June 26, 2009European Heart Journal178 citationsOpen Access

Magnetic resonance investigations in Brugada syndrome reveal unexpectedly high rate of structural abnormalities

OCOronzo CatalanoIstituti Clinici Scientifici Maugeri SAS. AntonaciUniversità Cattolica del Sacro Cuore GMGuido E. MoroMothers’ Milk Bank

Structured PICO

Does cardiac magnetic resonance imaging detect structural abnormalities in patients with Brugada syndrome compared to matched normal volunteers?

Population

30 consecutive patients with Brugada syndrome (BrS) and 30 sex-, body surface area-, and age-matched normal volunteers (total n=60).

Intervention

Cardiac magnetic resonance imaging (CMRI) including long- and short-axis ECG-gated breath-hold morphological T1-TSE sequences and cine-SSFP sequences

Comparator

Normal volunteers matched for sex, body surface area, and age

Outcome

Cardiac morphology and function, including fatty infiltration, right ventricle wall-motion abnormalities, outflow tract ejection fraction, inflow tract dimensions, and global RV volumessurrogate

CMRI detects a high prevalence of mild structural changes in the right ventricle of patients with Brugada syndrome, suggesting the disease may involve structural abnormalities rather than occurring in a completely structurally normal heart.

Abstract

AIMS: Recent data suggest that sub-clinical structural abnormalities may be part of the Brugada syndrome (BrS) phenotype, a disease traditionally thought to occur in the structurally normal heart. In this study, we carried out detailed assessment of cardiac morphology and function using cardiac magnetic resonance imaging (CMRI). METHODS AND RESULTS: Thirty consecutive patients with BrS were compared with 30 sex- (26/4 male/female), body surface area- (+/-0.2 m(2)), and age-matched (+/-5 years) normal volunteers. CMRI exam included long- and short-axis ECG-gated breath-hold morphological T1-TSE sequences for fatty infiltration and cine-SSFP sequences for kinetic assessment. Fatty infiltration was not found in any subject. Patients with BrS compared with normal subjects showed higher incidence of mild right ventricle (RV) wall-motion abnormalities 15 (50%) vs. 5 (17%) subjects (P = 0.006) with reduced radial fractional shortening in more than two segments, reduction of outflow tract ejection fraction (49 +/- 11% vs. 55 +/- 10%; P = 0.032), enlargement of the inflow tract diameter (46 +/- 4 vs. 41 +/- 5 mm, P < 0.001 in short-axis; 46 +/- 4 vs. 42 +/- 5 mm, P = 0.001 in four-chamber long-axis view) and area (22 +/- 2 vs. 20 +/- 3 cm(2); P = 0.050), and of global RV end-systolic volume (34 +/- 10 vs. 30 +/- 6 mL/m(2); P = 0.031) but comparable outflow tract dimensions, global RV end-diastolic volume, left ventricle parameters, and atria areas. CONCLUSION: CMRI detects a high prevalence of mild structural changes of the RV, and suggests further pathophysiological complexity in BrS. Prospective studies to assess the long-term evolution of such abnormalities are warranted.

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