title: Myocardial damage in patients with sarcoidosis and preserved left ventricular systolic function: an observational study.
abstract: OBJECTIVE
  Late gadolinium enhanced cardiovascular magnetic resonance (LGE-CMR) is a valuable test to detect myocardial damage in patients with sarcoidosis; however, the clinical significance of LGE in sarcoidosis patients with preserved left ventricular ejection fraction (LVEF) is not defined. We aim to characterize the prevalence of LGE, its associated cardiac findings, and its clinical implications in sarcoidosis patients with preserved LVEF.
  
  
  RESULTS
  One hundred and fifty-two patients with biopsy proven extra-cardiac sarcoidosis, no known cardiac sarcoidosis, and LVEF ≥ 50% referred for LGE-CMR were included in this observational study. The presence of LGE in the left ventricular myocardium was considered diagnostic for cardiac sarcoidosis. The cohort was divided into two groups based on the presence or absence of LGE. Twenty-nine patients (19%) had LGE involving 11 ± 9% of the left ventricle. The modified Japanese Ministry of Health and Welfare (JMHW) criteria for diagnosing cardiac sarcoidosis only had a sensitivity of 52% and specificity of 83% for identifying myocardial LGE in these patients. Compared with those patients without LGE, those with LGE had a higher heart rate (84 ± 19 vs. 76 ± 18 b.p.m., P= 0.002), greater prevalence of an abnormal electrocardiogram (76 vs. 31%, P< 0.001), diastolic dysfunction (67 vs. 33%, P= 0.05), reduced right ventricular ejection fraction (49 ± 8 vs. 55 ± 6%, P= 0.012), and evidence of non-sustained ventricular tachycardia (33 vs. 6%).
  
  
  CONCLUSIONS
  In patients with sarcoidosis and preserved systolic function, myocardial damage is commonly present and may increase the risk of ventricular tachy-arrhythmias. The JMHW Criteria were neither sensitive nor specific for predicting the presence of myocardial LGE.
authors.affiliation: Department of Medicine, University of Chicago, 5841 South Maryland Avenue, MC 5084, Chicago, IL 60637, USA. amitpatel@uchicago.edu
authors.forename: Amit R
authors.initials: AR
authors.lastname: Patel
authors.forename: Michael R
authors.initials: MR
authors.lastname: Klein
authors.forename: Sonal
authors.initials: S
authors.lastname: Chandra
authors.forename: Kirk T
authors.initials: KT
authors.lastname: Spencer
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Decara
authors.forename: Roberto M
authors.initials: RM
authors.lastname: Lang
authors.forename: Martin C
authors.initials: MC
authors.lastname: Burke
authors.forename: Edward R
authors.initials: ER
authors.lastname: Garrity
authors.forename: D Kyle
authors.initials: DK
authors.lastname: Hogarth
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Archer
authors.forename: Nadera J
authors.initials: NJ
authors.lastname: Sweiss
authors.forename: John F
authors.initials: JF
authors.lastname: Beshai
mesh_terms: D000328:Adult; D009202:Cardiomyopathies / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009206:Myocardium; D015995:Prevalence; D012507:Sarcoidosis / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D013599:Systole; D017180:Tachycardia, Ventricular / Q000209:etiology; D016277:Ventricular Function, Left