Extensive late gadolinium enhancement on cardiovascular magnetic resonance predicts adverse outcomes and lack of improvement in LV function after steroid therapy in cardiac sarcoidosis.
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.
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
Takayuki
T
Ise
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
Takuya
T
Hasegawa
Department of Radiology, National Cerebral and Cardiovascular Center, Osaka, Japan.
Yoshiaki
Y
Morita
Department of Radiology, National Cerebral and Cardiovascular Center, Osaka, Japan.
Naoaki
N
Yamada
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
Akira
A
Funada
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
Hiroyuki
H
Takahama
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
Makoto
M
Amaki
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
Hideaki
H
Kanzaki
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
Hideo
H
Okamura
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
Shiro
S
Kamakura
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
Wataru
W
Shimizu
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
Toshihisa
T
Anzai
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan Department of Clinical Research and Development, National Cerebral and Cardiovascular Center, Osaka, Japan.
Masafumi
M
Kitakaze
D009202:Cardiomyopathies / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D003287:Contrast Media; D004305:Dose-Response Relationship, Drug; D004452:Echocardiography / Q000379:methods; D005500:Follow-Up Studies; D019786:Gadolinium DTPA; D005938:Glucocorticoids / Q000008:administration & dosage; D006352:Heart Ventricles / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology; D007089:Image Enhancement / Q000379:methods*; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D009206:Myocardium / Q000473:pathology; D011237:Predictive Value of Tests; D011241:Prednisone / Q000008:administration & dosage*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012507:Sarcoidosis / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D013318:Stroke Volume; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000187:drug effects / Q000502:physiology*
D003287:Contrast Media; D005938:Glucocorticoids; D019786:Gadolinium DTPA; D011241:Prednisone
Myocardial Disease