Magnetic resonance imaging for identifying patients with cardiac sarcoidosis and preserved or mildly reduced left ventricular function at risk of ventricular arrhythmias

Thomas Crawford, Gisela Mueller, Sinan Sarsam, Hutsaya Prasitdumrong, Naiyanet Chaiyen, Xiaokui Gu, Joseph Schuller, Jordana Kron, Khaled A. Nour, Alan Cheng, Sang Yong Ji, Shawn Feinstein, Sanjaya Gupta, Karl Ilg, Mohamad Sinno, Saddam Abu-Hashish, Mouaz Al-Mallah, William H. Sauer, Kenneth Ellenbogen, Fred MoradyFrank Bogun

Research output: Contribution to journalArticle

66 Scopus citations

Abstract

Background: The purpose of this study was to assess whether delayed enhancement (DE) on MRI is associated with ventricular tachycardia (VT)/ventricular fibrillation or death in patients with cardiac sarcoidosis and left ventricular ejection fraction >35%. Methods and Results: Fifty-one patients with cardiac sarcoidosis and left ventricular ejection fraction >35% underwent DE-MRI. DE was assessed by visual scoring and quantified with the full-width at half-maximum method. The patients were followed for 48.0±20.2 months. Twenty-two of 51 patients (63%) had DE. Forty patients had no prior history of VT (primary prevention cohort). Among those, 3 patients developed VT and 2 patients died. DE was associated with risk of VT/ventricular fibrillation or death (P=0.0032 for any DE and P<0.0001 for right ventricular DE). The positive predictive values of the presence of any DE, multifocal DE, and right ventricular DE for death or VT/ventricular fibrillation at mean follow-up of 48 months were 22%, 48%, and 100%, respectively. Among the 11 patients with a history of VT before the MRI, 10 patients had subsequent VTs, 1 of whom died. Conclusions: RV DE in patients with cardiac sarcoidosis is associated with a risk of adverse events in patients with cardiac sarcoidosis and preserved ejection fraction in the absence of a prior history of VT. Patients with DE and a prior history of VT have a high VT recurrence rate. Patients without DE on MRI have a low risk of VT.

Original languageEnglish (US)
Pages (from-to)1109-1115
Number of pages7
JournalCirculation: Arrhythmia and Electrophysiology
Volume7
Issue number6
DOIs
StatePublished - Dec 1 2014
Externally publishedYes

Keywords

  • Delayed enhancement
  • Implantable cardioverter-defibrillator
  • MRI
  • Sarcoid
  • Sarcoidosis
  • Sudden cardiac death
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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