title: Subclinical left ventricular dysfunction by echocardiographic speckle-tracking strain analysis relates to outcome in sarcoidosis.
abstract: OBJECTIVE
  Limited data exist on the risk of developing cardiac sarcoidosis (CS) and/or adverse events in sarcoidosis patients. Using LV global longitudinal strain (GLS), an emerging sensitive parameter of LV function, we evaluated the prevalence of subclinical cardiac dysfunction in sarcoidosis and investigated whether LVGLS predicts adverse outcomes in this population.
  
  
  RESULTS
  A total of 130 patients with proven sarcoidosis undergoing echocardiography at our referral centre were identified. Following exclusion of those with evidence of CS (n = 14) or other pre-existing structural heart disease (n = 16), 100 patients (55 ± 13 years, 48% male, 90% pulmonary involvement) and 100 age- and gender-matched controls were included. LVGLS was measured by speckle-tracking analysis. The primary endpoint was a composite of all-cause mortality, heart failure hospitalization, device implantation, new arrhythmias, or future development of CS on advanced cardiac imaging modalities. LVGLS was significantly impaired in sarcoidosis patients compared with controls (-17.3 ± 2.5 vs. -20.0 ± 1.6%, P < 0.001). Overall, 27 patients (27%) reached the endpoint during a median follow-up of 35 months. On Cox proportional hazards model analysis, abnormal 24-h Holter, larger LV end-diastolic diameters, and more impaired LVGLS were significantly associated with the endpoint; however, only LVGLS remained independently associated on multivariate analysis [hazard ratio (HR) 1.4, 95% confidence interval (CI) 1.1-1.7, P = 0.006]. Patients with LVGLS less than -17.3% were significantly more likely to be free of the primary endpoint (log-rank P = 0.01).
  
  
  CONCLUSIONS
  LVGLS is impaired in sarcoidosis patients, suggesting subclinical cardiac dysfunction despite the absence of conventional evidence of cardiac disease, and is independently associated with occurrence of cardiac events and/or development of CS.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Advanced Heart Disease, Brigham and Womens Hospital, Boston, MA, USA.
authors.forename: Emer
authors.initials: E
authors.lastname: Joyce
authors.forename: Maarten K
authors.initials: MK
authors.lastname: Ninaber
authors.forename: Spyridon
authors.initials: S
authors.lastname: Katsanos
authors.forename: Philippe
authors.initials: P
authors.lastname: Debonnaire
authors.forename: Vasilis
authors.initials: V
authors.lastname: Kamperidis
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Christian
authors.initials: C
authors.lastname: Taube
authors.forename: Victoria
authors.initials: V
authors.lastname: Delgado
authors.forename: Nina
authors.initials: N
authors.lastname: Ajmone Marsan
mesh_terms: D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000209:etiology*; D009202:Cardiomyopathies / Q000209:etiology*; D018450:Disease Progression; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000209:etiology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012507:Sarcoidosis / Q000150:complications*; D017565:Sarcoidosis, Pulmonary / Q000150:complications; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology
keywords: Cardiac sarcoidosis; Longitudinal strain; Prognosis; Sarcoid cardiomyopathy; Speckle-tracking analysis