Background
Echocardiography, cardiac magnetic resonance (CMR) and cardiac 18fluorodeoxyglucose
positron emission tomography (FDG-PET) imaging play key roles in the diagnosis and
management of cardiac sarcoidosis (CS), but the relative value of each modality in predicting
outcomes has yet to be determined. This study sought to determine the prognostic importance
of multimodality imaging data over and above demographic characteristics and left ventricular
ejection fraction (LVEF).
Methods
Consecutive patients newly diagnosed with CS were included. Parameters evaluated included
echocardiographic regional wall motion abnormality (RWMA), myocardial strain, LVEF,
RVEF, late gadolinium enhancement (LGE) extent, SUVmax and RV FDG uptake. The
primary endpoint was a composite of all-cause mortality and serious ventricular arrhythmia.
Results
The study population consisted of 208 patients with mean age of 55±13 years and LVEF of
55±12%. During a median follow-up period of 46 (interquartile range: 18-55) months, 14
patients died and 28 suffered serious ventricular arrhythmias. On multivariable analysis,
RWMA (hazard ratio [HR] for RWMA presence 2.55, 95% CI 1.27-5.28, p=0.008), LGE
extent (HR per 1% increase 1.02, 95% CI 1.00-1.04, p=0.018), RVEF (HR per 1% decrease
0.97, 95% CI 0.94-0.99, p=0.008) and RV FDG uptake (HR for RV FDG presence 2.48, 95%
CI 1.15-5.33, p=0.020) were independent predictors of the primary endpoint, while LVEF was
not predictive. The risk of adverse events was significantly greater in those with LGE extent
≥15% (HR for ≥15% presence 3.96, 95% CI 2.17-.7.23, p<0.001).
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Conclusion
In our CS population, RWMA, LGE extent, RVEF, and RV FDG uptake were strong
independent predictors of an adverse outcome. These findings offer an important insight into
the key multimodality imaging parameters that may be used in a future risk stratification model
of CS patients.