- Oral presentation
- Open Access
Sarcoidosis: comprehensive CMR evaluation and major adverse cardiac events
https://doi.org/10.1186/1532-429X-18-S1-O101
© Higgins et al. 2016
- Published: 27 January 2016
Keywords
- Sarcoidosis
- Ventricular Arrhythmia
- Major Adverse Cardiac Event
- Cardiac Sarcoidosis
- Atrial Size
Background
Sarcoidosis is an idiopathic granulomatous disease that can affect any organ system, including the heart. We examined the predictive relationship of CMR imaging and clinical parameters with major adverse cardiac events (MACE) in patients with sarcoidosis.
Methods
A consecutive series of 93 study subjects undergoing clinical CMR for evaluation of cardiac sarcoidosis from 2002 to 2012 were identified from the CMR reporting database. All studies were performed using a 1.5T CMR system (Philips Achieva). Anatomic, functional and late gadolinium enhanced (LGE) images were acquired and analyzed according to standard clinical protocols. Clinical data were derived from the medical record. Vital status was confirmed using medical record and the Social Security Administration Death Master File. MACE was defined as mortality, ventricular arrhythmia, or device placement. Relationship to MACE was evaluated using proportional hazards regression.
Results
The cohort characteristics are shown in the table. Evidence of extracardiac sarcoidosis was present in 81(87%) and proven by biopsy in 39(42%). MACE occurred in 28(30%); 7(8%) died, 16(17%) had ventricular arrhythmia, and 11 (12%) underwent device placement. Analysis results are shown in the Table, including elements of the Japanese Ministry of Health guidelines for diagnosis of cardiac sarcoidosis revised in 2006 and imaging measurements. CMR measures associated with MACE include left and right atrial size, and left ventricular cavity size, mass, and function. LGE had a borderline association with MACE but was not associated with mortality. Study subjects who received steroid therapy had a reduction in MACE that was borderline significant but with no apparent reduction in mortality.
Conclusions
Characteristics of the study cohort and associations with adverse cardiac events and mortality
Major Adverse Cardiac Event | Mortality | ||||
---|---|---|---|---|---|
Variable | Value | Hazard Ratio | P | Hazard Ratio | P |
Age,y* | 52 ± 11 | 1.3(0.9-1.8) | 0.168 | 2.1(1.1-4.4) | 0.033 |
Male | 51(55%) | 1.4(0.7-3.1) | 0.350 | 0.7(0.15-3.0) | 0.601 |
AV block+ | 7(8%) | 8.8(3.5-21.9) | < 0.001 | 6.1(1.2-31.4) | 0.032 |
Basal LV thinning+ | 3(3%) | Not defined | 0.989 | Not defined | 0.995 |
LV ejection fraction < 50%+ | 17(18%) | 3.1(1.4-6.5) | 0.004 | 6.2(1.4-27.5) | 0.018 |
Ventricular ectopy+ | 9(10%) | 5.0(2.1-11.9) | < 0.001 | Not defined | 0.995 |
Right bundle branch block+ | 16(17%) | 3.2(1.4-7.1) | 0.005 | 4.9(1.1-22.3) | 0.038 |
Axis deviation+ | 19(20%) | 2.4(1.4-4.2) | 0.002 | 3.4(1.3-8.9) | 0.011 |
Pathologic Q waves+ | 7(8%) | 4.1(1.7-10.2) | 0.002 | 14.6(3.2-66.9) | < 0.001 |
LV wall motion abnormality+ | 11(12%) | 3.1(1.3-7.3) | 0.011 | 10.1(2.3-45.2) | 0.003 |
Heart failure | 13(14%) | 2.5(1.1-5.8) | 0.027 | 4.8(1.1-21.7) | 0.040 |
Coronary artery disease | 6(6%) | 2.0(0.6-6.5) | 0.267 | 7.8(1.5-40.6) | 0.014 |
Diabetes mellitus | 12(13%) | 0.8(0.2-2.6) | 0.678 | 1.1(0.1-9.4) | 0.912 |
Hypertension | 33(35%) | 2.1(1.0-4.3) | 0.056 | 12.2(1.5-101.6) | 0.021 |
Left atrial AP dimension, mm* | 35 ± 8 | 1.0(0.6-1.5) | 0.940 | 3.6(1.7-7.6) | < 0.001 |
Right atrial 4-chamber dimension, mm* | 51 ± 8 | 0.7(0.4-1.2) | 0.193 | 2.4(1.0-5.3) | 0.040 |
LV end diastolic volume, ml* | 163 ± 46 | 1.1(1.0-1.2) | 0.001 | 1.2(1.1-1.4) | 0.007 |
LV end diastolic volume index, ml/m2* | 82 ± 20 | 1.4(1.2-1.6) | < 0.001 | 1.4(1.1-1.9) | 0.010 |
LV end systolic volume, ml* | 89 ± 40 | 1.1(1.1-1.2) | < 0.001 | 1.3(1.1-1.4) | < 0.001 |
LV ejection fraction,%* | 57 ± 11 | 0.6(0.5-0.8) | 0.001 | 0.5(0.3-0.8) | 0.008 |
LV mass, g* | 111 ± 42 | 1.1(1.0-1.2) | 0.056 | 1.3(1.1-1.5) | < 0.001 |
RV end diastolic volume, ml* | 154 ± 42 | 1.0(1.0-1.1) | 0.318 | 1.1(0.9-1.3) | 0.446 |
RV end diastolic volume index, ml/m2* | 77 ± 16 | 1.2(1.0-1.5) | 0.074 | 1.3(0.8-2.1) | 0.393 |
RV end systolic volume, ml* | 69 ± 28 | 1.1(1.0-1.2) | 0.236 | 1.2(1.0-1.4) | 0.100 |
RV ejection fraction, %* | 56 ± 7 | 0.8(0.5-1.4) | 0.474 | 1.0(0.3-3.4) | 0.950 |
Presence of LGE+ | 15(16%) | 2.2(0.9-5.2) | 0.072 | 0.9(0.1-7.8) | 0.956 |
Number of segments with LGE | 1 ± 3 | 1.1(1.0-1.3) | 0.042 | 1.2(0.9-1.4) | 0.204 |
Steroid therapy | 37(40%) | 0.5(0.2-1.1) | 0.087 | 2.7(0.5-14.9) | 0.248 |
Authors’ Affiliations
Copyright
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.