Detection of Myocardial Damage in Patients with Sarcoidosis

By M. Patel, P. Cawley, J. Heitner, I. Klem, M. Parker, W. Jaroudi, T. Meine, James White, M. Elliott, Han W. Kim and 2 more. Circulation, 2009

681 citations recorded by the source corpus.

Background— In patients with sarcoidosis, sudden death is a leading cause of mortality, which may represent unrecognized cardiac involvement. Delayed-enhancement cardiovascular magnetic resonance (DE-CMR) can detect minute amounts of myocardial damage. We sought to compare DE-CMR with standard clinical evaluation for the identification of cardiac involvement. Methods and Results— Eighty-one consecutive patients with biopsy-proven extracardiac sarcoidosis were prospectively recruited for a parallel and masked comparison of cardiac involvement between (1) DE-CMR and (2) standard clinical evaluation with the use of consensus criteria (modified Japanese Ministry of Health [JMH] guidelines). Standard evaluation included 12-lead ECG and at least 1 dedicated non-CMR cardiac study (echocardiography, radionuclide scintigraphy, or cardiac catheterization). Patients were followed for 21±8 months for major adverse events (death, defibrillator shock, or pacemaker requirement). Patients were predominantly middle-aged (46±11 years), female (62%), and black (73%) and had chronic sarcoidosis (median, 7 years) and preserved left ventricular ejection fraction (median, 56%). DE-CMR identified cardiac involvement in 21 patients (26%) and JMH criteria in 10 (12%, 8 overlapping), a >2-fold higher rate for DE-CMR (P=0.005). All patients with myocardial damage on DE-CMR had coronary disease excluded by x-ray angiography. Pathology evaluation in 15 patients (19%) identified 4 with cardiac sarcoidosis; all 4 were positive by DE-CMR, whereas 2 were JMH positive. On follow-up, 8 had adverse events, including 5 cardiac deaths. Patients with myocardial damage on DE-CMR had a 9-fold higher rate of adverse events and an 11.5-fold higher rate of cardiac death than patients without damage. Conclusions— In patients with sarcoidosis, DE-CMR is more than twice as sensitive for cardiac involvement as current consensus criteria. Myocardial damage detected by DE-CMR appears to be associated with future adverse events including cardiac death, but events were few, and this needs confirmation in a larger cohort.

Subfields: Physiology, Pulmonary and Respiratory Medicine, Radiology, Nuclear Medicine and Imaging

View Paper: https://www.semanticscholar.org/paper/ee0dace969c835b16201a80d514889d3b90b1f09

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Citations in the corpus

Diagnosis and Detection of Sarcoidosis. An Official American Thoracic Society Clinical Practice Guideline (2020, methodology): “The clinical importance of CMR-LGE abnormalities is supported by several observations: 1) CMR-LGE has direct histopathological correlation with CS (157); 2) the prevalence of CMR-LGE abnormalities among patients with sarcoidosis approaches the prevalence of CS reported by serial autopsies (157, 163,”
HRS expert consensus statement on the diagnosis and management of arrhythmias associated with cardiac sarcoidosis. (2014, neutral): “57%); however, 29% of the LGE-CMR-positive patients had an LVEF of 450%.(24) Recently, Greulich et al(31) reported on 155 consecutive patients with systemic sarcoidosis diagnosed by using biopsy and/or clinical criteria who underwent CMR.”
Cardiovascular Magnetic Resonance in Nonischemic Myocardial Inflammation: Expert Recommendations. (2018, result): “One study of 81 patients showed an incidence of 26% of LGE, much higher than the 12% of patients identified by the Japanese Ministry of Health criteria (102).”