[ARVD-FORUM] Some more remarks. Dr. Martini

Thu Apr 7 13:56:52 ART 2005

English - Spanish

Dear Andres,
Your excellent analysis of literature confirm my previous letter to the
symposium:
What You call Brugada pattern (first published by Nava in "Mises
Yjour Cardiologiques, as You can download from this page:
http://digilander.libero.it/martini_syndrome/page01.html)
1) is not a so rare ECG pattern
2) is is so rarely associated with a syndrome which means ECG+sudden death.
This last event is fortunately much rare, and so different from the
terryfing data you presented
and that are not based on evidence but on unconfirmed hypothesis

Bortolo

-----------------------

Estimado Andres,
Su analisis excelente de la literatura confirma mi mensaje previo al
simposio:
Lo que Ud. llama patron Brugada (publicado por primera vez por Nava en:
Mises Your Cardiologiques, que se puede obtener en esta pagina:
http://digilander.libero.it/martini_syndrome/page01.html)
1)      no es un patron ECG tan raro
2)      se asocia tan raramente con un sindrome, lo que significa ECG + muerte
subita.
El ultimo evento es afortunadamente muy raro, y tan diferente de los datos
aterradores que Ud. presento y que no se basan en evidencia sino en
hipotesis no confirmadas.

Bortolo

>
> English - Portuguese
>
> Dear Bortolo:
>
> The prevalence, incidence and prognostic value of the Brugada-type ECG has
> been studied in a general adult Japanese population. The 4,788 subjects
> (1,956 men and 2,832 women) were under 50 years of age in 1958 and had
> undergone biannual health examinations, including ECG, through 1999. There
> were a total of 32 Brugada-type ECG cases. The prevalence and incidence
> were 146.2 in 100,000 persons and 14.2 persons per 100,000 person-years,
> respectively. The incidence was nine times higher among men than women, and
> the average age at presentation was 45 +/- 10.5 years. The Brugada-type ECG
> appeared intermittently in most cases and was found in 26% of subjects who
> died unexpectedly. Cox survival analysis revealed that mortality from
> unexpected death was significantly higher in subjects with a Brugada-type
> ECG than in control subjects (p < 0.01). Unexpected deaths were more
> frequent among subjects with the Brugada-type ECG who had a history of
> syncope (p < 0.05). The Brugada-type ECG was found in 0.70% of 13,929 study
> subjects (98 cases) in a community-based population in Japan, predominantly
> in men. The typical coved-type ST-T morphology with the RBBB pattern-an
> rsR' pattern in the V1 lead ("typical" Brugada-type  1)-was found in 0.12%
> of all subjects.
>
> The prevalence of cardiac events among male subjects with a Brugada-type
> ECG (81%) was significantly higher than it was for those without it.
>
>  The Brugada-type ECG was found in 2.14% of male subjects, and the
> "typical" Brugada-type 1 was found in 0.38%. After 2.6 +/- 0.3 years of
> follow-up, there was one death of a subject with the Brugada-type ECG,
> whereas there were 139 deaths of those without the Brugada-type ECG (p =
> 0.9943, log-rank test). The total mortality of subjects with the
> Brugada-type ECG did not differ from the mortality of those without the
> Brugada-type ECG (Miyasaka Y, Tsuji H, Yamada K, et al. Prevalence and
> mortality of the Brugada-type electrocardiogram in one city in Japan.  J Am
> Coll Cardiol 2001;38:771-774.)
>
> From about 12,000 non-selected and non-cardiac patients in just one
> University Hospital, collected prospectively for a period of two years,
> there were 52 cases with the typical ECG pattern, i.e., with Brugada sign
> (Monroe MH, Littmann L. Two-year case collection of the Brugada syndrome
> electrocardiogram pattern at a large teaching hospital. Clin Cardiol.
> 2000;23:849-851.)
>
> A report in France have shown a prevalence of Brugada pattern of ECG in 1
> per 1,000 normal asymptomatic individuals (Hermida J, Lemoine J, Aoun FB,
> et al.: Prevalence of the Brugada syndrome in an apparently healthy
> population. Am J Cardiol; 2000; 86:91-94.)
>
> The prevalence, incidence, and prognosis of the Brugada-type ECG were
> analyzed in the general population of Japan, based on a study of four
> decades. Thus, from a group of 4788 individuals, 32 Brugada-type ECGs were
> detected, the prevalence and incidence being 146.2 in 100,000 people and
> 14.2 per 100,000 individuals/year, respectively. This incidence was nine
> times higher in men than in women; the intermittence of the Brugada-type
> ECG was found in 26% of cases of those who underwent SCD, and the Cox
> survival analysis showed that unexpected mortality was significantly higher
> in subjects with the Brugada-type ECG than in control subjects ( Matsuo K,
> Akahoshi M, Nakashima E, et al. The prevalence, incidence and prognostic
> value of the Brugada-type electrocardiogram: a population-based study of
> four decades.  J Am Coll Cardiol 2001; 38:765-770.)
>
> Monroe and Littmann (2000), in 12,000 consecutive ECG in non-cardiac
> patients, during two years, they found Brugada pattern in 52 ECGs showing a
> higher prevalence than thought before( Monroe MH, Littmann L. Two-year case
> collection of the Brugada syndrome electrocardiogram pattern at a large
> teaching hospital. Clin Cardiol. 2000; 23:849-851.)
>
> Prevalence and prognosis of subjects with Brugada-type ECG pattern was
> studied in 2479 healthy young male Air Force applicants age 18-30 years)
> and in 542 healthy middle-aged subjects age between   40-60 years Finnish
> population. Fifteen (0.61%) subjects in the first population and three
> subjects in the second population (0.55%) fulfilled the ECG criteria for
> Type 1 or 2 Brugada syndrome pattern. They had J-point elevation and a
> saddleback-type ST-segment configuration in the right precordial leads.
> Type 1 Brugada ECG pattern (coved ST-segment elevation) was not seen in any
> subject. The benign natural course of the patients with the "Brugada sign"
> suggests that in asymptomatic subjects without a family history of SCD,
> Type 2 or 3 Brugada ECG pattern is a normal variant rather than a specific
> predictor of life-threatening ventricular arrhythmias (Junttila MJ,
> Raatikainen MJ, Karjalainen J, Kauma H, Kesaniemi YA, Huikuri HV.
> Prevalence and prognosis of subjects with Brugada-type ECG pattern in a
> young and middle-aged Finnish population. Eur Heart J. 2004; 25:874-878.)
>
> The prevalence of typical drug-induced Brugada syndrome ECGs was 5 of the
> 1,000 patients. This value was fivefold greater than the reported
> prevalence of spontaneous Brugada syndrome ECGs in the healthy population
> (Hermida JS, Jandaud S, Lemoine JL, Rodriguez-Lafrasse C, Delonca J,
> Bertrand C, Jarry G, Rochette J, Rey JL. Prevalence of drug-induced
> electrocardiographic pattern of the Brugada syndrome in a healthy
> population. Am J Cardiol. 2004; 94:230-233.)
>
> Best Regard
>
> Andrés Ricardo Pérez Riera
>
> ---------------------------------------
>
> Português
>
> Prezado Bortolo:
>
> A prevalência, incidência e valor prognóstico do padrão ECG Brugada ha sido
> estudado na população adulta Japonesa.  De 4.788 pessoas  (1,956 homens e
> 2,832 women)  estavam abaixo dos 50 anos desde 1958 ate 1999 Se detectaram
> um total de 32 ECG tipo Brugada, A prevalência e incidência foi  146.2 em
> 100.000 pessoas e 14.2 pessoas por 100.000 pessoas-ano respectivamente. A
> incidência foi 9 vezes mais alta entre homens do que mulheres e a média de
> idade no momento da apresentação foi de 45+/- 10.5 anos. O tipo
> eletrocardiográfico  foi intermitente na maioria dos casos e se encontrou
> morte inesperada em 26%. Análise Cox de sobrevida revelou que a mortalidade
> por MS inesperada foi significativamente mais alta em sujeitos com o padrão
> eletrocardiográfico Brugada que no controle ( p<0.01) Mortes inesperadas
> foram mais freqüentes entre sujeitos com o padrão eletrocardiográfico
> Brugada os quais tinha história de síncope ( p<0.05).
>
> O padrão ECG Brugada foi encontrado em 0.70% de 13,929 pessoas estudadas
> (98 casos) numa comunidade japonesa predominantemente em homens.O padrão
> ECG tipo 1 coved de ST com BRD foi encontrado em 0.12% de todo o universo.
>
> A prevalência de eventos cardíacos entre homens com o padrão ECG Brugada
> (81%) foi significativamente mais alto que em aqueles sem ele.
>
> A prevalência do tipo ECG Brugada foi encontrado em 2.14% de homens e o
> tipo 1 se encontrou em 0.38%. Apos  2.6+-0.3 anos de seguimento, se
> encontrou uma morte num paciente portador do padrão ECG Brugada apesar que
> ocorreram 139 mortes entre aqueles sem o padrão ECG Brugada (p = 0.9943,
> log-rank test).
>
> A mortalidade total de pessoas com o padrão ECG Brugada não foi diferente
> da mortalidade de aqueles sem o padrão Eletrocardiográfico Brugada
> (Miyasaka Y, Tsuji H, Yamada K, et al. Prevalence and mortality of the
> Brugada-type electrocardiogram in one city in Japan.  J Am Coll Cardiol
> 2001;38:771-774.)
>
> De aproximadamente 12,000 pacientes não cardíacos procedentes de um
> Hospital Universitário coletados em forma prospectiva em um período de 2
> anos se encontraram 52 casos com o típico padrão eletrocardiográfico
> Brugada Ex com o sinal de Brugada (Monroe MH, Littmann L. Two-year case
> collection of the Brugada syndrome electrocardiogram pattern at a large
> teaching hospital. Clin Cardiol. 2000;23:849-851.)
>
> Numa publicação procedente  da França tem mostrado uma prevalência do
> padrão eletrocardiográfico Brugada de 1 cada 1000 entre indivíduos
> assintomáticos (Hermida J, Lemoine J, Aoun FB, et al.: Prevalence of the
> Brugada syndrome in an apparently healthy population. Am J Cardiol; 2000;
> 86:91-94.).
>
> A prevalência, incidência e prognóstico do padrão Eletrocardiográfico
> Brugada na população geral do Japão num estudo de 4 décadas  De 4788
> indivíduos 32 padrões ECG Brugada foram detectados a prevalência e
> incidência foi de 146.2 em 100,00 habitantes e 14.2 por 100.000 indivíduos
> /ano respectivamente.
>
> Esta incidência foi 9 vezes mais alta em homens do que em mulheres e a
> intermitência do padrão de ECG Brugada foi encontrada em 26% dos casos de
> aqueles que tiveram MCS  e a análise de sobrevida Cox mostrou que a
> mortalidade inesperada foi significativamente mayor em sujeitos com o
> padrão ECG Brugada  ( Matsuo K, Akahoshi M, Nakashima E, et al. The
> prevalence, incidence and prognostic value of the Brugada-type
> electrocardiogram: a population-based study of four decades.  J Am Coll
> Cardiol 2001;
> 38:765-770.)
>
> Monroe e  Littmann (2000), em 12,000 ECG consecutivos de pacientes no
> cardíacos de um Hospital de ensino durante 2 anos encontraram o padrão ECG
> Brugada em 52 mostrando uma prevalência mais elevada que a previamente
> mostrada ( Monroe MH, Littmann L. Two-year case collection of the Brugada
> syndrome electrocardiogram pattern at a large teaching hospital. Clin
> Cardiol. 2000; 23:849-851.).
>
> A prevalência e prognóstico dos sujeitos com o padrão eletrocardiográfico
> Brugada foram estudado em 2479 homens jovens candidatos da força aérea com
> idades entre 18 e 30 anos e em 542 pessoas de média idade sadias com idades
> entre 40 e 60 anos na população da Finlândia. 15 sujeitos ( 0.62%) do
> primeiro grupo e três do segundo ( 0.55%) preenchiam os critérios ECG do
> padrão tipo 1 ou tipo 2. O tipo 1 coved não foi visto em nenhum sujeito . A
> natureza benigna da evolução dos pacientes com o sinal de Brugada sugere
> que em assintomáticos sem história familiar de MCS   ou tipo 2 ou 3 de
> padrão de ECG é uma variante normal e não preditiva de arritmias
> ventriculares ( Junttila MJ, Raatikainen MJ, Karjalainen J, Kauma H,
> Kesaniemi YA, Huikuri HV. Prevalence and prognosis of subjects with
> Brugada-type ECG pattern in a young and middle-aged Finnish population. Eur
> Heart J. 2004; 25:874-878.).
>
> A prevalência do padrão ECG Brugada induzido por drogas oi de 5 em 1000
> pacientes Este valor foi 5 vezes maior que o reportado na forma esontânea
> da síndrome de Brugada  na populaçõa sadia (Hermida JS, Jandaud S, Lemoine
> JL, Rodriguez-Lafrasse C, Delonca J, Bertrand C, Jarry G, Rochette J, Rey
> JL. Prevalence of drug-induced electrocardiographic pattern of the Brugada
> syndrome in a healthy population. Am J Cardiol. 2004; 94:230-233. )
>
> Saludações
>
> Andrés Ricardo Pérez Riera
>
> > English - Spanish
> >
> > Dear Andres,
> >
> > Dr Wlodarska expressed a correct opinion, based on evidence based data.
> > You well know that the data which You enphasize on the "so called"
> > Brugada Syndrome are mostly derived from opinions and not epidemiological
> > data. In the far east detailed necropsy study and preventive
> > cardiological examination are not much available, so data on the
> > underlying basis of sudden death are presumed and not proved.
> > It must be clarified that an ECG is not a syndrome.
> > The discussed ECG is not so rare, but the syndrome, firtly described in
> > Italy, is rare as pointed out by more than an epidemiological study,
> > http://digilander.libero.it/martini_syndrome/page26.html
> > Recent surveys in Finland and Japan, are also more restrictive.
> > A big mistake to avoid is to presume (without any evidence based data),
> > that the unrare healthy people with this ECG will suffer of the syndrome,
> > in which case the "so called"  Brugada syndrome should be a problem
> > bigger than AIDS, as pointed out by Dr Littmann in his letter: "The
> > Brugada Numbers" Circulation. 2003 May 1;107(18):e122;
> > Your statement "Brugada syndrome is believed to be responsible of 4-12%
> > of all SCD and around 20% of death with structural normal hearts".  has
> > not been proven by any well evidence based serie.
> > Moreover, almost all the patients died suddenly with this syndrome, and
> > submitted to a detailed necropsy study,  had a structural heart disease,
> > of the conduction system (as demonstrated decades ago by Kirschner), and
> > of the right ventricular Outflow tract,  as re-established also in a
> > recent abstract, unfortunately not yet published:  ?A multicenter
> > histological study of autopsied and biopsied specimens in BS?. Morimoto
> > S. Eur Heart J 2003;24:147.
> > As a conclusion I would like to answer to   Jose Luiz Pantaleon Albornoz
> > Padilla from Malaga.
> > My point of view on the "so called" Brugada syndrome is that this
> > syndrome (not the ECG), is an organic heart disease closely linked to
> > ARVD/C My opinions can be read in the following article.
> >
> > http://www.italheartj.org/pdf_files/Martini.pdf
> >
> > Bortolo Martini  MD
> >
> > ---------------------
> >
> > Estimado Andres:
> > La Dra. Wlodarska expreso una opinion correcta, basandose en informacion
> > basada en evidencia. Usted bien sabe que la informacion que Ud. enfatiza
> > en el "llamado" Sindrome de Brugada deriva principalmente de opiniones y
> > no de datos epidemiologicos. En el lejano oriente, el estudio de la
> > necropsia detallada y el examen cardiologico preventivo no estan
> > demasiado disponibles, de modo que la informacion sobre las bases
> > subyacentes de la muerte subita es supuesta y no comprobada.
> > Debe quedar claro que un ECG no es un sindrome.
> > El ECG que se discute no es tan raro, pero el sindrome, primeramente
> > descrito en Italia, es raro como lo seniala mas de un estudio
> > epidemiologico,
> > http://digilander.libero.it/martini_syndrome/page26.html
> > Encuestas recientes en Finlandia y Japon tambien son mas restrictas.
> > Un gran error que hay que evitar es suponer (sin ninguna informacion
> > basada en evidencia) que las personas comunmente saludables con este ECG
> > padecen el sindrome, en cuyo caso el "llamado" Sindrome de Brugada
> > deberia ser un problema mas grande que el SIDA, como lo senialo el Dr.
> > Littmann en su carta: "Los Numeros de Brugada" Circulation.
> > 2003 May 1;107(18):e122;
> > Su afirmacion de que se cree que el Sindrome de Brugada es responsable de
> > un 4-12% de todas las MS y de alrededor del 20% de las muertes con
> > corazones estructuralmente normales, no se ha comprobado por ninguna
> > serie basada en evidencia.
> > Ademas, casi todos los pacientes que murieron subitamente con este
> > sindrome, y que fueron sometidos a un estudio detallado de necropsia,
> > tenian una cardiopatia estructural del sistema de conduccion (como lo
> > demostro Kirschner hace decadas) y del tracto de salida del ventriculo
> > derecho, como se reestablecio tambien en un resumen reciente,
> > desafortunadamente no publicado todavia: "A multicenter histological
> > study of autopsied and biopsied specimens in BS". Morimoto S. Eur Heart J
> > 2003;24:147.
> > Como conclusion, me gustaria responder a Jose Luiz Pantaleon Albornoz
> > Padilla de Malaga.
> > Mi punto de vista acerca del "llamado" Sindrome de Brugada es que este
> > sindrome (no el ECG), es una cardiopatia organica estrechamente vinculada
> > con la M/DAVD. Mis opiniones se pueden leer en el siguiente articulo.
> >
> > http://www.italheartj.org/pdf_files/Martini.pdf
> >
> > Bortolo Martini  MD
> >
> > > English - Spanish
> > >
> > > Dear Andres,
> > >
> > > I am fully aware of the data you quoted and I want to emphasize that
> > > ARVD is most likely underdiagnozed entity. recognized mostly by
> > > tertiary centers. Increasing awareness about ARVD, through variety of
> > > educational programs including this symposium, will contribute to more
> > > frequent diagnosis of this disorder. Looking back 10 years ago,
> > > diagnosis of LQTS was quite infrequent, decade later physicans know it
> > > well and diagnose it more frequently. The same pattern hopefully will
> > > be followed by ARVD.
> > >
> > > The paper by Dr. Wlodarska is of major importance reconfirming familial
> > > form of the disorder in the majority of cases with various penetrance
> > > among studied families. This observation further prompts physicians to
> > > evaluate and monitor family members of ARVD probands.
> > >
> > > The data from autopsy of athletes are very intiguing, but could
> > > represent biased sample. There is a theory that vigorous physical
> > > activity might contibute to expression of otherwise silent ARVD genes.
> > > Overstrech of right ventricle (both ventricles) during athletic
> > > activities might be the factor turnning on clinical form of ARVD. More
> > > studies are needed to determine this potential association.
> > >
> > > Best regards
> > >
> > > Wojciech Zareba
> > >
> > > ------------------------
> > >
> > > Estimado Andres,
> > >
> > > Soy totalmente consciente de la informacion que cita y deseo enfatizar
> > > que la DAVD es muy probablemente, una entidad subdiagnosticada,
> > > reconocida principalmente por centros terciarios. Una mayor conciencia
> > > sobre la DAVD, a traves de una variedad de programas educativos
> > > incluyendo este simposio, contribuira a una diagnostico mas frecuente
> > > de este trastorno. Mirando hacia atras, hace 10 anios el diagnostico de
> > > LQTS era bastante poco frecuente; pero una decada mas tarde los medicos
> > > la conocen bien y la diagnostican con mayor frecuencia. Esperemos que
> > > se siga el mismo patron con la DAVD.
> > >
> > > El trabajo de la Dra. Wlodarska es sumamente importante, y reconfirma
> > > la forma familiar de este trastorno en la mayoria de los casos con
> > > penetrancias diversas en las familias estudiadas. Esta observacion
> > > anima aun mas a los medicos a evaluar y monitorear a los parientes de
> > > los casos testigos con DAVD.
> > >
> > > Los datos de las autopsias de los atletas son muy intrigantes, pero
> > > pueden representar una muestra parcializada. Hay una teoria que
> > > establece que la actividad fisica vigorosa puede contribuir con la
> > > expresion de los genes DAVD que de lo contrario permanecen silentes. El
> > > sobreestiramiento del ventriculo derecho (ambos ventriculos) durante
> > > las actividades atleticas puede ser el factor que activa la forma
> > > clinica de la DAVD. Se necesitan mas para determinar esta asociacion
> > > potencial.
> > >
> > > Saludos cordiales,
> > >
> > > Wojciech Zareba
> > >
> > > > English - Portuguese
> > > >
> > > > Dear Dr .Zareba,
> > > > Here Andrés Ricardo Pérez Riera form São Paulo Brazil.
> > > > Prevalence of ARVC/D is estimated as 1/5000 (Czarnowska E, Wlodarska
> > > > EK, Zaleska T.  Arrhythmogenic right ventricular cardiomyopathy
> > > > (dysplasia): etiology, clinical presentation, diagnosis and treatment
> > > > Kardiol Pol. 2003; 58:58-63.)
> > > >
> > > > The prevalence is estimated at 0.4% depending on geographic
> > > > circumstances. (Hagenah G, Andreas S, Konstantinides S. Accidental
> > > > left ventricular placement of a defibrillator probe due to a patent
> > > > foramen ovale in arrhythmogenic right ventricular dysplasia. Acta
> > > > Cardiol. 2004; 59:449-451.) like Brugada Syndrome. The entity is
> > > > endemic in Veneto region (Italy), Nova Scotia and Naxus Greek island
> > > > (recesive form). The incidence of SCD is approximately 2.5% a year.
> > > > In the athletes group < 35 years, ARVC/D is the more important cause
> > > > of death in Europe. Studies have shown that ARVC/D is a significant
> > > > cause of SCD among young athletes despite, circumstances of death are
> > > > various, but 75.6% occurred during everyday life events (at home,
> > > > 63.1%; in the street, 6.6%; or at work, 6.1%); only 3.5% occurred
> > > > during sports activity. (Tabib A, Loire R, Chalabreysse L, et al
> > > > Circumstances of death and gross and microscopic observations in a
> > > > series of 200 cases of sudden death associated with arrhythmogenic
> > > > right ventricular cardiomyopathy and/or dysplasia. Circulation. 2003;
> > > > 108:3000-3005).
> > > >
> > > >  ARVC/D may account for as many as 5% of unexpected SCD under the age
> > > > of 65 and 3-4% of SCD during sports.
> > > >
> > > > ARVC/D is an important cause of SCD in the young.
> > > >
> > > > Best regard
> > > >
> > > > Andres
> > > >
> > > > -----------------------
> > > >
> > > > Portuguese
> > > >
> > > > Prezado Dr Zareba:
> > > > Aqui Andrés Ricardo Pérez Riera de São Paulo Brasil. A prevalencia da
> > > > DAVD se ha estimando en 1/5000, o 0.4% dependendo de circuntâncias
> > > > geográficas. Como a sindrome de Brugada  tiene areas endémicas, como
> > > > na região de Veneto na Italia nova Escocia e na ilha grega de Naxos
> > > > (na forma recessiva). Entre jovens atletas menores de 35 anos é a
> > > > principal causa de morte na Europa. Estudos tem mostrado que a DAVD é
> > > > uma causa significativa de MCS entre atletas porem as circunstacias
> > > > da morte são varias 75,6% ocorrem durante o dia no lar; 63% na rua; 
> > > > 6.6% no trabalho 6,1% e apenas em  3,5% durante a atividade
> > > > esportiva. A la DAVD se le pode atribuir tanto quanto 5% das mortes
> > > > subitas inesperada abaixo de 65 anos e 3-4% das MCS durante esportes.
> > > > A DAVD é uma importante causa de morte no jovem.
> > > >
> > > > Saludacoes
> > > >
> > > > Andres.
> > > >
> > > > > English - Spanish
> > > > > Dear Guy,
> > > > >
> > > > > We definitely value your opinion and it could well be that the
> > > > > disease is largely underestimated. At least when we compare with
> > > > > number of cases seen clinically of LQTS, HCM, even Brugada
> > > > > syndrome, ARVD is far behind, very rare.
> > > > >
> > > > > But, the virtual symposium is exactly good forum to express such
> > > > > opinions and
> > > > > we appreciate you writing a paragraph on it and we will send your
> > > > > comment to all participants.
> > > > >
> > > > > Best regards
> > > > >
> > > > > Wojciech
> > > > >
> > > > > ----------------------
> > > > >
> > > > > Estimado Guy:
> > > > >
> > > > > Definitivamente valoramos tu opinion y bien podria ser que la
> > > > > enfermedad este enormemente menospreciada. Por lo menos cuando la
> > > > > comparamos con el numero de casos vistos clinicamente de LQTS, CMH,
> > > > > incluso del Sindrome de Brugada, la DAVD esta muy por detras con
> > > > > respecto a las otras, por eso es rara.
> > > > >
> > > > > Pero el Simposio Virtual es exactamente el foro para expresar tales
> > > > > opiniones, y apreciamos que escribas un parrafo al respecto.
> > > > > Nosotros enviaremos tus comentarios a todos los participantes.
> > > > >
> > > > > Saludos cordiales,
> > > > >
> > > > > Wojciech
> > > > >
> > > > >
> > > > > t _______________________________________
> > > > >
> > > > > > English - Spanish
> > > > > >
> > > > > > Dear Wojciech
> > > > > >
> > > > > > I do not agree with the statement that ARVD is a rare disease !
> > > > > >
> > > > > > The histologic substrate of RVD is found in 3.7 % of the general
> > > > > > population
> > > > > >
> > > > > > only few patients are referred to tertiary centers because of
> > > > > > arrhythmias.
> > > > > >
> > > > > > Around 3-5 cases each month are seen in Paris in the Forensic
> > > > > > Medicine Institution
> > > > > >
> > > > > > 10 cases are studied each day !
> > > > > >
> > > > > > In addition many patients have concealed RV dysfunction. This is
> > > > > > visible only in case of independent LV failure
> > > > > > Therefore ARVD and Fat Dissociation Syndrome (see my
> > > > > > histopathologic plates) are important pronostic factors as
> > > > > > recently reported.
> > > > > >
> > > > > > Best regards
> > > > > >
> > > > > > Guy
> > > > > >
> > > > > > ----------------
> > > > > >
> > > > > > Estimado Wojciech
> > > > > >
> > > > > > No coincido con la idea de que la DAVD es una enfermedad rara!
> > > > > > El sustrato histologico de DVD se encuentra en el 3,7 % de la
> > > > > > poblacion general, solo unos pocos pacientes son derivados a
> > > > > > centros terciarios debido a arritmias.
> > > > > >
> > > > > > En Paris se ven alrededor de 3-5 casos por mes; en la Forensic
> > > > > > Medicine Institution se estudian 10 casos cada dia!
> > > > > >
> > > > > > Ademas, muchos pacientes tienen disfuncion oculta del VD. Esto
> > > > > > solo es evidente en el caso de insuficiencia independiente del
> > > > > > VI. Por lo tanto, la DAVD y el Sindrome de Disociacion de
> > > > > > Adiposidad (ver mis placas histopatologicas) son factores de
> > > > > > pronostico importantes como se informo recientemente.
> > > > > >
> > > > > > Saludos cordiales,
> > > > > >
> > > > > > Guy