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 Morady; Frank Bogun

doi:10.1161/CIRCEP.113.000156

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

Circ Arrhythm Electrophysiol. 2014 Dec;7(6):1109-15. doi: 10.1161/CIRCEP.113.000156. Epub 2014 Sep 29.

Authors

Thomas Crawford¹, Gisela Mueller², Sinan Sarsam², Hutsaya Prasitdumrong², Naiyanet Chaiyen², Xiaokui Gu², Joseph Schuller², Jordana Kron², Khaled A Nour², Alan Cheng², Sang Yong Ji², Shawn Feinstein², Sanjaya Gupta², Karl Ilg², Mohamad Sinno², Saddam Abu-Hashish², Mouaz Al-Mallah², William H Sauer², Kenneth Ellenbogen², Fred Morady², Frank Bogun²

Affiliations

¹ From the Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Internal Medicine (T.C., X.G., S.G., K.I., M.S., S.A.-H., F.M., F.B.), and Department of Radiology (G.M., H.P., N.C.), University of Michigan, Ann Arbor; Department of Internal Medicine, Detroit Medical Center, MI (S.S.); Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, University of Colorado, Aurora (J.S., W.H.S.); Department of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond (J.K., S.F., K.E.); Division of Cardiology, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI (K.A.N., M.A.-M.); and Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, Johns Hopkins University, Baltimore, MD (A.C., S.Y.J.). thomcraw@umich.edu.
² From the Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Internal Medicine (T.C., X.G., S.G., K.I., M.S., S.A.-H., F.M., F.B.), and Department of Radiology (G.M., H.P., N.C.), University of Michigan, Ann Arbor; Department of Internal Medicine, Detroit Medical Center, MI (S.S.); Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, University of Colorado, Aurora (J.S., W.H.S.); Department of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond (J.K., S.F., K.E.); Division of Cardiology, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI (K.A.N., M.A.-M.); and Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, Johns Hopkins University, Baltimore, MD (A.C., S.Y.J.).

PMID: 25266311
DOI: 10.1161/CIRCEP.113.000156

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.

Keywords: MRI; delayed enhancement; implantable cardioverter-defibrillator; sarcoid; sarcoidosis; sudden cardiac death; ventricular tachycardia.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Cardiomyopathies / complications
Cardiomyopathies / diagnosis*
Cardiomyopathies / mortality
Cardiomyopathies / physiopathology
Female
Humans
Kaplan-Meier Estimate
Magnetic Resonance Imaging*
Male
Middle Aged
Myocardium / pathology*
Predictive Value of Tests
Proportional Hazards Models
Registries
Retrospective Studies
Risk Assessment
Risk Factors
Sarcoidosis / complications
Sarcoidosis / diagnosis*
Sarcoidosis / mortality
Sarcoidosis / physiopathology
Severity of Illness Index
Stroke Volume*
Tachycardia, Ventricular / diagnosis
Tachycardia, Ventricular / etiology*
Tachycardia, Ventricular / mortality
Tachycardia, Ventricular / physiopathology
United States
Ventricular Dysfunction, Left / diagnosis
Ventricular Dysfunction, Left / etiology*
Ventricular Dysfunction, Left / mortality
Ventricular Dysfunction, Left / physiopathology
Ventricular Fibrillation / diagnosis
Ventricular Fibrillation / etiology*
Ventricular Fibrillation / mortality
Ventricular Fibrillation / physiopathology
Ventricular Function, Left*