Evaluation of Brugada syndrome by cardiac magnetic resonance

Abstract

Brugada syndrome (BrS) has been originally considered to occur in structural normal hearts. However recent pathological and imaging data suggest that structural and functional changes may be present in this syndrome. This study was designed to elucidate whether any macroscopic heart abnormality is detectable in patients with BrS. For this purpose we used cardiac magnetic resonance (CMR). Twenty-nine patients displaying the BrS type-1 ECG pattern and 29 healthy controls underwent CMR (1.5 Tesla). Left (LV) and right ventricular (RV) dimensions, function and regional contractility were evaluated. Late-gadolinium-enhancement (LGE) imaging was obtained in 24 patients. We found no difference between BrS patients and controls regarding LV and RV dimensions and ejection fraction. RV wall motion abnormalities (WMA) were detected in 19 patients (65.5%) and in 22 control subjects (75.9%). The majority of these WMA were attributable to areas of hypokinesia and found in the RV inferior wall. None of the patients showed LGE. No differences were detected between controls and the different subgroups of BrS patients according to symptoms, family history and spontaneous type-1 ECG pattern. BrS patients do not differ from normal subjects with regard to dimensions and global function of both LV and RV. BrS patients may show RV-WMA, however similar changes are also present in healthy subjects and may therefore represent a physiological behaviour of RV. The lack of LGE further confirms the absence of myocardial structural damage. Our results indicate that BrS seems to occur in individuals with structurally and functionally normal heart.

Relations between right ventricular morphology and clinical, electrical and genetic parameters in Brugada Syndrome

“…Studies have demonstrated significantly larger RVOT area and reduced RVOT ejection fraction in BrS patients compared with normal controls[ 5 , 6 , 13 , 14 ]. However this has not been a universal finding[ 26 ]. Using quantitative analysis of the RV and RVOT, we confirmed that the overall incidence of RVOT morphologic abnormalities was high, being 67% in our cohort.…”

Recurrent exercise-induced ventricular tachycardia in a patient with Brugada syndrome

“…While some studies have demonstrated either decreased RV systolic function or increased RV dimensions, others have found no increased prevalence of abnormal findings as compared to a control population. 13,14 Evidence of LGE was noted in 1 of 2 studies with 8% in BS patients vs 0% in matched controls (P 5 .028). 13,14 Furthermore, 1 study of T1 mapping showed 20% prevalence of elevated T1 signal consistent with fat signal, a marker of AC, in BS patients vs none in controls.…”

Brugada Syndrome: A Heterogeneous Disease with a Common ECG Phenotype?

“…Similarly, in a study of 30 BrS patients compared to 30 age and sex matched controls, the BrS patients were found to have higher incidence of mild RV wall motion abnormalities, reduced RVOT EF and increased RV inflow tract diameter with no fatty infiltration seen in either group . However, these morphologic changes may be heterogeneous because the finding of structural abnormalities was not replicated in another cMRI study of 29 BrS patients compared with 20 normal controls …”