Abstract 10080: Predicting Potentially Fatal Conductive Disease in Sarcoidosis; Can Cardiac MRI Define the Risk?
Background: Sarcoidosis incidence is approximately 1:135,000 Americans. Cardiac involvement triggers multiple conduction disturbances, the most severe being complete heart block and VT/VF. Non-caseating granulomas have been found in the myocardium in up to 50% of the cases of fatal sarcoidosis, and 67% of pts that died from cardiac causes had myocardial involvement. Late gadolinium enhancement cardiovascular MRI (LGE) has been shown to be more than twice as sensitive for cardiac involvement per current consensus Japanese Ministry of Health criteria and is widely held but, as yet unproven, to be more sensitive than the invasive RV endomycardial biopsy.
Hypothesis: We hypothesized that there was an association between LGE-CMR evident cardiac sarcoidosis and advanced conduction disease.
Methods: A retrospective single center study was performed by searching our cardiac MRI database for patients with pulmonary sarcoidosis and possible cardiac involvement. These patients’ electronic medical records were then evaluated for documented history of complete heart block, ventricular arrhythmias and pacemaker and/or AICD implantation. Using the keyword “cardiac sarcoidosis”, out of 6108 clinical cardiac MRIs performed from 2001-2010 at our institution, 72 pts were identified, 51 of whom had evidence of pulmonary sarcoidosis (23 by biopsy, 9 by CT, 13 by MRI, and 6 by history).
Results: LGE identified additional cardiac involvement in 22 patients (43%). Five pts had documented VT while one patient had complete heart block. All six had an AICD/PM placed. In the other 29 pts without cardiac involvement on LGE, only 1 patient required AICD placed for a history of VT (p<0.05). LGE-defined cardiac involvement led to a significant prediction for complete heart block and VT/VF (p<0.001) as compared to more standard metrics.
Conclusions: Patients with non-invasive LGE-CMR identified cardiac involvement have high potential to develop complete heart block/ventricular arrhythmias. Propensity risks suggest LGE may identify unstable electrical myocardium in a subset of pts warranting prophylactic AICD/PM placement. LGE defined yearly risk estimate for cardiac sarcoid (27%) is far greater than current post-implant AICD firing rate in ischemic CMX (<1%) at one year.
- © 2011 by American Heart Association, Inc.