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Right ventricle deformation imaging use in Brugada Syndrome patients: a useful tool?
Session:
Painel 3 - Imagiologia Cardiovascular 3
Speaker:
Dinis Mesquita
Congress:
CPC 2020
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Posters
FP Number:
---
Authors:
Dinis Valbom Mesquita; Marta Ferreira Fonseca; Leonor Parreira; Rita Marinheiro; José Maria Farinha; Pedro Campos Amador; Artur Lopes; Ana Fátima Esteves; Antonio Pinheiro Cumena Candjondjo; Rui Caria
Abstract
<p><strong>Introduction</strong>: In spite Brugada Syndrome (BS) is classically a channelopathy commonly found in apparently normally structural hearts, subtle functional and morphological alterations were previously demonstrated in vivo and post-mortem in BS patients. As deformation imaging is a sensible imaging technique able to show mild alternations in regional and global function of the right and left ventricles, it is unclear whether its use in BS has any diagnostic yield.</p> <p><strong>Purpose</strong>: We aim to evaluate if right ventricle deformation imaging is a useful tool that can be added to the evaluation of patients with Brugada Syndrome, as a proof of concept unveiling a marker of the disease in high risk patients.</p> <p><strong>Methods</strong>: We performed a retrospective study in a high risk Brugada Syndrome cohort with previous ICD implant by standard of care criteria, and prospectively assessed longitudinal strain (LS) of the right ventricle (RV) in the focused apical 4 chamber view including free wall and interventricular septum with a Vivid E95 from GE® and its dedicated EchoPac workstation for offline analysis, as well as RV mechanical dispersion (MD RV) and left ventricle global longitudinal strain. A population of healthy controls was also assessed in order to compare deformation imaging of the RV to BS patients and we further analyzed differences between BS patients who had previously documented life-threatening ventricular arrhythmias.</p> <p><strong>Results</strong>: A cohort of 12 healthy controls and 9 BS patients was included, all of which with ejection fraction in the normal range, with apparently structural normal hearts and in sinus rythm. BS patients were predominantly male (5, 55,5%), with a mean age of 50 years (IQR 40-61). Of these, 5 patients (55,5%) had ICD implant for primary prevention. Syncope was documented in 5 patients (55,5%), type 1 spontaneous ECG pattern in 7 (77,8%) and an EPS was performed and positive in 4 (44,4%). One patient had an arrhythmic storm and 1 (11,1%) patient had appropriate ICD therapy for VA. Follow up duration was 90,7 months (IQR 28-175).</p> <p>BS patients had a median RV LS of -21,6 (IQR -22,8; -20,3) and MD of RV of 41,9 (IQR 14,3-91,7) and healthy controls a median RV LS of -22,8 (IQR -24; -20,6) and a MD or RV of 39,5 (16,6-50,6) (non-significant), table 1. Among BS, there were no significant differences in RV LS or MD of RV between patients with type 1 or type 2 ECG, previous syncope or in whom ICD was implanted for secondary prevention or had VA treated by ICD, as well as among other parameters of RV function or LV GLS (table 1).</p> <p><strong>Conclusions</strong>: Among Brugada Syndrome patients, abnormal motion contractility or electrical desynchrony of the right ventricle, as expected to be present with previous studies demonstrating structural alterations in the RV among these patients, are not evident among this cohort when assessed by longitudinal strain and mechanical dispersion.</p>
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