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Volume 18 Supplement 1

19th Annual SCMR Scientific Sessions

  • Oral presentation
  • Open Access

Sarcoidosis: comprehensive CMR evaluation and major adverse cardiac events

  • 2,
  • 3,
  • 1 and
  • 1
Journal of Cardiovascular Magnetic Resonance201618 (Suppl 1) :O101

https://doi.org/10.1186/1532-429X-18-S1-O101

  • Published:

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

In this cohort of consecutive patients with sarcoidosis referred for CMR, measures of left and right atrial size, and left ventricular size, mass and function were highly predictive of both MACE and mortality. LGE was borderline associated with MACE but not predictive of mortality. Steroid therapy had a trend toward reduction of MACE but no influence on mortality. These data support the role of CMR in the routine evaluation of all patients with suspected cardiac sarcoidosis.
Table 1

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

*Hazard ratio shown for a 10 unit change.

+Included in the Japanese Ministry of Health guideline for the diagnosis of cardiac sarcoidosis, revised 2006.

Abbreviations as in the text.

Authors’ Affiliations

(1)
Cardiology, BIDMC, Boston, MA, USA
(2)
National Institutes of Health, Bethesda, MD, USA
(3)
Northwestern Medicine Central Dupage Hospital, Winfield, IL, USA

Copyright

© Higgins et al. 2016

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.

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