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Extensive late gadolinium enhancement on cardiovascular magnetic resonance predicts adverse outcomes and lack of improvement in LV function after steroid therapy in cardiac sarcoidosis
  1. Takayuki Ise1,
  2. Takuya Hasegawa1,
  3. Yoshiaki Morita2,
  4. Naoaki Yamada2,
  5. Akira Funada1,
  6. Hiroyuki Takahama1,
  7. Makoto Amaki1,
  8. Hideaki Kanzaki1,
  9. Hideo Okamura1,
  10. Shiro Kamakura1,
  11. Wataru Shimizu1,
  12. Toshihisa Anzai1,
  13. Masafumi Kitakaze1,3
  1. 1Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
  2. 2Department of Radiology, National Cerebral and Cardiovascular Center, Osaka, Japan
  3. 3Department of Clinical Research and Development, National Cerebral and Cardiovascular Center, Osaka, Japan
  1. Correspondence to Dr Takuya Hasegawa, Department of Cardiovascular Medicine National Cerebral and Cardiovascular Center, Osaka, Japan 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan; hasegawa{at}hsp.ncvc.go.jp

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.

  • Myocardial Disease

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