Brugada Syndrome: Clinical Features, Risk Stratification, and Management.

In 1992, the Brugada brothers published a patient series of aborted sudden death, who were successfully resuscitated from ventricular fibrillation (VF). These patients had a characteristic coved ST-segment elevation in the right precordial leads on their 12-lead electrocardiogram with no apparent structural heart abnormality. This disease was referred to as "right bundle branch block, persistent ST-segment elevation, and sudden death syndrome." The term Brugada syndrome (BrS) was first coined for this new arrhythmogenic entity in 1996. BrS is more prevalent in Southeast Asian ethnic groups and was considered a familial disease due to the presence of syncope and/or sudden deaths in several members of the same family, however, the genetic alteration was only noted in 1998. The genetic characterization of BrS has proven to be challenging. The most common and well-established BrS genotype involves loss-of-function mutations in the SCN5A gene, but only represents between 15% and 30% of the diagnosed patients. Patients with BrS can present with a range of symptoms which can include syncope, seizures, and nocturnal agonal breathing due to polymorphic ventricular tachycardia or VF. If these arrhythmias are sustained, sudden cardiac death may result. Despite the significant progress on the understanding of BrS over the last two decades, there remain a number of uncertainties and challenges; we present an update review on the subject.

Independent value of echocardiography and N-terminal pro-natriuretic Peptide for the prediction of major outcomes in patients with suspected heart failure.

N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) and echocardiography have been shown to have diagnostic and prognostic value for the assessment of heart failure (HF) in the community. This study evaluated whether echocardiography and serum NT-pro-BNP estimation have independent value for the prediction of major outcome in patients with suspected HF from the community. Accordingly, 137 patients with suspected HF referred from the community were followed up after undergoing clinical assessment, electrocardiography, NT-pro-BNP estimation, and echocardiography. Abnormal echocardiogram was defined as visual left ventricular ejection fraction 26 ml/m(2) or presence of left ventricular hypertrophy or significant valvular heart disease. Data were obtained in 132 patients (96%) over a mean follow-up period of 26 +/- 7 months during which 19 (14%) developed major cardiac events (14 deaths and 5 HF admissions). Univariate predictors for major cardiac event were age (p = 0.05), male gender (p = 0.007), presence of clinical signs of HF (p = 0.02), NT-pro-BNP level >/=50 pmol/L (p <0.001), abnormal electrocardiogram (p = 0.02), and abnormal echocardiogram (p = 0.004). However, the only independent predictors were male gender (odds ratio 3.09, 95% confidence interval 1.01 to 9.46, p = 0.05), NT-pro-BNP level >/=50 pmol/L (odds ratio 5.78, 95% confidence interval 1.63 to 20.5, p = 0.007), and abnormal echocardiogram (odds ratio 11.1, 95% confidence interval 1.43 to 85.6, p = 0.02). In conclusion, NT-pro-BNP and abnormal echocardiogram provided independent information for predicting adverse outcome in patients with suspected HF referred from the community.

Myocardial contrast echocardiography: Role in clinical cardiology.

Recent updates in the field of echocardiography have resulted in improvements in both image quality and techniques allowing echocardiography to maintain its position as the primary non-invasive imaging modality. In particular, the development of new ultrasound contrast agents and imaging techniques have now made possible the assessment of myocardial perfusion. Myocardial contrast echocardiography utilises acoustically active gas filled microspheres (microbubbles), which have rheology similar to that of red blood cells. The detection of myocardial perfusion during echocardiographic examinations permits simultaneous assessment of global and regional myocardial structure, function, and perfusion, enabling the optimal non-invasive assessment of coronary artery disease. Myocardial contrast echocardiography is equally adept in assessing chronic coronary artery disease as well as acute coronary syndromes. Furthermore, its use is not limited solely to diagnostic assessment. Preliminary evidence suggests that targeted microbubbles may be useful in enhancing delivery of genes / drugs and in clot lysis.