Regional abnormalities on cardiac magnetic resonance imaging and arrhythmic events in patients with cardiac sarcoidosis

J Cardiovasc Electrophysiol. 2019 Oct;30(10):1967-1976. doi: 10.1111/jce.14082. Epub 2019 Aug 1.

Abstract

Background: Patients with cardiac sarcoidosis (CS) may present with arrhythmic events (AE): atrioventricular block (AVB) and/ or ventricular arrhythmias (VA). We sought to: (a) use regional analysis of cardiac magnetic resonance imaging (CMR) to describe anatomic and functional phenotypes of patients with CS and AE; (b) Assess the association of regional CMR abnormalities with the combined endpoint of death, heart transplantation (HT) and AE; and (c) use machine learning (ML) to predict the combined endpoint based on CMR features.

Methods: we included 76 patients with CS and CMR. We analyzed cine images to determine regional longitudinal (LS) and radial strain (RS); and late gadolinium enhancement imaging to determine regional scar burden (%scar).

Results: Patients with AVB (n = 7), compared with those without, had higher %scar in the anterior (21.8 ± 27.4 vs 5.1 ± 8.9; P = 0.0005) and anteroseptal (19.3 ± 24.5 vs 3.5 ± 5.5; P < .0001) walls. Patients with VA (n = 12), compared with those without, had higher %scar in the basal inferoseptum (20.4 ± 30.8 vs 8.3 ± 13.4; P = .03). During mean follow-up of 4.4 ± 3.3 years, four patients died or underwent HT; eight had VA; and zero developed AVB. Multiple regional abnormalities were associated with the combined endpoint, including scar in the anteroseptal wall (HR 1.06 [1.02-1.09] per 1%scar increase, P = .002). The ML algorithm predicted the combined endpoint with a C-statistic of 0.91.

Conclusion: Regional CMR abnormalities are associated with AE in patients with CS.

Keywords: AV node disease; cardiac magnetic resonance imaging; cardiac sarcoidosis; heart block; sudden cardiac death; ventricular arrhythmia.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Atrioventricular Block / diagnosis
  • Atrioventricular Block / etiology*
  • Atrioventricular Block / mortality
  • Atrioventricular Block / physiopathology
  • Cardiomyopathies / complications
  • Cardiomyopathies / diagnostic imaging*
  • Cardiomyopathies / mortality
  • Cardiomyopathies / physiopathology
  • Contrast Media / administration & dosage
  • Death, Sudden, Cardiac / etiology*
  • Disease Progression
  • Female
  • Fibrosis
  • Gadolinium DTPA / administration & dosage
  • Heart Transplantation
  • Humans
  • Machine Learning
  • Magnetic Resonance Imaging, Cine*
  • Male
  • Middle Aged
  • Myocardium / pathology
  • Organometallic Compounds / administration & dosage
  • Predictive Value of Tests
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Sarcoidosis / complications
  • Sarcoidosis / diagnostic imaging*
  • Sarcoidosis / mortality
  • Sarcoidosis / physiopathology
  • Tachycardia, Ventricular / diagnosis
  • Tachycardia, Ventricular / etiology*
  • Tachycardia, Ventricular / mortality
  • Tachycardia, Ventricular / physiopathology
  • Ventricular Fibrillation / diagnosis
  • Ventricular Fibrillation / etiology*
  • Ventricular Fibrillation / mortality
  • Ventricular Fibrillation / physiopathology
  • Ventricular Function, Left*

Substances

  • Contrast Media
  • Organometallic Compounds
  • gadobutrol
  • Gadolinium DTPA