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Right ventricular involvement is an important prognostic factor and risk stratification tool in suspected cardiac sarcoidosis: analysis by cardiac magnetic resonance imaging

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Abstract

Background

Late gadolinium enhancement imaging (LGE) of the left ventricle (LV) by cardiac magnetic resonance (CMR) has prognostic value for patients with cardiac sarcoidosis (CS). Right ventricle (RV) dysfunction is also associated with adverse outcomes in patients with heart failure. Therefore, we sought to determine if RV LGE and dysfunction predicted adverse events in patients with suspected CS.

Methods

In 103 consecutive patients with suspected CS who underwent CMR, functional and remodeling indexes of both the LV and RV were measured and the extent and localization of LGE were also analyzed. Major adverse cardiac events (MACE) were defined as cardiovascular mortality, severe ventricular tachyarrhythmia, hospitalization with heart failure, and advanced atrioventricular block.

Results

During a median follow-up of 20.6 months, Kaplan–Meier analysis showed that decreased RV ejection fraction (EF) was associated with MACE (P < 0.001) and receiver operating characteristics curve (ROC) analysis indicated good predictive performance of RV EF for MACE (area under the ROC = 0.834). RV EF operated independently of LV EF or LGE extent for predicting MACE. In addition, the presence of LGE in RV was independently associated with MACE (P = 0.011), and a combined analysis of RV EF and RV LGE showed better risk stratification for MACE (P < 0.001).

Conclusions

Both RV EF and LGE were independently associated with MACE and enhanced risk stratification in patients with suspected CS. CMR may be a useful tool for detecting myocardial function and fibrosis in both the LV and RV.

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Funding

This work was supported by grants from the Vehicle Racing Commemorative Foundation (Y.I.).

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Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osakasayama, 589-8511, Japan

    Yoshinori Kagioka, Masakazu Yasuda, Mana Okune, Kazuyoshi Kakehi, Takayuki Kawamura, Kazuhiro Kobuke, Shunichi Miyazaki & Yoshitaka Iwanaga

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  1. Yoshinori Kagioka
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  2. Masakazu Yasuda
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  3. Mana Okune
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  4. Kazuyoshi Kakehi
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  5. Takayuki Kawamura
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  6. Kazuhiro Kobuke
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  7. Shunichi Miyazaki
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  8. Yoshitaka Iwanaga
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Correspondence to Yoshitaka Iwanaga.

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The authors declare that they have no conflict of interest.

Ethical standards

The study was conducted in accordance with the 1964 Declaration of Helsinki and its later amendments and was approved by Kindai University Faculty of Medicine Ethics Committee in Osakasayama, Japan, and all subjects provided written informed consent.

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Kagioka, Y., Yasuda, M., Okune, M. et al. Right ventricular involvement is an important prognostic factor and risk stratification tool in suspected cardiac sarcoidosis: analysis by cardiac magnetic resonance imaging. Clin Res Cardiol 109, 988–998 (2020). https://doi.org/10.1007/s00392-019-01591-y

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  • DOI: https://doi.org/10.1007/s00392-019-01591-y

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