title: Magnetic resonance imaging for identifying patients with cardiac sarcoidosis and preserved or mildly reduced left ventricular function at risk of ventricular arrhythmias.
abstract: BACKGROUND
  The purpose of this study was to assess whether delayed enhancement (DE) on MRI is associated with ventricular tachycardia (VT)/ventricular fibrillation or death in patients with cardiac sarcoidosis and left ventricular ejection fraction >35%.
  
  
  RESULTS
  Fifty-one patients with cardiac sarcoidosis and left ventricular ejection fraction >35% underwent DE-MRI. DE was assessed by visual scoring and quantified with the full-width at half-maximum method. The patients were followed for 48.0 ± 20.2 months. Twenty-two of 51 patients (63%) had DE. Forty patients had no prior history of VT (primary prevention cohort). Among those, 3 patients developed VT and 2 patients died. DE was associated with risk of VT/ventricular fibrillation or death (P=0.0032 for any DE and P<0.0001 for right ventricular DE). The positive predictive values of the presence of any DE, multifocal DE, and right ventricular DE for death or VT/ventricular fibrillation at mean follow-up of 48 months were 22%, 48%, and 100%, respectively. Among the 11 patients with a history of VT before the MRI, 10 patients had subsequent VTs, 1 of whom died.
  
  
  CONCLUSIONS
  RV DE in patients with cardiac sarcoidosis is associated with a risk of adverse events in patients with cardiac sarcoidosis and preserved ejection fraction in the absence of a prior history of VT. Patients with DE and a prior history of VT have a high VT recurrence rate. Patients without DE on MRI have a low risk of VT.
authors.affiliation: From the Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Internal Medicine (T.C., X.G., S.G., K.I., M.S., S.A.-H., F.M., F.B.), and Department of Radiology (G.M., H.P., N.C.), University of Michigan, Ann Arbor; Department of Internal Medicine, Detroit Medical Center, MI (S.S.); Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, University of Colorado, Aurora (J.S., W.H.S.); Department of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond (J.K., S.F., K.E.); Division of Cardiology, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI (K.A.N., M.A.-M.); and Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, Johns Hopkins University, Baltimore, MD (A.C., S.Y.J.). thomcraw@umich.edu.
authors.forename: Thomas
authors.initials: T
authors.lastname: Crawford
authors.affiliation: From the Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Internal Medicine (T.C., X.G., S.G., K.I., M.S., S.A.-H., F.M., F.B.), and Department of Radiology (G.M., H.P., N.C.), University of Michigan, Ann Arbor; Department of Internal Medicine, Detroit Medical Center, MI (S.S.); Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, University of Colorado, Aurora (J.S., W.H.S.); Department of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond (J.K., S.F., K.E.); Division of Cardiology, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI (K.A.N., M.A.-M.); and Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, Johns Hopkins University, Baltimore, MD (A.C., S.Y.J.).
authors.forename: Gisela
authors.initials: G
authors.lastname: Mueller
authors.affiliation: From the Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Internal Medicine (T.C., X.G., S.G., K.I., M.S., S.A.-H., F.M., F.B.), and Department of Radiology (G.M., H.P., N.C.), University of Michigan, Ann Arbor; Department of Internal Medicine, Detroit Medical Center, MI (S.S.); Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, University of Colorado, Aurora (J.S., W.H.S.); Department of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond (J.K., S.F., K.E.); Division of Cardiology, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI (K.A.N., M.A.-M.); and Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, Johns Hopkins University, Baltimore, MD (A.C., S.Y.J.).
authors.forename: Sinan
authors.initials: S
authors.lastname: Sarsam
authors.affiliation: From the Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Internal Medicine (T.C., X.G., S.G., K.I., M.S., S.A.-H., F.M., F.B.), and Department of Radiology (G.M., H.P., N.C.), University of Michigan, Ann Arbor; Department of Internal Medicine, Detroit Medical Center, MI (S.S.); Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, University of Colorado, Aurora (J.S., W.H.S.); Department of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond (J.K., S.F., K.E.); Division of Cardiology, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI (K.A.N., M.A.-M.); and Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, Johns Hopkins University, Baltimore, MD (A.C., S.Y.J.).
authors.forename: Hutsaya
authors.initials: H
authors.lastname: Prasitdumrong
authors.affiliation: From the Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Internal Medicine (T.C., X.G., S.G., K.I., M.S., S.A.-H., F.M., F.B.), and Department of Radiology (G.M., H.P., N.C.), University of Michigan, Ann Arbor; Department of Internal Medicine, Detroit Medical Center, MI (S.S.); Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, University of Colorado, Aurora (J.S., W.H.S.); Department of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond (J.K., S.F., K.E.); Division of Cardiology, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI (K.A.N., M.A.-M.); and Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, Johns Hopkins University, Baltimore, MD (A.C., S.Y.J.).
authors.forename: Naiyanet
authors.initials: N
authors.lastname: Chaiyen
authors.affiliation: From the Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Internal Medicine (T.C., X.G., S.G., K.I., M.S., S.A.-H., F.M., F.B.), and Department of Radiology (G.M., H.P., N.C.), University of Michigan, Ann Arbor; Department of Internal Medicine, Detroit Medical Center, MI (S.S.); Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, University of Colorado, Aurora (J.S., W.H.S.); Department of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond (J.K., S.F., K.E.); Division of Cardiology, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI (K.A.N., M.A.-M.); and Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, Johns Hopkins University, Baltimore, MD (A.C., S.Y.J.).
authors.forename: Xiaokui
authors.initials: X
authors.lastname: Gu
authors.affiliation: From the Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Internal Medicine (T.C., X.G., S.G., K.I., M.S., S.A.-H., F.M., F.B.), and Department of Radiology (G.M., H.P., N.C.), University of Michigan, Ann Arbor; Department of Internal Medicine, Detroit Medical Center, MI (S.S.); Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, University of Colorado, Aurora (J.S., W.H.S.); Department of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond (J.K., S.F., K.E.); Division of Cardiology, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI (K.A.N., M.A.-M.); and Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, Johns Hopkins University, Baltimore, MD (A.C., S.Y.J.).
authors.forename: Joseph
authors.initials: J
authors.lastname: Schuller
authors.affiliation: From the Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Internal Medicine (T.C., X.G., S.G., K.I., M.S., S.A.-H., F.M., F.B.), and Department of Radiology (G.M., H.P., N.C.), University of Michigan, Ann Arbor; Department of Internal Medicine, Detroit Medical Center, MI (S.S.); Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, University of Colorado, Aurora (J.S., W.H.S.); Department of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond (J.K., S.F., K.E.); Division of Cardiology, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI (K.A.N., M.A.-M.); and Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, Johns Hopkins University, Baltimore, MD (A.C., S.Y.J.).
authors.forename: Jordana
authors.initials: J
authors.lastname: Kron
authors.affiliation: From the Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Internal Medicine (T.C., X.G., S.G., K.I., M.S., S.A.-H., F.M., F.B.), and Department of Radiology (G.M., H.P., N.C.), University of Michigan, Ann Arbor; Department of Internal Medicine, Detroit Medical Center, MI (S.S.); Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, University of Colorado, Aurora (J.S., W.H.S.); Department of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond (J.K., S.F., K.E.); Division of Cardiology, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI (K.A.N., M.A.-M.); and Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, Johns Hopkins University, Baltimore, MD (A.C., S.Y.J.).
authors.forename: Khaled A
authors.initials: KA
authors.lastname: Nour
authors.affiliation: From the Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Internal Medicine (T.C., X.G., S.G., K.I., M.S., S.A.-H., F.M., F.B.), and Department of Radiology (G.M., H.P., N.C.), University of Michigan, Ann Arbor; Department of Internal Medicine, Detroit Medical Center, MI (S.S.); Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, University of Colorado, Aurora (J.S., W.H.S.); Department of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond (J.K., S.F., K.E.); Division of Cardiology, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI (K.A.N., M.A.-M.); and Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, Johns Hopkins University, Baltimore, MD (A.C., S.Y.J.).
authors.forename: Alan
authors.initials: A
authors.lastname: Cheng
authors.affiliation: From the Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Internal Medicine (T.C., X.G., S.G., K.I., M.S., S.A.-H., F.M., F.B.), and Department of Radiology (G.M., H.P., N.C.), University of Michigan, Ann Arbor; Department of Internal Medicine, Detroit Medical Center, MI (S.S.); Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, University of Colorado, Aurora (J.S., W.H.S.); Department of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond (J.K., S.F., K.E.); Division of Cardiology, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI (K.A.N., M.A.-M.); and Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, Johns Hopkins University, Baltimore, MD (A.C., S.Y.J.).
authors.forename: Sang Yong
authors.initials: SY
authors.lastname: Ji
authors.affiliation: From the Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Internal Medicine (T.C., X.G., S.G., K.I., M.S., S.A.-H., F.M., F.B.), and Department of Radiology (G.M., H.P., N.C.), University of Michigan, Ann Arbor; Department of Internal Medicine, Detroit Medical Center, MI (S.S.); Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, University of Colorado, Aurora (J.S., W.H.S.); Department of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond (J.K., S.F., K.E.); Division of Cardiology, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI (K.A.N., M.A.-M.); and Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, Johns Hopkins University, Baltimore, MD (A.C., S.Y.J.).
authors.forename: Shawn
authors.initials: S
authors.lastname: Feinstein
authors.affiliation: From the Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Internal Medicine (T.C., X.G., S.G., K.I., M.S., S.A.-H., F.M., F.B.), and Department of Radiology (G.M., H.P., N.C.), University of Michigan, Ann Arbor; Department of Internal Medicine, Detroit Medical Center, MI (S.S.); Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, University of Colorado, Aurora (J.S., W.H.S.); Department of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond (J.K., S.F., K.E.); Division of Cardiology, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI (K.A.N., M.A.-M.); and Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, Johns Hopkins University, Baltimore, MD (A.C., S.Y.J.).
authors.forename: Sanjaya
authors.initials: S
authors.lastname: Gupta
authors.affiliation: From the Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Internal Medicine (T.C., X.G., S.G., K.I., M.S., S.A.-H., F.M., F.B.), and Department of Radiology (G.M., H.P., N.C.), University of Michigan, Ann Arbor; Department of Internal Medicine, Detroit Medical Center, MI (S.S.); Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, University of Colorado, Aurora (J.S., W.H.S.); Department of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond (J.K., S.F., K.E.); Division of Cardiology, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI (K.A.N., M.A.-M.); and Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, Johns Hopkins University, Baltimore, MD (A.C., S.Y.J.).
authors.forename: Karl
authors.initials: K
authors.lastname: Ilg
authors.affiliation: From the Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Internal Medicine (T.C., X.G., S.G., K.I., M.S., S.A.-H., F.M., F.B.), and Department of Radiology (G.M., H.P., N.C.), University of Michigan, Ann Arbor; Department of Internal Medicine, Detroit Medical Center, MI (S.S.); Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, University of Colorado, Aurora (J.S., W.H.S.); Department of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond (J.K., S.F., K.E.); Division of Cardiology, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI (K.A.N., M.A.-M.); and Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, Johns Hopkins University, Baltimore, MD (A.C., S.Y.J.).
authors.forename: Mohamad
authors.initials: M
authors.lastname: Sinno
authors.affiliation: From the Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Internal Medicine (T.C., X.G., S.G., K.I., M.S., S.A.-H., F.M., F.B.), and Department of Radiology (G.M., H.P., N.C.), University of Michigan, Ann Arbor; Department of Internal Medicine, Detroit Medical Center, MI (S.S.); Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, University of Colorado, Aurora (J.S., W.H.S.); Department of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond (J.K., S.F., K.E.); Division of Cardiology, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI (K.A.N., M.A.-M.); and Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, Johns Hopkins University, Baltimore, MD (A.C., S.Y.J.).
authors.forename: Saddam
authors.initials: S
authors.lastname: Abu-Hashish
authors.affiliation: From the Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Internal Medicine (T.C., X.G., S.G., K.I., M.S., S.A.-H., F.M., F.B.), and Department of Radiology (G.M., H.P., N.C.), University of Michigan, Ann Arbor; Department of Internal Medicine, Detroit Medical Center, MI (S.S.); Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, University of Colorado, Aurora (J.S., W.H.S.); Department of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond (J.K., S.F., K.E.); Division of Cardiology, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI (K.A.N., M.A.-M.); and Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, Johns Hopkins University, Baltimore, MD (A.C., S.Y.J.).
authors.forename: Mouaz
authors.initials: M
authors.lastname: Al-Mallah
authors.affiliation: From the Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Internal Medicine (T.C., X.G., S.G., K.I., M.S., S.A.-H., F.M., F.B.), and Department of Radiology (G.M., H.P., N.C.), University of Michigan, Ann Arbor; Department of Internal Medicine, Detroit Medical Center, MI (S.S.); Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, University of Colorado, Aurora (J.S., W.H.S.); Department of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond (J.K., S.F., K.E.); Division of Cardiology, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI (K.A.N., M.A.-M.); and Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, Johns Hopkins University, Baltimore, MD (A.C., S.Y.J.).
authors.forename: William H
authors.initials: WH
authors.lastname: Sauer
authors.affiliation: From the Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Internal Medicine (T.C., X.G., S.G., K.I., M.S., S.A.-H., F.M., F.B.), and Department of Radiology (G.M., H.P., N.C.), University of Michigan, Ann Arbor; Department of Internal Medicine, Detroit Medical Center, MI (S.S.); Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, University of Colorado, Aurora (J.S., W.H.S.); Department of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond (J.K., S.F., K.E.); Division of Cardiology, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI (K.A.N., M.A.-M.); and Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, Johns Hopkins University, Baltimore, MD (A.C., S.Y.J.).
authors.forename: Kenneth
authors.initials: K
authors.lastname: Ellenbogen
authors.affiliation: From the Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Internal Medicine (T.C., X.G., S.G., K.I., M.S., S.A.-H., F.M., F.B.), and Department of Radiology (G.M., H.P., N.C.), University of Michigan, Ann Arbor; Department of Internal Medicine, Detroit Medical Center, MI (S.S.); Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, University of Colorado, Aurora (J.S., W.H.S.); Department of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond (J.K., S.F., K.E.); Division of Cardiology, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI (K.A.N., M.A.-M.); and Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, Johns Hopkins University, Baltimore, MD (A.C., S.Y.J.).
authors.forename: Fred
authors.initials: F
authors.lastname: Morady
authors.affiliation: From the Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Internal Medicine (T.C., X.G., S.G., K.I., M.S., S.A.-H., F.M., F.B.), and Department of Radiology (G.M., H.P., N.C.), University of Michigan, Ann Arbor; Department of Internal Medicine, Detroit Medical Center, MI (S.S.); Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, University of Colorado, Aurora (J.S., W.H.S.); Department of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond (J.K., S.F., K.E.); Division of Cardiology, Department of Internal Medicine, Henry Ford Hospital, Detroit, MI (K.A.N., M.A.-M.); and Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, Johns Hopkins University, Baltimore, MD (A.C., S.Y.J.).
authors.forename: Frank
authors.initials: F
authors.lastname: Bogun
mesh_terms: D000328:Adult; D000368:Aged; D009202:Cardiomyopathies / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012507:Sarcoidosis / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D012720:Severity of Illness Index; D013318:Stroke Volume; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D014481:United States; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D016277:Ventricular Function, Left
keywords: MRI; delayed enhancement; implantable cardioverter-defibrillator; sarcoid; sarcoidosis; sudden cardiac death; ventricular tachycardia