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Doctoral Thesis
DOI
https://doi.org/10.11606/T.5.2021.tde-20102021-111225
Document
Author
Full name
Bruna Affonso Madaloso
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2021
Supervisor
Committee
Pastore, Carlos Alberto (President)
Moreira, Dalmo Antonio Ribeiro
Pinho, Cláudio
Scanavacca, Mauricio Ibrahim
Title in Portuguese
Contribuição do vetorcardiograma no diagnóstico diferencial do padrão eletrocardiográfico de Brugada
Keywords in Portuguese
Canalopatias
Diagnóstico diferencial
Eletrocardiografia
Síndrome de Brugada
Técnica de diagnóstico cardiovascular
Vetorcardiografia
Abstract in Portuguese
O termo elevação do ponto J ganhou destaque atualmente por englobar diferentes situações com manejos terapêuticos e prognósticos diversos. Nesse grupo, a síndrome de Brugada destaca-se com vários estudos realizados na tentativa de diferenciar seus padrões eletrocardiográficos das demais entidades que elevam o ponto J. Na visão vetocardiográfica os estudos anteriores focaram na representação gráfica do padrão de Brugada. Nesse trabalho objetivamos realizar esta análise criando uma nova medida (distância JT) que identificou o padrão de Brugada. Foi estudada uma coorte retrospectiva de Janeiro de 2005 a Julho de 2020 com inclusão de 115 pacientes com elevação do segmento ST em V1 e V2. Destes, após 19 exclusões por alterações que prejudicavam a análise, os 96 remanescentes foram analisados. A idade média foi de 47 ± 16 anos, sendo 80% homens. Grupo 1 (Brugada tipo 1) n= 28; grupo 2 (Brugada tipo 2) n= 18, grupo 3 (outros) n= 50. A distância JT 1,5 mm (plano horizontal) diferenciou os grupos 1 e 2 do grupo 3 (sensibilidade 80%, especificidade 86%). Destes, os que no plano sagital apresentaram a distância JT > 1,25 mm possibilitaram a diferenciação do grupo 1 dos outros dois (sensibilidade 95%, especificidade 68%). Os pacientes que apresentaram distância JT < 1,5 mm no plano horizontal e distância JT > 1,25 mm no plano sagital obtiveram sensibilidade de 100% e especificidade de 85% para o diagnóstico de Brugada tipo 1. Portanto a distância JT no plano horizontal diferenciou o padrão de Brugada de outras entidades clínicas e no plano sagital identificou Brugada tipo 1
Title in English
Contribution of the vectorcardiogram in the differential diagnosis of Brugada electrocardiographic pattern
Keywords in English
Brugada syndrome
Channelopathies
Diagnosis differential
Diagnostic techniques cardiovascular
Electrocardiography
Vectorcardiography
Abstract in English
The J-point elevation term has gained prominence today for encompassing different situations with different therapeutic management and prognosis. In that group, Brugada syndrome stands out with several studies carried out in an attempt to differentiate its electrocardiographic patterns from the other entities that raise the J-point. In the vectorcardiographic view, previous studies focused on the graphic representation of Brugada pattern. In this study we aimed to analyze a new measurement (JT- distance) that identified Brugada pattern. A retrospective cohort study, from January/2005-July/2020, included 115 patients with J-point elevation in V1 and V2. From those, 19 were excluded based on exclusion criteria, and the ECG tracings of the remaining 96 were analyzed. Mean age was 47 ± 16 y.o., mostly men (80%). Group 1 (Brugada type 1) - n=28; Group 2 (Brugada type 2) - n=18; and Group 3 (other entities) - n=50. The JT-distance 1.5 mm (tranverse plane) differentiated Groups 1 and 2 from 3 with sensitivity 80%, specificity 86%. Of these, those with a JT-distance >1.25 mm in the sagittal plane, enabled the differentiation of Group 1 from the other two groups with sensitivity 95%, specificity 68%. The patients with JTdistance < 1.5 mm in the transverse plane and JT >1.25 mm in the sagittal plane had sensitivity of 100% and specificity of 85% for Brugada type 1 diagnosis. Therefore JT-distance in the transverse plane differentiated between Brugada and other clinical entities, and the sagittal plane identified Brugada type 1
 
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Publishing Date
2021-10-25
 
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