Lucia Agoston-Coldea1, Sylvain Kouaho1, Karim Sacre2, Antoine Dossier2, Brigitte Escoubet3, Sylvie Chillon1, Jean-Pierre Laissy1, François Rouzet4, Shelby Kutty1, Fabrice Extramiana5, Antoine Leenhardt5, Raphael Borie6, Bruno Crestani6, Phalla Ou7. 1. Service de Radiologie, Hopital Bichat, APHP, University Paris Diderot, France. 2. Service de Médecine Interne, Hopital Bichat, APHP, University Paris Diderot, France. 3. Service d'Explorations Fonctionnelles, Hospital Bichat, APHP, University Paris Diderot, France. 4. Service de Medecine Nucleaire, Hopital Bichat, APHP, University Paris Diderot, France. 5. Service de Cardiologie, Hopital Bichat, APHP, University Paris Diderot, France. 6. Service de Pneumologie, Hopital Bichat, APHP; University Paris Diderot, France. 7. Service de Radiologie, Hopital Bichat, APHP, University Paris Diderot, France; Service de Radiologie, Hopital Bichat, APHP, University Paris Diderot, and Inserm 1148, Paris, France. Electronic address: phalla.ou@aphp.fr.
Abstract
BACKGROUND: Cardiac involvement is the most important cause of mortality in patients with systemic sarcoidosis. Late gadolinium enhancement (LGE) on cardiovascular magnetic resonance imaging (CMR) has been shown to be a predictor of major cardiovascular adverse events (MACE) in the setting of systemic sarcoidosis. We sought to evaluate the relationship between LGE mass and adverse long-term outcome in patients with biopsy-proven extracardiac sarcoidosis. METHODS: Between 2001 and 2013, 197 consecutive patients with suspected cardiac sarcoidosis were identified in our institution database. Of them, 56 patients have had biopsy-proven extracardiac sarcoidosis and represented our studied population. Patients were divided into two groups based on LGE mass by a median value (mild LGE<18g, high LGE>18g) for comparison of MACE. RESULTS: Twenty-eight patients had a high mass of LGE. Of them, 15 (54%) experienced MACE (OR=31.15, 95% CI 3.7-262). Except for 1 patient, no patient with mild LGE presented with any MACE during follow-up (median of 32months). Patients with high LGE had lower CMR-derived left (53.6±14.9 vs. 62.2±6.7, p<0.01) and right (49.1±11.5 vs. 56.4±9.2, p<0.05) ventricular ejection fractions. LGE mass of 18g discriminated patients with and without MACE (93% sensitivity, 88% specificity, AUC=0.972). LGE mass was the only independent predictor of MACE on multivariate Cox analysis adjusted (OR=1.7, 95% CI 1.06 to 2.72, p=0.03). CONCLUSION: In biopsy-proven extracardiac sarcoidosis patients, a high mass of LGE >18g was associated with MACE.
BACKGROUND: Cardiac involvement is the most important cause of mortality in patients with systemic sarcoidosis. Late gadolinium enhancement (LGE) on cardiovascular magnetic resonance imaging (CMR) has been shown to be a predictor of major cardiovascular adverse events (MACE) in the setting of systemic sarcoidosis. We sought to evaluate the relationship between LGE mass and adverse long-term outcome in patients with biopsy-proven extracardiac sarcoidosis. METHODS: Between 2001 and 2013, 197 consecutive patients with suspected cardiac sarcoidosis were identified in our institution database. Of them, 56 patients have had biopsy-proven extracardiac sarcoidosis and represented our studied population. Patients were divided into two groups based on LGE mass by a median value (mild LGE<18g, high LGE>18g) for comparison of MACE. RESULTS: Twenty-eight patients had a high mass of LGE. Of them, 15 (54%) experienced MACE (OR=31.15, 95% CI 3.7-262). Except for 1 patient, no patient with mild LGE presented with any MACE during follow-up (median of 32months). Patients with high LGE had lower CMR-derived left (53.6±14.9 vs. 62.2±6.7, p<0.01) and right (49.1±11.5 vs. 56.4±9.2, p<0.05) ventricular ejection fractions. LGE mass of 18g discriminated patients with and without MACE (93% sensitivity, 88% specificity, AUC=0.972). LGE mass was the only independent predictor of MACE on multivariate Cox analysis adjusted (OR=1.7, 95% CI 1.06 to 2.72, p=0.03). CONCLUSION: In biopsy-proven extracardiac sarcoidosis patients, a high mass of LGE >18g was associated with MACE.
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