Abstract 14018: Myocardial T2 is Increased in Sarcoidosis to a Greater Extent Compared to Late Gadolinium Enhancement
Background: Sarcoidosis is present in a disproportionate number of female African-Americans, and cardiac sarcoidosis (CS) is the second leading cause of sarcoidosis-related death. Late gadolinium enhancement (LGE) is currently used to diagnose CS. We hypothesized that T2 imaging is a more sensitive indicator of CS and indicates arrhythmic substrate.
Methods and Results: Among 130 patients undergoing CMR at our institution between 2005 and 2012 for suspected CS, 94 had tissue or other confirmed diagnosis of sarcoidosis. Among these, 54 patients (age 52.1±11.9 years, 50% female, 42.6% African-American) had quantitative T2 mapping as part of CMR examination that included cine and LGE acquisitions. Standard LV myocardial segments were rated for presence/absence of LGE-positivity, and maximum myocardial T2 was recorded. Most (88.9%) patients had pulmonary involvement. 28 patients (51.9%) had documented ventricular arrhythmia, high-grade A-V block or QRS >120 ms. Despite a high prevalence (50%) of steroid or other immunosuppressive therapy at the time of CMR examination, the majority (57.4%) had significantly elevated myocardial T2 compared to healthy controls (61.7±5.6 vs. 51.5±2.0 ms, p<0.0001; Figure). The prevalence of abnormal T2 was higher compared to the prevalence of LGE-positivity (29.6%, p=0.002), suggesting greater sensitivity of T2 imaging for myocardial abnormality in sarcoidosis. Patients with vs. those without significant ECG abnormalities had higher myocardial T2 values (63.3±6.3 vs. 60.6±4.6, p=0.05) despite similar prevalence of LGE-positivity (39% vs. 23%, p=0.23).
Conclusions: Myocardial T2 is quantitatively abnormal in patients with sarcoidosis, and the prevalence of T2 abnormality exceeds that of LGE abnormality. Importantly, T2 elevation predicts ECG and rhythm abnormalities. Further prospective studies are warranted using myocardial T2 for risk stratification and decision-making regarding device therapy.
- © 2013 by American Heart Association, Inc.