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Rattanawong P, Mattanapojanat N, Mead-Harvey C, Van Der Walt C, Kewcharoen J, Kanitsoraphan C, Vutthikraivit W, Prasitlumkum N, Putthapiban P, Chintanavilas K, Sahasthas D, Ngarmukos T, Thakkinstian A, Sorajja D, Makarawate P, Shen WK. Predicting arrhythmic event score in Brugada syndrome: Worldwide pooled analysis with internal and external validation. Heart Rhythm 2023; 20:1358-1367. [PMID: 37355026 DOI: 10.1016/j.hrthm.2023.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 06/02/2023] [Accepted: 06/16/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Brugada syndrome is an inherited arrhythmic disease associated with major arrhythmic events (MAE). Risk predictive scores were previously developed with various performances. OBJECTIVE The purpose of this study was to create a novel score-Predicting Arrhythmic evenT (PAT)-with internal and external validation. METHODS A systematic review was performed to identify risk factors for MAE. The odds ratios (ORs) of each factor were pooled across studies. The PAT scoring scheme was developed based on pooled ORs. The PAT score was internally validated with published 105 Asian patients (follow-up 8.0 ± 4.1 [SD] years) and externally validated with unpublished 164 multiracial patients (82.3% White, 14.6% Asian, 3.2% Black; mean follow-up 8.0 ± 6.9 years) with Brugada syndrome. Performances were assessed and compared with previous scores using receiver operating characteristic curve (ROC) analysis. RESULTS Sixty-seven studies published between 2002 and 2022 from 26 countries (7358 patients) were included. Pooled ORs were estimated, indicating that 15 of 23 risk factors were significant. The PAT score was then developed accordingly. The PAT score had significantly better discrimination (ROC 0.9671) than the BRUGADA-RISK score (ROC 0.7210; P = .006), Shanghai Score System (ROC 0.7079; P = .003), and Sieira et al score (ROC 0.8174; P = .026) in an external validation cohort. PAT score ≥ 10 predicted the first MAE with 95.5% sensitivity and 89.1% specificity (ROC 0.9460) and the recurrent MAE (ROC 0.7061) with 15.4% sensitivity and 93.3% specificity. CONCLUSION The PAT score was shown to be useful in predicting MAE for primary prevention in patients with Brugada syndrome.
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Affiliation(s)
- Pattara Rattanawong
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona; Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Carolyn Mead-Harvey
- Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, Arizona
| | | | - Jakrin Kewcharoen
- Division of Cardiology, Department of Medicine, Loma Linda University, Loma Linda, California
| | | | - Wasawat Vutthikraivit
- Division of Cardiovascular Diseases, Department of Internal Medicine, University of Iowa, Iowa City, Iowa
| | - Narut Prasitlumkum
- Department of Cardiology, University of California Riverside, Riverside, California
| | - Prapaipan Putthapiban
- Division of Cardiology, Department of Medicine, Loma Linda University, Loma Linda, California
| | - Kumpol Chintanavilas
- Cardiology Department, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand
| | | | - Tachapong Ngarmukos
- Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ammarin Thakkinstian
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Dan Sorajja
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona
| | | | - Win-Kuang Shen
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona.
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Lee S, Chung CT, Chou OHI, Lee TTL, Radford D, Jeevaratnam K, Wong WT, Cheng SH, Mok NS, Liu T, Tse G. Attendance-related Healthcare Resource Utilisation and Costs in Patients With Brugada Syndrome in Hong Kong: A Retrospective Cohort Study. Curr Probl Cardiol 2023; 48:101513. [PMID: 36414041 DOI: 10.1016/j.cpcardiol.2022.101513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 11/13/2022] [Indexed: 11/21/2022]
Abstract
Understanding health care resource utilisation and its associated costs are important for identifying areas of improvement regarding resource allocations. However, there is limited research exploring this issue in the setting of Brugada syndrome (BrS).This was a retrospective territory-wide study of BrS patients from Hong Kong. Healthcare resource utilisation for accident and emergency (A&E), inpatient and specialist outpatient attendances were analyzed over a 19-year period, with their associated costs presented in US dollars. A total of 507 BrS patients with a mean presentation age of 49.9 ± 16.3 years old were included. Of these, 384 patients displayed spontaneous type 1 electrocardiographic (ECG) Brugada pattern and 77 patients had presented with ventricular tachycardia/ventricular fibrillation (VT/VF). At the individual patient level, the median annualized costs were $110 (52-224) at the (A&E) setting, $6812 (1982-32414) at the inpatient setting and $557 (326-1001) for specialist outpatient attendances. Patients with initial VT/VF presentation had overall greater costs in inpatient ($20161 [9147-189215] vs $5290 [1613-24937],P < 0.0001) and specialist outpatient setting ($776 [438-1076] vs $542 [293-972],P = 0.015) compared to those who did not present VT. In addition, patients without Type 1 ECG pattern had greater median costs in the specialist outpatient setting ($7036 [3136-14378] vs $4895 [2409-10554],p=0.019). There is a greater health care demand in the inpatient and specialist outpatient settings for BrS patients. The most expensive attendance type was inpatient setting stay at $6812 per year. The total median annualized cost of BrS patients without VT/VF presentation was 78% lower compared to patients with VT/VF presentation.
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Affiliation(s)
- Sharen Lee
- Cardiac Electrophysiology Unit, Cardiovascular Analytics Group, Hong Kong, Hong Kong, P. R. China-UK
| | - Cheuk To Chung
- Cardiac Electrophysiology Unit, Cardiovascular Analytics Group, Hong Kong, Hong Kong, P. R. China-UK
| | - Oscar Hou In Chou
- Cardiac Electrophysiology Unit, Cardiovascular Analytics Group, Hong Kong, Hong Kong, P. R. China-UK
| | - Teddy Tai Loy Lee
- Cardiac Electrophysiology Unit, Cardiovascular Analytics Group, Hong Kong, Hong Kong, P. R. China-UK
| | - Danny Radford
- Kent and Medway Medical School, Canterbury, Kent, UK
| | | | - Wing Tak Wong
- School of Life Sciences, Chinese University of Hong Kong, Hong Kong, Hong Kong, P. R. China
| | - Shuk Han Cheng
- Department of Biomedical Sciences, City University of Hong Kong, Hong Kong, Hong Kong, P.R.China
| | - Ngai Shing Mok
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong Hospital Authority, Hong Kong, Hong Kong, P.R.China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, Tianjin, P.R.China.
| | - Gary Tse
- Kent and Medway Medical School, Canterbury, Kent, UK; Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, Tianjin, P.R.China; School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China.
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Golubenko M, Mikhailov V, Rusinova V, Shestak A, Zaklyazminskaya E. Lack of association between mitochondrial DNA haplogroups J and T and clinical manifestation in Russian patients with Brugada syndrome. Biomed Rep 2020; 13:16. [PMID: 32765855 DOI: 10.3892/br.2020.1324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 04/16/2020] [Indexed: 11/06/2022] Open
Abstract
Brugada syndrome (BrS) is an inherited disorder characterized by specific ST segment elevation in the right precordial leads, pseudo right bundle branch block, and a high risk of sudden cardiac death due to ventricular tachycardia. It was initially described as a monogenic disorder with an autosomal dominant mode of inheritance. It is hypothesized that modifying genetic factors, in addition to disease-causing mutations, may significantly contribute to the clinical symptoms and the risk of sudden cardiac death. These modifying factors can include mitochondrial DNA (mtDNA) variants. In particular, combination of mtDNA m.T4216C, m.A11251G, m.C15452A and m.T16126C variants (defining haplogroups T and J), is considered to be a factor that promotes manifestation of BrS manifestation, with no pro-arrhythmic effects. The aim of the present study was to confirm the reported association of BrS with MtDNA variants in a cohort of Russian patients. mtDNA haplogroups were genotyped in 47 Russian BrS probands and the prevalence of common mtDNA haplogroups was compared with the general population in European part of Russia. The distribution and prevalence of all but the J mtDNA haplogroups were comparable in BrS probands and the general Russian population. The mitochondrial J haplogroup was not found in the BrS cohort. In conclusion, it was shown that the mtDNA polymorphism, m.T4216C (haplogroups J and T) does not contribute significantly to the clinical manifestation of BrS in Russian patients.
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Affiliation(s)
- Maria Golubenko
- Laboratory of Population Genetics, Research Institute of Medical Genetics, Tomsk National Research Medical Centre of The Russian Academy of Sciences, Tomsk 634050, Russia
| | - Vadim Mikhailov
- Petrovsky National Research Centre of Surgery, Moscow 119991, Russia
| | - Valeria Rusinova
- Petrovsky National Research Centre of Surgery, Moscow 119991, Russia
| | - Anna Shestak
- Petrovsky National Research Centre of Surgery, Moscow 119991, Russia
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Rattanawong P, Kewcharoen J, Kanitsoraphan C, Vutthikraivit W, Putthapiban P, Prasitlumkum N, Mekraksakit P, Mekritthikrai R, Chung EH. The utility of drug challenge testing in Brugada syndrome: A systematic review and meta‐analysis. J Cardiovasc Electrophysiol 2020; 31:2474-2483. [DOI: 10.1111/jce.14631] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/17/2020] [Accepted: 06/21/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Pattara Rattanawong
- Department of Cardiovascular Medicine Mayo Clinic Phoenix Arizona
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital Mahidol University Bangkok Thailand
| | - Jakrin Kewcharoen
- Internal Medicine Residency Program University of Hawaii Honolulu Hawaii
| | | | - Wasawat Vutthikraivit
- Department of Internal Medicine Texas Tech University Health Sciences Center Lubbock Texas
| | | | - Narut Prasitlumkum
- Internal Medicine Residency Program University of Hawaii Honolulu Hawaii
| | - Poemlarp Mekraksakit
- Department of Internal Medicine Texas Tech University Health Sciences Center Lubbock Texas
| | | | - Eugene H. Chung
- Department of Internal Medicine, Frankel Cardiovascular Center, Michigan Medicine University of Michigan Ann Arbor Michigan
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The 10-Year Prognosis and Prevalence of Brugada-Type Electrocardiograms in Elderly Women: A Longitudinal Nationwide Community-Based Prospective Study. J Cardiovasc Nurs 2020; 35:E25-E32. [PMID: 32609463 PMCID: PMC7553189 DOI: 10.1097/jcn.0000000000000722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/30/2022]
Abstract
BACKGROUND Brugada syndrome is a disorder associated with sudden cardiac death and characterized by an abnormal electrocardiogram (ECG). Previous studies were predominantly conducted in men, and the data on long-term prognosis are limited. Information about women, especially elderly women, is lacking. OBJECTIVE The aim of this study was to investigate the long-term prognosis of the Brugada ECG pattern in elderly women. METHOD We investigated the 10-year prognosis of the Brugada ECG pattern in elderly women in a nationwide community-based population in Taiwan. Community-dwelling women older than 55 years were prospectively recruited from December 2008 to March 2013 by a stratified random sampling method. All enrolled individuals were followed up annually until April 2019, and the cause of death was documented by citizen death records. RESULTS Among 2597 women, 60 (2.31%) had a Brugada-type ECG, and this prevalence was higher than the mean global prevalence of 0.23%. One woman had a type 1 ECG (0.04%), whereas 15 (0.58%) and 44 (1.70%) women had type 2 and type 3 ECG patterns, respectively. Cox survival analysis revealed that all-cause mortality and cardiac mortality were similar in the individuals with and without a Brugada-type ECG during a mean follow-up of 96.1 ± 20.5 months. CONCLUSIONS Our findings suggest that Brugada ECG patterns are not infrequent in elderly women but are not associated with increased risk of mortality in long-term follow-up; these findings may help reduce unnecessary anxiety for physicians, nurses, allied health caregivers, and patients.
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Kewcharoen J, Rattanawong P, Kanitsoraphan C, Mekritthikrai R, Prasitlumkum N, Putthapiban P, Mekraksakit P, Pattison RJ, Vutthikraivit W. Atrial fibrillation and risk of major arrhythmic events in Brugada syndrome: A meta-analysis. Ann Noninvasive Electrocardiol 2019; 24:e12676. [PMID: 31353765 DOI: 10.1111/anec.12676] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 07/03/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Brugada syndrome (BrS) is a common cause of sudden cardiac death (SCD). There is recent evidence that atrial fibrillation (AF) is associated with increased risk of SCD in general population. However, whether AF increases a risk of major arrhythmic events (MAE) in patients with BrS is still unclear. We performed a systematic review and meta-analysis to explore the effect of AF on MAE in BrS population. METHODS We searched the databases of MEDLINE and EMBASE from inception to March 2019. Included studies were published cohort studies reporting rates of MAE (ventricular fibrillation, sustained ventricular tachycardia, SCD, or sudden cardiac arrest) in BrS patients, with and without previous documented AF. Data from each study were combined using the random-effects model. RESULTS Six studies from 1,703 patients were included. There was a significant association between AF and an increased risk of MAE in patients with BrS (pooled OR = 2.37, 95% CI = 1.36-4.13, p-value = .002, I2 = 40.3%). CONCLUSIONS Our meta-analysis demonstrated that AF is associated with an increased risk of MAE in patients with BrS.
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Affiliation(s)
- Jakrin Kewcharoen
- University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA
| | - Pattara Rattanawong
- University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA.,Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | | | - Narut Prasitlumkum
- University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA
| | | | - Poemlarp Mekraksakit
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Robert J Pattison
- University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA
| | - Wasawat Vutthikraivit
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Rattanawong P, Chenbhanich J, Mekraksakit P, Vutthikraivit W, Chongsathidkiet P, Limpruttidham N, Prasitlumkum N, Chung EH. SCN5A mutation status increases the risk of major arrhythmic events in Asian populations with Brugada syndrome: systematic review and meta-analysis. Ann Noninvasive Electrocardiol 2018; 24:e12589. [PMID: 30126015 DOI: 10.1111/anec.12589] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/22/2018] [Accepted: 06/05/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Brugada syndrome (BrS) is an inherited arrhythmic disease linked to SCN5A mutations. It is controversial whether SCN5A mutation carriers possess a greater risk of major arrhythmic events (MAE). We examined the association of SCN5A mutations and MAE in BrS patients. METHODS We comprehensively searched the databases of MEDLINE and EMBASE from inception to September 2017. Included studies were published cohort and case-control studies that compared MAE in BrS patients with and without SCN5A mutations. Data from each study were combined using the random-effects model. Generic inverse variance method of DerSimonian and Laird was employed to calculate the risk ratios (RR) and 95% confidence intervals (CI). RESULTS Seven studies from March 2002 to October 2017 were included (1,049 BrS subjects). SCN5A mutations were associated with MAE in Asian populations (RR = 2.03, 95% CI: 1.37-3.00, p = 0.0004, I2 = 0.0%), patients who were symptomatic (RR = 2.66, 95% CI: 1.62-4.36, p = 0.0001, I2 = 23.0%), and individuals with spontaneous type-1 Brugada pattern (RR = 1.84, 95% CI: 1.05-3.23, p = 0.03, I2 = 0.0%). CONCLUSIONS SCN5A mutations in BrS increase the risk of MAE in Asian populations, symptomatic BrS patients, and individuals with spontaneous type-1 Brugada pattern. Our study suggests that SCN5A mutation status should be an important tool for risk assessment in BrS patients.
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Affiliation(s)
- Pattara Rattanawong
- University of Hawaii Internal Medicine Residency Program, Honolulu, Hawaii.,Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jirat Chenbhanich
- Department of Internal Medicine, Metrowest Medical Center, Framingham, Massachusetts
| | | | - Wasawat Vutthikraivit
- Department of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | | | - Nath Limpruttidham
- University of Hawaii Internal Medicine Residency Program, Honolulu, Hawaii
| | - Narut Prasitlumkum
- University of Hawaii Internal Medicine Residency Program, Honolulu, Hawaii
| | - Eugene H Chung
- Department of Internal Medicine, University of Michigan Medical School, Michigan Medicine, Ann Arbor, Michigan
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