Identification of the pathological mechanism and prognostic factors in early repolarization syndrome

• Project/Area Number: 17K09545
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Research Field: Cardiovascular medicine
• Research Institution: National Cardiovascular Center Research Institute
• Principal Investigator: Kamakura Tsukasa 国立研究開発法人国立循環器病研究センター, 病院, 医師 (80726943)
• Co-Investigator(Kenkyū-buntansha): 草野 研吾 国立研究開発法人国立循環器病研究センター, 病院, 部長 (60314689)
• Project Period (FY): 2017-04-01 – 2020-03-31
• Project Status: Completed (Fiscal Year 2019)
• Budget Amount: ¥4,030,000 (Direct Cost: ¥3,100,000、Indirect Cost: ¥930,000); Fiscal Year 2019: ¥1,170,000 (Direct Cost: ¥900,000、Indirect Cost: ¥270,000); Fiscal Year 2018: ¥1,170,000 (Direct Cost: ¥900,000、Indirect Cost: ¥270,000); Fiscal Year 2017: ¥1,690,000 (Direct Cost: ¥1,300,000、Indirect Cost: ¥390,000)
• Keywords: 突然死 / 心室細動 / 早期再分極症候群

Outline of Final Research Achievements

Early repolarization syndrome (ERS) is a sudden death syndrome due to ventricular fibrillation (VF) that occurs in apparently healthy people without organic heart disease. The accurate diagnosis of ERS is difficult. In addition, the mechanisms and risk markers for VF occurence in ERS also remain unknown.
First, we investigated the incidence of silent coronary artery spasm in patients with idiopathic VF and early repolarization pattern. Approximately 20% of the patients were not ERS, and were diagnosed with silent coronary artery spasm without chest pain. We could show the importance of excluding coronary artery spasm by induction test for the accurate diagnosis of ERS.
Second, we performed a multicenter retrospective study to investigate the risk markers for the recurrence of VF in true ERS. The study showed that the existence of broad J waves in the 12 lead electrocardiograms were predictive of VF recurrence.

Academic Significance and Societal Importance of the Research Achievements

早期再分極症候群(ERS)の診断の基礎となる心電図指標である早期再分極パターンは、健常人の約10%に認められる比較的ありふれた所見でありながら、正確な診断自体が困難であり、心室細動(VF)の発生を予測する指標や有効な治療について不明な点が多い。
今回の研究成果により、冠攣縮性狭心症の誘発試験が、正確なERSの診断と治療方針の決定において重要であることを示した。また、従来ERSにおける予後予測因子として従来より報告されていた心電図指標に加え、広範な誘導に広がるJ波の存在がVF再発の予測因子となることを示し、ERSの新たなリスク層別法を示したという点で、本研究の臨床的意義は高いものと考えられる。

Research Products

• [Journal Article] Long-term prognosis of patients with J-wave syndrome. (2020)
  • Author(s): Kamakura T, Shinohara T, Yodogawa K, Murakoshi N, Morita H, Takahashi N, Inden Y, Shimizu W, Nogami A, Horie M, Aiba T, Kusano K.
  • Journal Title: Heart Volume: 106 Issue: 4 Pages: 299-306
  • DOI: 10.1136/heartjnl-2019-315007
  • Peer Reviewed / Open Access / Int'l Joint Research
• [Journal Article] The significance of coronary artery spasm diagnosis in patients with early repolarization syndrome. (2018)
  • Author(s): Kamakura T, Wada M, Ishibashi K, Inoue Y, Miyamoto K, Okamura H, Nagase S, Noda T, Aiba T, Yasuda S, Shimizu W, Kamakura S, Kusano K.
  • Journal Title: J Am Heart Assoc. Volume: in press Issue: 4
  • DOI: 10.1161/jaha.117.007942
  • Peer Reviewed / Open Access
• [Journal Article] Differences in the onset mode of ventricular tachyarrhythmia between patients with J wave in anterior leads and those with J wave in inferolateral leads. (2017)
  • Author(s): Kamakura T, Wada M, Ishibashi K, Inoue YY, Miyamoto K, Okamura H, Nagase S, Noda T, Aiba T, Yasuda S, Shimizu W, Kamakura S, Kusano K
  • Journal Title: Heart Rhythm. Volume: 14 Issue: 4 Pages: 553-561
  • DOI: 10.1016/j.hrthm.2016.11.027
  • Peer Reviewed / Open Access
• [Presentation] Significance of Coronary Artery Spasm Diagnosis in Patients With Early Repolarization Syndrome. (2018)
  • Author(s): Tsukasa Kamakura
  • Organizer: 日本循環器学会
• [Book] Early Repolarization Syndrome: Etiology and Therapeutics (2017)
  • Author(s): Tsukasa Kamakura, Shimizu Wataru
  • Total Pages: 107
  • Publisher: Springer Singapore
  • ISBN: 9789811033797