Abstract 2027: Detection and Prognostic Significance of Myocardial Damage in Patients with Sarcoidosis Using Delayed-Enhancement Cardiac Magnetic Resonance
Background: In sarcoid patients (pts), sudden death is a leading cause of mortality and may represent unrecognized cardiac involvement. Delayed enhancement cardiac magnetic resonance (DE-CMR) can detect minute amounts of myocardial damage (necrosis and scarring). We hypothesized DE-CMR is more sensitive for cardiac involvement than standard evaluation.
Methods: 81 consecutive pts with biopsy proven extra-cardiac sarcoidosis were prospectively recruited for a parallel and masked comparison between a standard evaluation (Japanese Ministry of Health [JMH] criteria) and DE-CMR for cardiac involvement. JMH evaluation included a 12-lead ECG and a dedicated non-CMR cardiac imaging study (echo, radionuclide perfusion, or cath). All pts were followed (mean 15 months) for major adverse cardiac events (death, defibrillator shock, or pacemaker requirement).
Results: Pts (age, 45.8±10.6 years) were predominantly female (62%) and African-American (73%). The LVEF was preserved, 50±12%. JMH criteria identified cardiac involvement in 10 (12.3%) pts and DE-CMR in 21 (26%, 8 overlapping), a two-fold higher rate (p=0.0001). Pts with damage on DE-CMR had no obstructive CAD on angiography. Damage on DE-CMR predicted future adverse events (n=8, p=0.006) and cardiac death (n=5, p=0.046), whereas JMH criteria predicted neither (Figure⇓). Multivariate analysis found damage on DE-CMR to be the strongest predictor of future adverse events (OR 9.4, p=0.006).
Conclusion: DE-CMR is more sensitive for cardiac involvement than current clinical criteria in sarcoid patients, identifying damage at a two-fold higher rate. Damage on DE-CMR predicted major adverse events including cardiac death.