Regional abnormalities on cardiac magnetic resonance imaging and arrhythmic events in patients with cardiac sarcoidosis. (1st August 2019)

• Record Type: Journal Article
• Authors: Okada, David R.; Xie, Eric; Assis, Fabrizio; Smith, John; Derakhshan, Arsalan; Gowani, Zain; Ambale‐Venkatesh, Bharath; Gilotra, Nisha A.; Zimmerman, Stefan L.; Berger, Ronald D.; Calkins, Hugh; Lima, Joao A. C.; Tandri, Harikrishna; Chrispin, Jonathan
• Is Part Of: Journal of cardiovascular electrophysiology. Volume 30:Number 10(2019)
• Page Start: 1967
• Page End: 1976
• Publication Date: 2019-08-01
• Subjects: AV node disease -- cardiac magnetic resonance imaging -- cardiac sarcoidosis -- heart block -- sudden cardiac death -- ventricular arrhythmia; Blood vessels -- Physiology -- Periodicals; Electrophysiology -- Periodicals; Heart -- Physiology -- Periodicals; 612.1
• DOI: 10.1111/jce.14082
• Languages: English
• ISSNs: 1045-3873

Abstract

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.