Extensive late gadolinium enhancement on cardiovascular magnetic resonance predicts adverse outcomes and lack of improvement in LV function after steroid therapy in cardiac sarcoidosis. Issue 15 (14th May 2014)

• Record Type: Journal Article
• Authors: Ise, Takayuki; Hasegawa, Takuya; Morita, Yoshiaki; Yamada, Naoaki; Funada, Akira; Takahama, Hiroyuki; Amaki, Makoto; Kanzaki, Hideaki; Okamura, Hideo; Kamakura, Shiro; Shimizu, Wataru; Anzai, Toshihisa; Kitakaze, Masafumi
• Is Part Of: Heart. Volume 100:Issue 15(2014)
• Page Start: 1165
• Page End: 1172
• Publication Date: 2014-05-14
• Subjects: Myocardial Disease; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2013-305187
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Background: Gadolinium-enhanced cardiovascular magnetic resonance is an emerging tool for the diagnosis of cardiac sarcoidosis (CS); however, the correlations between extent of late gadolinium enhancement (LGE) and efficacy of steroid therapy and adverse outcomes in patients with CS remain unclear. Objective: We aimed to clarify the prognostic impact of extent of LGE in patients with CS. Methods: Before the start of steroid therapy, 43 consecutive LGE-positive patients with CS were divided into two groups based on the extent of LGE by a median value: small-extent LGE (LGE mass <20% of LV mass; n=21) and large-extent LGE (LGE mass ≥20% of LV mass; n=22). We examined the correlations between extent of LGE and outcomes after steroid therapy. Results: Among the 6 patients who died from heart disorders, 11 patients who were hospitalised because of heart failure and 6 patients who suffered life-threatening arrhythmia during the follow-up period, large-extent LGE predicted higher incidences of cardiac mortality and hospitalisation for heart failure. Multivariate Cox regression analysis showed that large-extent LGE was independently associated with combined adverse outcomes including cardiac death, hospitalisation for heart failure, and life-threatening arrhythmias. In the small-extent LGE group, LV end-diastolic volume index significantly decreased and LVEF significantly increased after steroid therapy, whereas in the large-extent LGE group, neither LV volume nor LVEF changed substantially. Conclusions: Large-extent LGE correlates with absence of LV functional improvement and high incidence of adverse outcomes in patients with CS after steroid therapy.