Kelly M Stanton1, Madhusudan Ganigara2, Peter Corte3, David S Celermajer4, Mark A McGuire4, Paul J Torzillo5, Tamera J Corte6, Rajesh Puranik4. 1. Cardiology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia; The Heart Research Institute, Sydney, NSW, Australia; Sydney Medical School, the University of Sydney, Sydney, NSW, Australia. Electronic address: kelly.m.stanton@gmail.com. 2. Department of Cardiology, Faculty of Pediatrics, the University of Sydney, Sydney, NSW, Australia; The Children's Hospital at Westmead, Sydney, NSW, Australia. 3. Respiratory Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia. 4. Cardiology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, the University of Sydney, Sydney, NSW, Australia. 5. Sydney Medical School, the University of Sydney, Sydney, NSW, Australia; Respiratory Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia; The Intensive Care Service, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW, Australia. 6. Sydney Medical School, the University of Sydney, Sydney, NSW, Australia; Respiratory Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
Abstract
BACKGROUND: Autopsy reports suggest that cardiac sarcoidosis occurs in 20 to 25% of patients with pulmonary sarcoidosis, yet the clinical ante-mortem diagnosis is made in only 5% of cases. Current diagnostic algorithms are complex and lack sensitivity. Cardiac Magnetic Resonance imaging (CMR) provides an opportunity to detect myocardial involvement in sarcoidosis. The aim of this study is to determine the prevalence and clinical significance of late gadolinium enhancement (LGE) on CMR in patients with sarcoidosis. METHODS: Consecutive patients with biopsy-proven sarcoidosis undergoing CMR were retrospectively evaluated for cardiac sarcoidosis. Medical records were correlated with CMR. RESULTS: Forty-six patients were evaluated. Late gadolinium enhancement was present in 22%, indicating myocardial involvement, and 70% had corresponding hyper-intense T2 signal indicating active inflammation. Late gadolinium enhancement was 18%+/-9.7% of overall left ventricular (LV) mass and most commonly located in the basal to mid septum. There was no association between LGE and cardiovascular symptoms or pulmonary stage. Eighty per cent of patients with LGE did not fulfill conventional diagnostic criteria for cardiac sarcoidosis. However, LGE was associated with clinically significant arrhythmia (p<0.01) and a lower LVEF (p=0.04). CONCLUSIONS: Using CMR, we identified a higher prevalence of cardiac sarcoidosis than previously reported clinical studies, a prevalence which is more consistent with autopsy data. The presence of LGE was highly correlated with clinically significant arrhythmias and lower LVEF.
BACKGROUND: Autopsy reports suggest that cardiac sarcoidosis occurs in 20 to 25% of patients with pulmonary sarcoidosis, yet the clinical ante-mortem diagnosis is made in only 5% of cases. Current diagnostic algorithms are complex and lack sensitivity. Cardiac Magnetic Resonance imaging (CMR) provides an opportunity to detect myocardial involvement in sarcoidosis. The aim of this study is to determine the prevalence and clinical significance of late gadolinium enhancement (LGE) on CMR in patients with sarcoidosis. METHODS: Consecutive patients with biopsy-proven sarcoidosis undergoing CMR were retrospectively evaluated for cardiac sarcoidosis. Medical records were correlated with CMR. RESULTS: Forty-six patients were evaluated. Late gadolinium enhancement was present in 22%, indicating myocardial involvement, and 70% had corresponding hyper-intense T2 signal indicating active inflammation. Late gadolinium enhancement was 18%+/-9.7% of overall left ventricular (LV) mass and most commonly located in the basal to mid septum. There was no association between LGE and cardiovascular symptoms or pulmonary stage. Eighty per cent of patients with LGE did not fulfill conventional diagnostic criteria for cardiac sarcoidosis. However, LGE was associated with clinically significant arrhythmia (p<0.01) and a lower LVEF (p=0.04). CONCLUSIONS: Using CMR, we identified a higher prevalence of cardiac sarcoidosis than previously reported clinical studies, a prevalence which is more consistent with autopsy data. The presence of LGE was highly correlated with clinically significant arrhythmias and lower LVEF.
Authors: Elliott D Crouser; Lisa A Maier; Kevin C Wilson; Catherine A Bonham; Adam S Morgenthau; Karen C Patterson; Eric Abston; Richard C Bernstein; Ron Blankstein; Edward S Chen; Daniel A Culver; Wonder Drake; Marjolein Drent; Alicia K Gerke; Michael Ghobrial; Praveen Govender; Nabeel Hamzeh; W Ennis James; Marc A Judson; Liz Kellermeyer; Shandra Knight; Laura L Koth; Venerino Poletti; Subha V Raman; Melissa H Tukey; Gloria E Westney; Robert P Baughman Journal: Am J Respir Crit Care Med Date: 2020-04-15 Impact factor: 21.405