Cardiovascular magnetic resonance-guided diagnosis of cardiac affection in a Caucasian sarcoidosis population

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Carmen Pizarro
Andreas Goebel
Darius Dabir
Christoph Hammerstingl
Stefan Pabst
Christian Grohé
Rolf Fimmers
Birgit Stoffel-Wagner
Georg Nickenig
Hans Schild
Dirk Skowasch
Daniel Thomas

Keywords

Histologically proven sarcoidosis, Cardiac sarcoidal involvement, Caucasian population, Cardiovascular magnetic resonance imaging

Abstract

Background: Clinically evidenced cardiac involvement in systemic sarcoidosis occurs in approximately 5% of patients, whereas post-mortem examinations identify cardiac sarcoidosis in over 60% of cases. Objective: Given the inconsistency of diagnostic approaches, we took aim at prospectively investigating the prevalence of cardiac sarcoidosis by cardiovascular magnetic resonance (CMR) in a primary Caucasian population and at correlating the results with standard clinical parameters. Methods: 188 patients with histologically proven sarcoidosis were included, provenient from the local pneumological department and a national sarcoidosis self-help association. All of them underwent CMR-imaging. Complementary 12-lead ECG, Holter monitoring, laboratory and pulmonary function testing were performed. Results: CMR-based diagnosis of cardiac sarcoidosis was made in 29 patients (15.4%), of whom 17 patients (9% of total cohort) exhibited increased relative gadolinium enhancement – reflecting acute inflammatory processes -, while 11 patients (5.9% of total cohort) showed late gadolinium enhancement as a marker for nonviable tissue damage. Both abnormalities were present in 1 patient (0.5%). Correlation analysis evinced significant association between CMR-diagnosed cardiac sarcoidosis and reduction in LVEF, increase in diastolic interventricular septal thickness, diastolic dysfunction as well as limited electrocardiographic abnormalities. Neither laboratory values nor pulmonary function parameters correlated with presence or activity of cardiac sarcoidosis. Conclusions: Among our predominantly Caucasian sarcoidosis study population, CMR-detected cardiac affection occurred in 15.4% and was missed by internationally valid standard clinical testing in all but one case. It reinforces CMR’s diagnostic value as modality of choice to evaluate cardiac sarcoidosis. The estimation of its prognostic potential and its value in assessing the incidence of cardiac sarcoidosis however requires further longitudinal investigation. (Sarcoidosis Vasc Diffuse Lung Dis 2015; 32: 325-335)

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