Author + information
- Edward Hulten,
- Bobak Heydari,
- Marcio Bittencourt,
- Ravi Shah,
- Daniel O'Leary,
- Siddique Abbasi,
- Marcelo Di Carli,
- Michael Steigner,
- Michael Jerosch-Herold,
- Raymond Kwong and
- Ron Blankstein
- Despite the Japanese Ministry of Health criteria (JMHC), the diagnosis of Cardiac Sarcoidosis (CS) is challenging as no reliable gold standard reference exists and endomyocardial biopsy has a poor sensitivity. Consequently, the comparative value of differing diagnostic criteria to prognosticate adverse outcomes after diagnosis remains unclear. Our aim was to compare the prognostic value of late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) with that of the JMHC.
- We included all consecutive patients referred for a clinical CMR for evaluation of suspected CS from 2002–2011 who had longitudinal follow-up in our system. Electronic medical records and social security death index were reviewed blinded to CMR results to ascertain whether JMHC were present or absent as well as to ascertain any adverse events including death or sustained ventricular tachycardia (VT) requiring therapy. CMR were categorized as having any LGE in a pattern which could be consistent with CS versus no LGE.
66 patients with mean age of 51 +/−12 years were followed for a mean 3.4 years during which 2 deaths and 3 VT events occurred. All patients had a clinical suspicion of CS, with 48(73%) having extra-cardiac sarcoid and 60 (91%) the presence of a major or minor JMHC. However, only 4 (6%) met the JMHC of 2 major or 1 major with 2 minor criteria. In contrast, based on CMR, 12 (18%) patients had LGE consistent with CS, one of whom had (+) JMHC. 3 patients with (+) JMHC had no LGE and no adverse event. A total of 13 patients underwent endomyocardial biopsy (4 patients with LGE and 9 without LGE); all were negative. Among 15 patients who had implantation of defibrillators, 3 experienced VT (2 had LGE and 1 did not). The annualized event rate was 14.1% for patients with LGE, versus 0.5% without LGE, p = 0.001. Area under receiver operator characteristic curve for prediction of death/VT was 0.83 for LGE versus 0.58 for JMHC, p = 0.046.
- Among patients referred to CMR for suspected cardiac sarcoidosis, the presence of LGE resulted in improved prediction of future death or VT compared to JMHC, while the absence of LGE was associated with excellent event free survival.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Imaging: MRI III – CMR in Myocardial Disease and Dysfunction
Abstract Category: 19. Imaging: MRI
Presentation Number: 1184-367
- 2013 American College of Cardiology Foundation