Abstract 12694: Extent of Late Gadolinium Enhancement on Cardiovascular Magnetic Resonance Predicts Improvement in Left Ventricular Function and Adverse Outcomes After Steroid Therapy in Patients with Cardiac Sarcoidosis
Background: Gadolinium-enhanced cardiac magnetic resonance imaging is an emerging tool for the diagnosis of cardiac sarcoidosis (CS). Although the presence of late gadolinium enhancement (LGE) reflects myocardial involvement, the impact of the extent of LGE on the efficacy of steroid therapy has not been well investigated in patients with CS. Accordingly, we sought to determine whether the extent of LGE could be associated with the improvement in left ventricular (LV) function and the incidence of adverse outcomes after steroid therapy.
Methods: We reviewed 43 consecutive LGE positive CS patients before steroid therapy (59±11 years; 15 men). The patients were divided into two groups based on the extent of LGE: lesser-extent LGE (LGE mass<40% of LV mass) and greater-extent LGE (LGE mass≥40% of LV mass). LV ejection fraction was measured by echocardiography before and 6 months after steroid therapy.
Results: Twenty-two patients had greater-extent LGE and 21 had lesser-extent LGE. The mean LV ejection fraction in patients with greater-extent LGE (45±13%) was lower than in patients with lesser-extent LGE (33±12%) before steroid therapy. During the mean follow-up of 38 months, 5 patients died of heart disorders and 10 hospitalized for heart failure. The extent of LGE inversely correlated with the increase in LV ejection fraction (r= -0.64, p<0.01). Furthermore, greater-extent LGE predicted the higher incidence of either cardiac mortality or hospitalization for heart failure (p=0.027 and p<0.01, respectively). The associations persisted even after adjustment for LV ejection fraction before steroid therapy (HR 1.08 (95% CI 1.03-1.17) and 1.05 (95% CI 1.02-1.09), respectively).
Conclusions: Greater-extent of LGE is associated with less improvement in LV function and high incidence of adverse outcomes after steroid therapy in patients with CS.
- © 2011 by American Heart Association, Inc.