Long‐Term Prognosis of Brugada‐Type ECG and ECG With Atypical ST‐Segment Elevation in the Right Precordial Leads Over 20 Years: Results From the Circulatory Risk in Communities Study (CIRCS)

Abstract

BackgroundBrugada syndrome is recognized as being associated with sudden cardiac death; however, the prevalence of non–type 1 Brugada‐type ECG (BrS) or atypical ST‐segment elevation in the right precordial leads (STERP) and the long‐term prognosis for those patients remain unknown.Methods and ResultsWe analyzed standard 12‐lead ECGs of 7178 apparently healthy participants (age range 40–64 years) who underwent health checkups from 1982 to 1986 in the Circulatory Risk in Communities Study, a prospective, large, community‐based cohort study in Japan. ECGs with J point amplitude ≥0.2 mV in the right precordial leads were divided into 3 groups: (1) type 1 BrS, (2) type 2 or 3 BrS (non‐type 1 BrS), and (3) STERP. The others served as the non–ST‐segment elevation group. We identified 8 participants (0.1%) with type1 BrS, 84 (1.2%) with non–type 1 BrS, and 228 (3.2%) with STERP. During a median follow‐up of 18.7 years (133 987.0 person‐years), sudden cardiac death was observed in no participants (0.0%) with type 1 BrS, in 1 (1.2%) with non–type 1 BrS, in 7 (3.1%) with STERP, and in 50 (0.7%) with non–ST‐segment elevation. Participants with STERP had a markedly elevated risk of sudden cardiac death (multivariable hazard ratio 3.9, 95% CI 1.7–9.0).Conclusions STERP was associated with an elevated risk of sudden cardiac death in a middle‐aged population.

The 10-Year Prognosis and Prevalence of Brugada-Type Electrocardiograms in Elderly Women

“…In concordance with previous results reported for mixed populations of men and women 35 , 36 and those focused on men only, 42 our study adds further evidence that women with BrP tended to have significantly lower body mass index than those without (24.6 ± 3.6 vs 21.8 ± 3.0; P < .001). This relationship between low body mass index and a BrP was also reported in the Japanese population, 45 the Thai population, 40 and a Portuguese family with BrS.…”

“…Most previous studies focused only on men or reported the results for the sexes combined. In 2 exceptions, women made up most of Tsuji et al's 35 and Tsuneoka's 36 studies (n = 10 662 [73%] and n = 6114 [59.8%], respectively], and some of them were positive for a BrP, but the follow-up results did not clarify the sex ratio for events, such as sudden death or other kinds of mortality. None of the community studies looked into the outcomes that specifically happened to women.…”

Classification, Epidemiology, and Global Burden of Cardiomyopathies

“…28,29,35 Criteria for the diagnosis of Brugada syndrome include a type 1 ECG pattern (coved ST-segment elevation with J point amplitude ≥0.2 mV followed by negative T wave) with at least 1 additional feature suggestive of arrhythmia (eg, unexplained sudden cardiac death aged <45 years in a relative). 25,36 The prevalence of catecholaminergic polymorphic ventricular tachycardia is unknown, and reported figures of 1: 5000/10 000 may be an underestimate of this condition which typically presents with exercise-related syncope and sudden death in children and adolescents despite normal ECG and 2-dimensional echocardiographic studies. 37,38 Overall, cardiomyopathy is an important problem.…”

The Circulatory Risk in Communities Study (CIRCS): A Long-Term Epidemiological Study for Lifestyle-Related Disease Among Japanese Men and Women Living in Communities

“…CIRCS has led to the identification of several novel risk/preventive factors for CVD: lipids (eg, serum fatty acids composition 26 , 27 and high-density lipoprotein (HDL)-cholesterol particle size 28 ), glucose tolerance (non-fasting blood glucose 29 , 30 ), other biochemical factors (serum liver/biliary tract enzymes, 31 , 32 serum homocysteine, 33 serum C-reactive protein, 34 and adiponectins 35 ), hematological factors (leukocyte counts 36 ), fibrinolytic factors (plasma fibrinogen 37 – 39 ), electrocardiographic factors (ischemic abnormalities 40 , 41 and Brugada-type electrocardiogram 42 ), other physiological factors (carotid atherosclerosis 43 and ankle-brachial blood pressure index 44 ), dietary factors (fat and protein intakes 45 ), psychosomatic factors (depressive symptoms 46 ), height, 47 snoring, 48 metabolic syndrome, 49 , 50 chronic kidney disease, 51 and subclinical end-organ damage, 52 as well as traditional risk factors (eg, alcohol, 53 – 55 smoking, 56 blood glucose/diabetes, 57 , 58 blood pressure, 1 , 5 , 11 , 59 total-, 1 , 5 , 11 LDL-, 60 non-HDL- 61 and HDL-cholesterols, 62 , 63 and triglycerides 64 , 65 ). Recent reports included risk or preventive factors for dementia, such as smoking, 66 C-reactive protein, 67 serum coenzyme Q10, 68 serum α-linoleic acid, 69 and retinal vascular changes.…”