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CMR imaging predicted mortality in suspected cardiac sarcoidosis
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Among sarcoid patients with nonspecific symptoms who underwent cardiac magnetic resonance, late gadolinium enhancement was the best independent predictor of myocardial scar and other adverse events.
Researchers studied 155 consecutive patients (mean age, 50 years) with systemic sarcoidosis who underwent cardiac magnetic resonance (CMR) imaging for workup of suspected cardiac sarcoid involvement. The primary endpoint was death, aborted sudden cardiac death or implantable cardioverter defibrillator discharge. Secondary endpoints included ventricular tachycardia and non-sustained ventricular tachycardia.
“Cardiac sarcoidosis is the most important cause of patient mortality in systemic sarcoidosis, yielding a 5-year mortality rate between 25% and 66% despite immunosuppressive treatment,” Simon Greulich, MD, of the division of cardiology at Robert-Bosch-Medical Center, Stuttgart, Germany, and colleagues wrote. “Other groups have shown that late gadolinium enhancement may hold promise in predicting future adverse events in this patient group.”
Simon Greulich
Mean follow-up was 2.6 years. Researchers reported the presence of late gadolinium enhancement in 25.5% of patients. Presence of late gadolinium enhancement was associated with a Cox HR of 31.6 for death, aborted sudden cardiac death or ICD discharge and a Cox HR of 33.9 for any event. According to the researchers, this finding is superior to functional and clinical parameters, such as left ventricular ejection fraction, LV end-diastolic volume or presentation of HF.
Only one patient without late gadolinium enhancement died, related to rapid pulmonary infection.
“This study is unique in that we could demonstrate that the presence of late gadolinium enhancement is the best independent predictor of death and other adverse events in patients presenting for workup of suspected cardiac sarcoidosis in an international multicenter setting,” the researchers concluded. “These data support the necessity for future large, longitudinal, follow-up studies to definitely establish late gadolinium enhancement as an independent predictor of cardiac death in sarcoidosis, as well as to evaluate the incremental prognostic value of additional parameters.”
Disclosure: The researchers report no relevant financial disclosures.
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