Late gadolinium enhancement extent ≥15% strongly predicted all-cause mortality and serious ventricular arrhythmias in patients with cardiac sarcoidosis (HR 3.96; 95% CI 2.17-7.23; p<0.001).
Cohort (n=208)
Do multimodality imaging parameters predict adverse outcomes in patients newly diagnosed with cardiac sarcoidosis?
In patients with newly diagnosed cardiac sarcoidosis, multimodality imaging parameters including RWMA, LGE extent, RVEF, and RV FDG uptake are strong independent predictors of adverse outcomes, whereas LVEF is not.
Effect estimate: HR 3.96 (95% CI 2.17-7.23)
p-value: p=<0.001
BACKGROUND: fluorodeoxyglucose positron emission tomography (FDG-PET) imaging play key roles in the diagnosis and management of cardiac sarcoidosis (CS), but the relative value of each modality in predicting outcomes has yet to be determined. This study sought to determine the prognostic importance of multimodality imaging data over and above demographic characteristics and left ventricular ejection fraction (LVEF). METHODS: Consecutive patients newly diagnosed with CS were included. Parameters evaluated included echocardiographic regional wall motion abnormality (RWMA), myocardial strain, LVEF, right ventricular ejection fraction (RVEF), late gadolinium enhancement (LGE) extent, SUVmax and RV FDG uptake. The primary endpoint was a composite of all-cause mortality and serious ventricular arrhythmia. RESULTS: The study population consisted of 208 patients with mean age of 55±13 years and LVEF of 55±12%. During a median follow-up period of 46 (IQR: 18-55) months, 14 patients died and 28 suffered serious ventricular arrhythmias. On multivariable analysis, RWMA (HR for RWMA presence 2.55, 95% CI 1.27 to 5.28, p=0.008), LGE extent (HR per 1% increase 1.02, 95% CI 1.00 to 1.04, p=0.018), RVEF (HR per 1% decrease 0.97, 95% CI 0.94 to 0.99, p=0.008) and RV FDG uptake (HR for RV FDG presence 2.48, 95% CI 1.15 to 5.33, p=0.020) were independent predictors of the primary endpoint, while LVEF was not predictive. The risk of adverse events was significantly greater in those with LGE extent ≥15% (HR for ≥15% presence 3.96, 95% CI 2.17 to 7.23, p<0.001). CONCLUSION: In our CS population, RWMA, LGE extent, RVEF and RV FDG uptake were strong independent predictors of an adverse outcome. These findings offer an important insight into the key multimodality imaging parameters that may be used in a future risk stratification model of patients with CS.
Okafor et al. (Tue,) conducted a cohort in Cardiac sarcoidosis (n=208). Multimodality imaging (echocardiography, CMR, FDG-PET) was evaluated on Composite of all-cause mortality and serious ventricular arrhythmia (HR 3.96, 95% CI 2.17-7.23, p=<0.001). Late gadolinium enhancement extent ≥15% strongly predicted all-cause mortality and serious ventricular arrhythmias in patients with cardiac sarcoidosis (HR 3.96; 95% CI 2.17-7.23; p<0.001).