Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2025
TP-fusion at peak exercise: a novel marker for the recognition of unsuspected long QT syndrome patients.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Boeri Carlo, Sarto Patrizio, Cerea Paolo, Crotti Lia, Dagradi Federica, Giovenzana Fulvio L F, Alberio Chiara, Meneguzzo Giulia, Lucini Daniela, Musu Giulia, Spazzolini Carla, Schwartz Peter J
Аннотация
AIMS: The frequent occurrence of sudden death as the sentinel event in the long QT syndrome (LQTS) forces the search for still asymptomatic patients. We tested our hypothesis that complete fusion of the T and P waves (TP-fusion) at peak exercise might be a marker of likely LQTS.
METHODS AND RESULTS: A maximal exercise stress test, off-therapy, was performed by healthy athletes and genotype-positive LQTS patients. TP-fusion had to be complete in all precordial leads except V1. The study population (n = 578) included 310 healthy athletes (all with QTc <430 ms) and 268 LQTS patients. To deal only with clear-cut phenotypes, 64 athletes and 70 patients with incomplete TP-fusion were excluded. TP-fusion was present in 2% of controls and in 22% (P < 0.001) of the 198 LQTS patients. By limiting the analysis to subjects below age 25 (n = 262), the prevalence of TP-fusion increased to 3% in healthy athletes and to 32% in LQTS (P < 0.001). TP-fusion depends on the combination of QTc prolongation and fast heart rates; either alone is not sufficient. The appearance of TP-fusion predicted an 88% probability of being affected by LQTS. Importantly, of the 44 LQTS patients with TP-fusion, 24 (55%) had a borderline/normal baseline QTc (<460 ms).
CONCLUSION: TP-fusion, a qualitative trait more easily assessable at peak exercise than QTc prolongation, especially outside referral centres, unmasks a high probability of LQTS, even in subjects with normal baseline QTc. Further clinical assessment and genetic screening allow life-saving prophylactic therapy.
METHODS AND RESULTS: A maximal exercise stress test, off-therapy, was performed by healthy athletes and genotype-positive LQTS patients. TP-fusion had to be complete in all precordial leads except V1. The study population (n = 578) included 310 healthy athletes (all with QTc <430 ms) and 268 LQTS patients. To deal only with clear-cut phenotypes, 64 athletes and 70 patients with incomplete TP-fusion were excluded. TP-fusion was present in 2% of controls and in 22% (P < 0.001) of the 198 LQTS patients. By limiting the analysis to subjects below age 25 (n = 262), the prevalence of TP-fusion increased to 3% in healthy athletes and to 32% in LQTS (P < 0.001). TP-fusion depends on the combination of QTc prolongation and fast heart rates; either alone is not sufficient. The appearance of TP-fusion predicted an 88% probability of being affected by LQTS. Importantly, of the 44 LQTS patients with TP-fusion, 24 (55%) had a borderline/normal baseline QTc (<460 ms).
CONCLUSION: TP-fusion, a qualitative trait more easily assessable at peak exercise than QTc prolongation, especially outside referral centres, unmasks a high probability of LQTS, even in subjects with normal baseline QTc. Further clinical assessment and genetic screening allow life-saving prophylactic therapy.