Abstract 17202: Sensitivity and Specificity of Chest Imaging for Screening of Sarcoidosis in Patients With Cardiac Presentations: Insights From the Chasm-cs Registry
Background: Patients with sarcoidosis can present with cardiac symptoms as the first manifestation of disease in any organ. Typical presentations include ventricular arrhythmias, atrioventricular block, and cardiomyopathy - however these are common features of many cardiovascular diseases. The use of chest imaging modalities may serve as a screening tool to help identify patients requiring more comprehensive workup; however, their use for this purpose has not been well studied. In the current study, we assessed the utility of different chest imaging modalities for screening of sarcoidosis.
Methods: Using the Cardiac Sarcoidosis Multi-Center Prospective Cohort (CHASM-CS) database, we identified patients with suspected cardiac sarcoidosis who had chest imaging as part of their diagnostic workup on initial presentation - these included chest x-ray, chest CT, and cardiac/thorax MRI. We then used the final diagnosis based on international criteria (cardiac sarcoidosis versus no cardiac sarcoidosis) to calculate the sensitivity and specificity of different imaging modalities for initial screening of sarcoidosis.
Results: We identified 51 patients with suspected cardiac sarcoidosis meeting inclusion criteria (median age 56 (±11) years, 35.4% female) — a final diagnosis of cardiac sarcoidosis was made in 22 patients (45.8%). Initial presentation was related to atrioventricular block in 52.1% of patients, ventricular arrhythmia in 41.7%, and cardiomyopathy in 6.3%. The initial diagnostic workup included chest x-ray in 95.8% of patients, chest CT in 87.5%, and cardiac/thorax MRI in 58.3%. The sensitivity and specificity for screening of sarcoidosis were 30% and 85% for chest x-ray, respectively (AUC 0.54; 95%CI 0.30-0.79; p value = 0.72); 90% and 86% for chest CT (AUC 0.82; 95%CI 0.63-1.00; p value = 0.01); 100% and 50% for cardiac/thorax MRI (AUC 0.77; 95%CI 0.57-0.98; p value = 0.03).
Conclusions: During the initial diagnostic workup of patients with suspected cardiac sarcoidosis, CT chest and cardiac/thorax MRI have excellent sensitivity. Chest x-ray may be suboptimal as a screening test for patients in whom cardiac sarcoidosis is suspected due to low sensitivity. Chest CT has the highest specificity among imaging modalities.
Author Disclosures: J.J. Russo: None. P.B. Nery: None. A.C. Ha: None. J. Healey: None. L. Rivard: None. M.G. Friedrich: None. L. Gula: None. G. Wisenberg: None. R. deKemp: None. S. Chakraborty: None. T.W. Hruczkowski: None. R. Quinn: None. G. Dwivedi: None. R. Beanlands: None. D.H. Birnie: None.
- © 2016 by American Heart Association, Inc.