title: Prognosis of Myocardial Damage in Sarcoidosis Patients With Preserved Left Ventricular Ejection Fraction: Risk Stratification Using Cardiovascular Magnetic Resonance.
abstract: BACKGROUND
  Cardiac sarcoidosis is associated with an increased risk of heart failure and sudden death, but its risk in patients with preserved left ventricular ejection fraction is unknown. Using cardiovascular magnetic resonance in patients with extracardiac sarcoidosis and preserved left ventricular ejection fraction, we sought to (1) determine the prevalence of cardiac sarcoidosis or associated myocardial damage, defined by the presence of late gadolinium enhancement (LGE), (2) quantify their risk of death/ventricular tachycardia (VT), and (3) identify imaging-based covariates that predict who is at greatest risk of death/VT.
  
  
  RESULTS
  Parameters of left and right ventricular function and LGE burden were measured in 205 patients with left ventricular ejection fraction >50% and extracardiac sarcoidosis who underwent cardiovascular magnetic resonance for LGE evaluation. The association between covariates and death/VT in the entire group and within the LGE+ group was determined using Cox proportional hazard models and time-dependent receiver-operator curves analysis. Forty-one of 205 patients (20%) had LGE; 12 of 205 (6%) died or had VT during follow-up; of these, 10 (83%) were in the LGE+ group. In the LGE+ group (1) the rate of death/VT per year was >20× higher than LGE- (4.9 versus 0.2%, P<0.01); (2) death/VT were associated with a greater burden of LGE (14±11 versus 5±5%, P<0.01) and right ventricular dysfunction (right ventricular EF 45±12 versus 53±28%, P=0.04). LGE burden was the best predictor of death/VT (area under the receiver-operating characteristics curve, 0.80); for every 1% increase of LGE burden, the hazard of death/VT increased by 8%.
  
  
  CONCLUSIONS
  Sarcoidosis patients with LGE are at significant risk for death/VT, even with preserved left ventricular ejection fraction. Increased LGE burden and right ventricular dysfunction can identify LGE+ patients at highest risk of death/VT.
authors.affiliation: From the Departments of Medicine (G.M., L.J.L., F.M., C.A.B., A.V.P., Z.Y., K.A., V.M.-A., J.D.M., D.K.H., R.M.L., A.R.P.) and Radiology (R.M.L., A.R.P.), University of Chicago, IL; Department of Medicine, Mayo Clinic, Phoenix, AZ (J.F.B.); and Department of Medicine, University of Illinois at Chicago (N.J.S.).
authors.forename: Gillian
authors.initials: G
authors.lastname: Murtagh
authors.affiliation: From the Departments of Medicine (G.M., L.J.L., F.M., C.A.B., A.V.P., Z.Y., K.A., V.M.-A., J.D.M., D.K.H., R.M.L., A.R.P.) and Radiology (R.M.L., A.R.P.), University of Chicago, IL; Department of Medicine, Mayo Clinic, Phoenix, AZ (J.F.B.); and Department of Medicine, University of Illinois at Chicago (N.J.S.).
authors.forename: Luke J
authors.initials: LJ
authors.lastname: Laffin
authors.affiliation: From the Departments of Medicine (G.M., L.J.L., F.M., C.A.B., A.V.P., Z.Y., K.A., V.M.-A., J.D.M., D.K.H., R.M.L., A.R.P.) and Radiology (R.M.L., A.R.P.), University of Chicago, IL; Department of Medicine, Mayo Clinic, Phoenix, AZ (J.F.B.); and Department of Medicine, University of Illinois at Chicago (N.J.S.).
authors.forename: John F
authors.initials: JF
authors.lastname: Beshai
authors.affiliation: From the Departments of Medicine (G.M., L.J.L., F.M., C.A.B., A.V.P., Z.Y., K.A., V.M.-A., J.D.M., D.K.H., R.M.L., A.R.P.) and Radiology (R.M.L., A.R.P.), University of Chicago, IL; Department of Medicine, Mayo Clinic, Phoenix, AZ (J.F.B.); and Department of Medicine, University of Illinois at Chicago (N.J.S.).
authors.forename: Francesco
authors.initials: F
authors.lastname: Maffessanti
authors.affiliation: From the Departments of Medicine (G.M., L.J.L., F.M., C.A.B., A.V.P., Z.Y., K.A., V.M.-A., J.D.M., D.K.H., R.M.L., A.R.P.) and Radiology (R.M.L., A.R.P.), University of Chicago, IL; Department of Medicine, Mayo Clinic, Phoenix, AZ (J.F.B.); and Department of Medicine, University of Illinois at Chicago (N.J.S.).
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Bonham
authors.affiliation: From the Departments of Medicine (G.M., L.J.L., F.M., C.A.B., A.V.P., Z.Y., K.A., V.M.-A., J.D.M., D.K.H., R.M.L., A.R.P.) and Radiology (R.M.L., A.R.P.), University of Chicago, IL; Department of Medicine, Mayo Clinic, Phoenix, AZ (J.F.B.); and Department of Medicine, University of Illinois at Chicago (N.J.S.).
authors.forename: Amit V
authors.initials: AV
authors.lastname: Patel
authors.affiliation: From the Departments of Medicine (G.M., L.J.L., F.M., C.A.B., A.V.P., Z.Y., K.A., V.M.-A., J.D.M., D.K.H., R.M.L., A.R.P.) and Radiology (R.M.L., A.R.P.), University of Chicago, IL; Department of Medicine, Mayo Clinic, Phoenix, AZ (J.F.B.); and Department of Medicine, University of Illinois at Chicago (N.J.S.).
authors.forename: Zoe
authors.initials: Z
authors.lastname: Yu
authors.affiliation: From the Departments of Medicine (G.M., L.J.L., F.M., C.A.B., A.V.P., Z.Y., K.A., V.M.-A., J.D.M., D.K.H., R.M.L., A.R.P.) and Radiology (R.M.L., A.R.P.), University of Chicago, IL; Department of Medicine, Mayo Clinic, Phoenix, AZ (J.F.B.); and Department of Medicine, University of Illinois at Chicago (N.J.S.).
authors.forename: Karima
authors.initials: K
authors.lastname: Addetia
authors.affiliation: From the Departments of Medicine (G.M., L.J.L., F.M., C.A.B., A.V.P., Z.Y., K.A., V.M.-A., J.D.M., D.K.H., R.M.L., A.R.P.) and Radiology (R.M.L., A.R.P.), University of Chicago, IL; Department of Medicine, Mayo Clinic, Phoenix, AZ (J.F.B.); and Department of Medicine, University of Illinois at Chicago (N.J.S.).
authors.forename: Victor
authors.initials: V
authors.lastname: Mor-Avi
authors.affiliation: From the Departments of Medicine (G.M., L.J.L., F.M., C.A.B., A.V.P., Z.Y., K.A., V.M.-A., J.D.M., D.K.H., R.M.L., A.R.P.) and Radiology (R.M.L., A.R.P.), University of Chicago, IL; Department of Medicine, Mayo Clinic, Phoenix, AZ (J.F.B.); and Department of Medicine, University of Illinois at Chicago (N.J.S.).
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Moss
authors.affiliation: From the Departments of Medicine (G.M., L.J.L., F.M., C.A.B., A.V.P., Z.Y., K.A., V.M.-A., J.D.M., D.K.H., R.M.L., A.R.P.) and Radiology (R.M.L., A.R.P.), University of Chicago, IL; Department of Medicine, Mayo Clinic, Phoenix, AZ (J.F.B.); and Department of Medicine, University of Illinois at Chicago (N.J.S.).
authors.forename: D Kyle
authors.initials: DK
authors.lastname: Hogarth
authors.affiliation: From the Departments of Medicine (G.M., L.J.L., F.M., C.A.B., A.V.P., Z.Y., K.A., V.M.-A., J.D.M., D.K.H., R.M.L., A.R.P.) and Radiology (R.M.L., A.R.P.), University of Chicago, IL; Department of Medicine, Mayo Clinic, Phoenix, AZ (J.F.B.); and Department of Medicine, University of Illinois at Chicago (N.J.S.).
authors.forename: Nadera J
authors.initials: NJ
authors.lastname: Sweiss
authors.affiliation: From the Departments of Medicine (G.M., L.J.L., F.M., C.A.B., A.V.P., Z.Y., K.A., V.M.-A., J.D.M., D.K.H., R.M.L., A.R.P.) and Radiology (R.M.L., A.R.P.), University of Chicago, IL; Department of Medicine, Mayo Clinic, Phoenix, AZ (J.F.B.); and Department of Medicine, University of Illinois at Chicago (N.J.S.).
authors.forename: Roberto M
authors.initials: RM
authors.lastname: Lang
authors.affiliation: From the Departments of Medicine (G.M., L.J.L., F.M., C.A.B., A.V.P., Z.Y., K.A., V.M.-A., J.D.M., D.K.H., R.M.L., A.R.P.) and Radiology (R.M.L., A.R.P.), University of Chicago, IL; Department of Medicine, Mayo Clinic, Phoenix, AZ (J.F.B.); and Department of Medicine, University of Illinois at Chicago (N.J.S.). amitpatel@uchicago.edu.
authors.forename: Amit R
authors.initials: AR
authors.lastname: Patel
mesh_terms: D001706:Biopsy; D009202:Cardiomyopathies / Q000503:physiopathology*; D003287:Contrast Media; D018450:Disease Progression; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012507:Sarcoidosis / Q000503:physiopathology*; D013318:Stroke Volume / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D003287:Contrast Media
keywords: cardiac arrhythmias; cardiac magnetic resonance; cardiomyopathy; defibrillator; gadolinium; heart failure; sarcoidosis