title: CMR imaging predicts death and other adverse events in suspected cardiac sarcoidosis.
abstract: OBJECTIVE
  This study aimed to demonstrate that the presence of late gadolinium enhancement (LGE) is a predictor of death and other adverse events in patients with suspected cardiac sarcoidosis.
  
  
  BACKGROUND
  Cardiac sarcoidosis is the most important cause of patient mortality in systemic sarcoidosis, yielding a 5-year mortality rate between 25% and 66% despite immunosuppressive treatment. Other groups have shown that LGE may hold promise in predicting future adverse events in this patient group.
  
  
  METHODS
  We included 155 consecutive patients with systemic sarcoidosis who underwent cardiac magnetic resonance (CMR) for workup of suspected cardiac sarcoid involvement. The median follow-up time was 2.6 years. Primary endpoints were death, aborted sudden cardiac death, and appropriate implantable cardioverter-defibrillator (ICD) discharge. Secondary endpoints were ventricular tachycardia (VT) and nonsustained VT.
  
  
  RESULTS
  LGE was present in 39 patients (25.5%). The presence of LGE yields a Cox hazard ratio (HR) of 31.6 for death, aborted sudden cardiac death, or appropriate ICD discharge, and of 33.9 for any event. This is superior to functional or clinical parameters such as left ventricular (LV) ejection fraction (EF), LV end-diastolic volume, or presentation as heart failure, yielding HRs between 0.99 (per % increase LVEF) and 1.004 (presentation as heart failure), and between 0.94 and 1.2 for potentially lethal or other adverse events, respectively. Except for 1 patient dying from pulmonary infection, no patient without LGE died or experienced any event during follow-up, even if the LV was enlarged and the LVEF severely impaired.
  
  
  CONCLUSIONS
  Among our population of sarcoid patients with nonspecific symptoms, the presence of myocardial scar indicated by LGE was the best independent predictor of potentially lethal events, as well as other adverse events, yielding a Cox HR of 31.6 and of 33.9, respectively. These data support the necessity for future large, longitudinal follow-up studies to definitely establish LGE as an independent predictor of cardiac death in sarcoidosis, as well as to evaluate the incremental prognostic value of additional parameters.
authors.affiliation: Division of Cardiology, Robert-Bosch-Medical Center, Stuttgart, Germany.
authors.forename: Simon
authors.initials: S
authors.lastname: Greulich
authors.forename: Claudia Christina
authors.initials: CC
authors.lastname: Deluigi
authors.forename: Steffen
authors.initials: S
authors.lastname: Gloekler
authors.forename: Andreas
authors.initials: A
authors.lastname: Wahl
authors.forename: Christine
authors.initials: C
authors.lastname: Zürn
authors.forename: Ulrich
authors.initials: U
authors.lastname: Kramer
authors.forename: Detlev
authors.initials: D
authors.lastname: Nothnagel
authors.forename: Helmut
authors.initials: H
authors.lastname: Bültel
authors.forename: Julia
authors.initials: J
authors.lastname: Schumm
authors.forename: Stefan
authors.initials: S
authors.lastname: Grün
authors.forename: Peter
authors.initials: P
authors.lastname: Ong
authors.forename: Anja
authors.initials: A
authors.lastname: Wagner
authors.forename: Steffen
authors.initials: S
authors.lastname: Schneider
authors.forename: Kai
authors.initials: K
authors.lastname: Nassenstein
authors.forename: Meinrad
authors.initials: M
authors.lastname: Gawaz
authors.forename: Udo
authors.initials: U
authors.lastname: Sechtem
authors.forename: Oliver
authors.initials: O
authors.lastname: Bruder
authors.forename: Heiko
authors.initials: H
authors.lastname: Mahrholdt
mesh_terms: D000328:Adult; D009202:Cardiomyopathies / Q000150:complications / Q000401:mortality* / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy; D003287:Contrast Media; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000295:instrumentation; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging / Q000379:methods; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009206:Myocardium / Q000473:pathology*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012507:Sarcoidosis / Q000150:complications / Q000401:mortality* / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy; D013318:Stroke Volume; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D016277:Ventricular Function, Left
chemical_list: D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA