECG, and male gender predict a more malignant natural history. Our findings do not support the use of a family history of SCD, the presence of an SCN5A gene mutation, or EPS to guide the management of patients with a Brugada ECG.