Exercise-induced ST elevation in patients with arrhythmogenic right ventricular dysplasia

Toyofuku, Mamoru; Takaki, Hiroshi; Sunagawa, Kenji; Kurita, Takashi; Shimizu, Wataru; Suyama, Kazuhiko; Aihara, Naohiko; Kamakura, Shiro

doi:10.1016/s0022-0736(99)90015-8

Cited by 17 publications

(5 citation statements)

References 12 publications

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“…A dilated RV with a normal pulmonary trunk might signify ARVC, but dilatation of both RV and pulmonary trunk is more indicative for pulmonary hypertension [31,32]. In our study severe RV dilatation was seen in majority of ARVC patients (64.7%) and in 16.7% of the non-ARVC group.…”

Section: Discussionsupporting

confidence: 42%

The value of magnetic resonance imaging for the diagnosis of arrhythmogenic right ventricular cardiomyopathy

et al. 2005

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This study evaluated the diagnostic significance of a magnetic resonance imaging (MRI) based scoring model for identification of arrhythmogenic right ventricular cardiomyopathy (ARVC) in patients with MRI evidence of RV abnormalities. Fifty-three patients with RV myocardial abnormalities on MRI were divided into a group with ARVC 1 (n=17) and a group with other RV arrhythmias (n=37). Decision tree learning (DTL) and linear classification (based on a modified ARVC scoring model of major and minor criteria) were used to identify and assess MRI criterion information value, and to induce ARVC diagnostic rules. All major ARVC criteria were more frequent in the ARVC group. Among minor criteria regional RV hypokinesia, mild segmental RV dilatation, and prominent trabeculae were more frequent in the ARVC group while mild global RV dilatation was more frequent in the non-ARVC group. RV aneurysm achieved highest importance in ARVC diagnosis (predictive accuracy 76.8%). Better diagnostic accuracy (sensitivity 93.3%, specificity 89.5%) was achieved when the MRI score for the major and minor criteria reached threshold value of four: two major criteria, or one major and two minor, or four minor criteria. Combinations between major and minor criteria contributed to a statistically valid model for ARVC diagnosis.

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Section: Discussionsupporting

confidence: 42%

The value of magnetic resonance imaging for the diagnosis of arrhythmogenic right ventricular cardiomyopathy

et al. 2005

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“…ECG normalisation of the ST segment by increasing the heart rate has been reported in patients with Brugada syndrome 67 9Recently, exercise induced ST segment elevation, which was frequently observed in V1 to V3, was reported in 65% of patients with arrhythmogenic right ventricular dysplasia 13. It has also been reported that arrhythmogenic right ventricular cardiomyopathy may underlie the cardiac manifestations in Brugada syndrome 14…”

Section: Discussionmentioning

confidence: 98%

Prevalence of asymptomatic ST segment elevation in right precordial leads with right bundle branch block (Brugada-type ST shift) among the general Japanese population

Furuhashi

Uno

Tsuchihashi

et al. 2001

Heart

102

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Objective-To examine the modality and morbidity of asymptomatic ST segment elevation in leads V1 to V3 with right bundle branch block (Brugada-type ST shift). Methods-8612 Japanese subjects (5987 men and 2625 women, mean age 49.2 years) who underwent a health check up in 1997 were investigated. Those with Brugada-type ST shift underwent the following further examinations over a two year period after the initial check up: ECG, echocardiogram, 24 hour Holter monitoring, treadmill exercise testing, signal averaged ECG, and slow kinetic sodium channel blocker loading test (cibenzoline, 1.4 mg/kg). Results-Asymptomatic Brugada-type ST shift was found in 12 of 8612 (0.14%) subjects. Eleven of these 12 subjects were followed up. Follow up ECG exhibited persistent Brugada-type ST shift in seven of 11 (63.6%) subjects. ST shift was transformed from a saddle back to a coved type in three subjects. None of the subjects had morphological abnormalities or abnormal tachyarrhythmias. Positive late potentials were found in seven of 11 (63.6%) subjects. Augmentation of ST shift was shown by both submaximal exercise and drug administration in one of the 11 subjects (9.1%). Conclusions-Asymptomatic subjects with Brugada-type ST shift were not unusual, at a rate of 0.14% in the general Japanese population. Almost all of the subjects had some abnormalities in non-invasive secondary examinations. Additional and prospective studies are needed to confirm the clinical significance and the prognosis of asymptomatic Brugada-type ST shift. (Heart 2001;86:161-166) Keywords: Brugada syndrome; signal averaged electrocardiogram; sodium channel blocker; sudden death Since Brugada and Brugada 1 first described eight cases of characteristic ECG features consisting of right bundle branch block (RBBB) and persistent ST segment elevation in leads V1 to V3 (Brugada-type ST shift) associated with aborted cardiac sudden death without structural heart diseases, clinical evidence of a link between Brugada-type ST shift and cardiac sudden death has been accumulating. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Because of increasing awareness of this evidence, a Brugada-type ST shift is being discovered incidentally in more and more asymptomatic subjects. Some recent reports describe Brugada-type ST shift recognised in asymptomatic subjects.5 15 However, the clinical significance of Brugada-type ST shift in asymptomatic subjects is unclear. Therefore, it is still not known whether a Brugada-type ST shift is a specific indicator of ventricular fibrillation or a life threatening sign of sudden cardiac death.On the basis of these speculations, we investigated the prevalence of asymptomatic Brugada-type ST shift in the general Japanese population and performed secondary cardiovascular examinations focusing on latent myocardial involvement in the screened subjects. Methods STUDY POPULATIONThe study population consisted of 8612 adult Japanese subjects (5987 men and 2625 women) ranging in age from 22-84 years (mean 49.2 years). All...

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“…With exercise testing, ventricular arrhythmias are provoked in 50 to 60% of patients [70]. Lack or worsening of the arrhythmias does not exclude ARVD.…”

Section: Exercise Testingmentioning

confidence: 99%

Arrhythmogenic Right Ventricular Dysplasia: MRI Findings

Wall

Kayser

Bootsma

et al. 2000

Herz

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Arrhythmogenic right ventricular dysplasia (ARVD) is a heart muscle disorder of unknown cause that is characterized pathologically by fibrofatty replacement of the right ventricular myocardium. Clinical manifestations include structural and functional malformations of the right ventricle, electrocardiographic abnormalities, and presentation with ventricular tachycardias with left bundle branch pattern or sudden death. The disease is often familial with an autosomal inheritance. In addition to right ventricular dilatation, right ventricular aneurysms are typical deformities of ARVD and they are distributed in the so-called "triangle of dysplasia", i.e., right ventricular outflow tract, apex, and infundibulum. Ventricular aneurysms at these sites can be considered pathognomonic of ARVD. Another typical hallmark of ARVD is fibrofatty infiltration of the right ventricular free wall. These functional and morphologic characteristics are relevant to clinical imaging investigations such as contrast angiography, echocardiography, radionuclide angiography, ultrafast computed tomography, and magnetic resonance imaging (MRI). Among these techniques, MRI allows the clearest visualization of the heart, in particular because the right ventricle is involved, which is usually more difficult to explore with the other imaging modalities. Furthermore, MRI offers the specific advantage of visualizing adipose infiltration as a bright signal of the right ventricular myocardium. MRI provides the most important anatomic, functional, and morphologic criteria for diagnosis of ARVD within one single study. As a result, MRI appears to be the optimal imaging technique for detecting and following patients with clinical suspicion of ARVD.

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Exercise-induced ST elevation in patients with arrhythmogenic right ventricular dysplasia

Cited by 17 publications

References 12 publications

The value of magnetic resonance imaging for the diagnosis of arrhythmogenic right ventricular cardiomyopathy

The value of magnetic resonance imaging for the diagnosis of arrhythmogenic right ventricular cardiomyopathy

Prevalence of asymptomatic ST segment elevation in right precordial leads with right bundle branch block (Brugada-type ST shift) among the general Japanese population

Arrhythmogenic Right Ventricular Dysplasia: MRI Findings

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