Contribution of the vectorcardiogram in the differential diagnosis of Brugada electrocardiographic pattern.

Autor: Madaloso BA; Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, AB - CEP 05403-000 São Paulo, Brazil. Electronic address: brunamadaloso@uol.com.br., Samesima N; Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, AB - CEP 05403-000 São Paulo, Brazil. Electronic address: nsamesima@hotmail.com., Tobias NMMO; Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, AB - CEP 05403-000 São Paulo, Brazil. Electronic address: nancy.tobias@uol.com.br., Tavares CAM; Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, AB - CEP 05403-000 São Paulo, Brazil. Electronic address: caio.tavares@usp.br., Pereira Filho HG; Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, AB - CEP 05403-000 São Paulo, Brazil. Electronic address: hgpfilho@gmail.com., Facin ME; Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, AB - CEP 05403-000 São Paulo, Brazil. Electronic address: mirellafacin@gmail.com., Pastore CA; Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, AB - CEP 05403-000 São Paulo, Brazil. Electronic address: ecg_pastore@incor.usp.br.
Jazyk: angličtina
Zdroj: Journal of electrocardiology [J Electrocardiol] 2022 May-Jun; Vol. 72, pp. 131-137. Date of Electronic Publication: 2022 Mar 30.
DOI: 10.1016/j.jelectrocard.2022.03.008
Abstrakt: Background: The electrocardiogram (ECG) is a powerful tool for differential diagnosis among a group of pathologies with different therapeutic approaches/prognoses, the so-called J-wave syndrome. The vectorcardiogram (VCG) can be used as a complementary method to the ECG in several dubious electrocardiographic alterations.
Objective: We carried out a VCG analysis after conceiving and measuring a novel parameter (JT-distance) that allows diagnosis of the Brugada ECG pattern.
Methods: A retrospective cohort study selected ninety-six ECGs with J-point elevation in V 1 /V 2 , ECG superior leads and VCGs, all performed on the same day. A new VCG measurement by Frank method (JT-distance) was conceived and designed in transverse and right sagittal planes by 3 lines drawn 1) at the final third of the QRS loop, comprehending the J-point; 2) at the initial portion of the T loop; 3) a parallel of the J-point line at the beginning of the T loop. JT measure was determined by the distance between parallels. A validation cohort was established in a new sample of thirty-five patients.
Results: JT-distance ≥1.5 mm (tranverse plane) and JT-distance >1.25 mm, in the sagittal plane, differentiated Brugada type-1 from Brugada type-2, early repolarization and others, with 95% sensitivity and 68% specificity. JT-distance <1.5 mm (transverse plane) and JT >1.25 mm (sagittal plane) had 100% sensitivity and 85% specificity for Brugada type-1 diagnosis. A validation cohort showed very similar Cohen's kappa levels (0.65 and 0.77, test and validation cohorts, respectively), with overlapping 95% confidence intervals.
Conclusions: The novel vectorcardiogram measurement (JT-distance) presented a new diagnostic criterion to identify Brugada pattern. Nevertheless, prospective studies should be performed by other centers to confirm these findings.
(Copyright © 2022 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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