Abstract 10820: Different Pathophysiology of Clinical Events in Cardiac Sarcoidosis: Insights From Cardiac Magnetic Resonance Analysis
Background: In patients with sarcoidosis, cardiac involvements are closely associated with the patients’ prognosis. Different cardiac events may happen, however it remains unclear what factors affect the onset in cardiac sarcoidosis (CS). Delayed-enhancement cardiac magnetic resonance (DE-CMR) is a valuable test to detect myocardial damage and recent data suggest that DE-CMR is more sensitive than the clinical diagnostic criteria for detecting CS. Therefore, we sought to examine the pathophysiological characteristics of clinical cardiac events in CS patients using DE-CMR.
Methods: Forty consecutive CS patients underwent CMR (cine, T2, and DE imaging). LV mass and % area of DE was calculated and the distribution/pattern was analyzed using 17 segment model. According to the mural location of DE; mid-wall, epicardial, or transmural, the DE pattern was classified into three groups; A; DE existing only at one location, B; DE at any two locations, C; DE at all locations.
Results: Patients were predominantly middle-aged (62±13years) and female (77%) and had reduced left ventricular (LV) ejection fraction (EF; mean, 48±14%). Myocardial damage was detected in 92% of the patients by DE imaging and most frequently observed in basal septal myocardium. % DE (% fibrosis area) was negatively correlated with LVEF (p<0.001) and positively with BNP (p=0.008), but not associated with LV mass (p=0.117). Group B and C showed the significantly decreased LVEF and increased %fibrosis area. In addition, all patients in group C had clinical cardiac events. In patients with heart failure (HF; n=17), reduced EF, increased LV mass and %fibrosis area were associated with the incidence (p<0.05 in all). In contrast, high grade atrio-ventricular block (AVB; n=10) was associated with only increased %fibrosis area (p=0.004). Ventricular tachycardia (VT; n=8) was related with LV mass (p=0.009).
Conclusions: Along with the development of myocardial fibrosis/damage, cardiac dysfunction and different clinical events such as HF, AVB, VT occur in CS. CMR may be a useful tool for characterizing of respective cardiac events by detecting myocardial damage and dysfunction in CS patients.
- © 2013 by American Heart Association, Inc.