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心脏病

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请铭记:心电图(ECG)用于区别运动员心脏和Brugada综合征
原作者: Semhar Tewelde, 江利冰 发布日期:2015-12-07

Title: The Unforgotten: ECG Utilization to Differentiate Athletic Heart vs. Brugada
题目:请铭记:心电图(ECG)用于区别运动员心脏和Brugada综合征
Author: Semhar Tewelde
作者:Semhar Tewelde
翻译:江利冰 校对:肖锋

The Unforgotten: ECG Utilization to Differentiate Athletic Heart vs. Brugada
请铭记:心电图(ECG)用于区别运动员心脏和Brugada综合征

- Highly trained athletes develop ECG changes as a physiologic consequence of increased vagal tone; The ECG manifestations of early repolarization (ER) can range from simple J–point elevation to anterior (V1 to V3) "domed" ST-segment elevation and negative T wave.
高强度训练的运动员的ECG改变是由于迷走神经兴奋性增强导致的生理性改变。早期复极导致的ECG表现可以是简单的J点抬高,也可以是胸前壁(V1-V3导联)ST段弓背状抬高以及T波倒置。

- The former raises problems of differential some forms of ER with the “ coved-type” pattern seen in Brugada Syndrome (BS).
前者和Brugada综合征中早期复极导致的下斜型鉴别诊断比较困难。

- A recent study compared the ECG tracings of 61 athletes w/a “domed” ST-segment elevation & negative T wave and 92 age/sex-matched BS patients w/a “ coved-type” pattern to identify an ECG criteria for distinguishing benign athletic changes seen in ER from BS.
最近一项研究将61例健康的、ECG表现为ST段弓背状抬高以及T波倒置的运动员的心电图和92例年龄和性别匹配的ECG表现为下斜型的Brugada综合征患者的心电图进行比较,从而识别使用ECG区别健康运动员中的早期复极和Brugada综合征患者的标准。

- ECG analysis focused on ST-segment elevation at J-point (STJ ) and at 80 milliseconds after J-point (ST80 ).
ECG分析主要集中于J点的ST段抬高(STJ )以及J点之后的80毫秒(ST80 )。

- Athletes had a lower maximum amplitude of STJ (p < 0.001) & lower STJ /ST80 (p < 0.001)
运动员的J点的ST段抬高的振幅较小(p < 0.001)而且STJ /ST80比值较小(p < 0.001)。

- All patients (100%) with BS showed a downsloping ST-segment configuration (STJ/ST80 > 1) versus only 2 (3%) athletes (p < 0.001)
所有的Brugada 综合征患者显示了ST段下斜型图形(STJ/ST80 > 1),然而这种心电图改变在运动员中只有2例(3%)(p < 0.001)。

- An upsloping ST-segment configuration (STJ /ST80 < 1) showed a sensitivity of 97%, a specificity of 100%, and a diagnostic accuracy of 98.7% for the diagnosis of ER.
上斜型ST段外形(STJ /ST80 < 1)诊断早期复极的敏感度为97%,特异度为100%,诊断准确性为98.7%。

References
参考文献
Zorzi A, Leoni L, et al. Differential Diagnosis Between Early Repolarization of Athlete’s Heart and Coved-Type Brugada Electrocardiogram. Am J Cardiol. 2015 Feb 15;115(4):529-532.