Abstract 16689: Can Cardiovascular Magnetic Resonance Identify Patients With Cardiac Sarcoidosis and Preserved Left Ventricular Ejection Fraction at Risk for Death and Sustained Ventricular Tachycardia?
Background: In sarcoidosis, late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) is useful in detecting cardiac involvement, even when left ventricular ejection fraction (LVEF) is preserved. However, covariates associated with adverse outcomes in patients with cardiac sarcoidosis (CS) and preserved LVEF, such as death and sustained ventricular tachycardia (VT), have not been fully explored. We sought to (1) determine whether CS (as defined by presence of LGE) conferred risk of death/VT, and (2) identify risk factors for death/VT in patients with CS, independent of pulmonary disease.
Methods: 218 patients with LVEF >50% and biopsy-proven extra-cardiac sarcoidosis referred for CS evaluation were identified. CMR short axis slices (1.5T Achieva, Philips) were obtained 10 min after contrast using a T1-weighted gradient echo pulse sequence. LGE was identified as regions with signal intensity >5 SD above mean of normal myocardium, and quantified as % LV mass (Virtue, Diagnosoft). Of 218 patients, 41 who had LGE (CS+) were matched by age, sex and severity of pulmonary disease (Scadding stage and pulmonary function) with 41 patients who did not have LGE (CS-). Parameters of left and right ventricular (RV) function were compared between the CS- and CS+ groups, and also within the CS+ group, between those with and without death/VT. The ability of each parameter to predict (1) CS and (2) death/VT within the CS+ group was determined using receiver-operator characteristics analysis.
Results: 12/218 (5.5%) patients died or had VT during follow-up (41±19 months), 10 of whom were CS+ (41 total CS+). Moreover, CS+ had a rate of death/VT per year which was > 20 times that of CS- (4.9 vs 0.2%, p=0.05). LGE yielded sensitivity 100%, specificity 58% for predicting death/VT.
Conclusions: In patients with biopsy-proven extra-cardiac sarcoidosis and preserved LVEF, death/VT are strongly associated with LGE. LGE burden >5% and RV dysfunction can identify patients with CS at higher risk of death/VT, independent of pulmonary disease severity.
Author Disclosures: G. Murtagh: None. L.L. Laffin: None. J.F. Beshai: None. C. Bonham: None. K. Addetia: None. A.V. Patel: None. Z. Yu: None. F. Maffesanti: None. D. Hogarth: None. J.D. Moss: None. N. Sweiss: None. R.M. Lang: Speakers Bureau; Modest; Philips. Honoraria; Modest; Philips. A.R. Patel: Research Grant; Significant; Astellas. Other Research Support; Significant; Philips.
- © 2014 by American Heart Association, Inc.