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Although cardiac sarcoidosis (CS) is associated with increased risk of sudden cardiac death, there is no consensus regarding the best strategy for risk stratification. We sought to determine whether cardiovascular magnetic resonance (CMR) guided- or Japanese Ministry of Health and Welfare Criteria (JMHW) guided- ICD implantation is the better strategy for improving survival.
A Markov decision model, a tool to guide decision making in the absence of randomized trials, was designed to assess survival outcomes in patients with CS. Model parameters were estimated using 19 published studies (Figure). Two strategies to diagnose CS were considered: 1) CMR with late gadolinium enhancement (LGE) or 2) JMHW. If CS was detected, ICD placement was considered in the model using published implantation rates in CS patients. A management strategy was considered optimal if it improved estimated survival.
The use of CMR increased estimated survival compared to JMHW by 7.5 months. Based on sensitivity analysis, important variables for establishing CMR as the best strategy were 1) LGE negative patients had higher annual survival than JMHW negative patients (98.08% vs. 95.90%); and 2) LGE positive patients had lower annual survival than JMHW positive patients who did not undergo ICD implantation (83.68% vs. 85.10%).
Markov analysis suggests CMR guided risk stratification for ICD implantation should be further evaluated in patients with CS as a strategy to improve 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: 1184-365
- 2013 American College of Cardiology Foundation