Key result
Transmural myocardial scar on MRI is linked to ~3.8-fold higher odds of inducible ventricular arrhythmias.
Why the study?
Do transmural myocardial scarring and edema on cardiac MRI predict inducible ventricular arrhythmias in patients with cardiac sarcoidosis and mildly impaired LVEF (≥40%)?
Cohort (n=101)
Yes
Do transmural myocardial scarring and edema on cardiac MRI predict inducible ventricular arrhythmias in patients with cardiac sarcoidosis and mildly impaired LVEF (≥40%)?
Odds Ratio: 3.78 (95% CI 1.05–14)
p-value: p=0.041
In patients with cardiac sarcoidosis and mildly impaired LVEF (≥40%), transmural myocardial scarring and myocardial edema on cardiac MRI are significantly associated with inducible ventricular arrhythmias, suggesting utility as noninvasive prognostic indicators for ICD risk stratification.
MRI scarring/edema may aid noninvasive EPS risk stratification in cardiac sarcoidosis with LVEF ≥40%; leaves open prospective validation for ICD decisions.
Background: Patients with cardiac sarcoidosis (CS) and mildly impaired left ventricular ejection fraction remain at high risk for sudden cardiac death. However, risk stratification for implantable cardioverter‐defibrillator implantation in this group is needed. We aimed to determine if electrophysiologic study (EPS) may be used as a noninvasive alternative for sudden cardiac death risk stratification. Methods: In this retrospective cohort study, we analyzed patients with CS (aged >18 years) with highly probable or probable sarcoidosis according to the World Association of Sarcoidosis and Other Granulomatous Disorders Sarcoidosis Organ Assessment Instrument, with evidence of late gadolinium enhancement on cardiac magnetic resonance imaging in a pattern consistent with CS and left ventricular ejection fraction ≥40%, who underwent EPS. Results: We identified 101 patients with CS, 15 EPS positive and 86 EPS negative. A higher proportion of patients with an EPS‐positive study was associated with antiarrhythmic therapy ( P= 0.005) and ventricular tachycardia on ECG or Holter monitoring ( P< 0.001). In multivariable analysis, transmural myocardial scarring (odds ratio, 3.78 [95% CI, 1.05–14]; P =0.041) and edema on T2‐weighted cardiac magnetic resonance imaging (odds ratio, 4.75 [95% CI, 1.09–21.2]; P= 0.036) were associated with higher odds of an EPS‐positive study. There was no association between anatomic distribution of scar within left ventricular and right ventricular segments and inducibility on EPS. Conclusions: In patients with CS and mildly impaired left ventricular ejection fraction, we demonstrated that transmural myocardial scarring and edema on T2‐weighted cardiac magnetic resonance imaging are associated with sustained ventricular arrhythmia during EPS, suggesting that noninvasive imaging features may be used as prognostic indicators in patients with CS. Larger, prospective studies are needed to inform implantable cardioverter‐defibrillator implantation guidelines.
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Treacy et al. (2026) conducted a cohort in Cardiac sarcoidosis with mildly impaired left ventricular function (n=101). Transmural myocardial scarring on cardiac MRI vs. Absence of transmural scarring was evaluated on Sustained inducible ventricular arrhythmia during electrophysiologic study (OR 3.78, 95% CI 1.05-14.0, p=0.041). Transmural myocardial scarring and T2-weighted edema on MRI were associated with inducible ventricular arrhythmias (OR 3.78 and 4.75) in cardiac sarcoidosis patients with mildly impaired LVEF.
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