title: Magnetic Resonance Imaging as a Predictor of Survival Free of Life-Threatening Arrhythmias and Transplantation in Cardiac Sarcoidosis.
abstract: Cardiac magnetic resonance imaging has a key role in today's diagnosis of cardiac sarcoidosis. We set out to investigate whether cardiac magnetic resonance imaging also helps predict outcome in cardiac sarcoidosis.
  
  
  
  Our work involved 59 patients with cardiac sarcoidosis (38 female, mean age 46±10 years) seen at our hospital since February 2004 and followed up after contrast-enhanced cardiac magnetic resonance imaging. The extent of myocardial late gadolinium enhancement (measured as percentage of left ventricular mass), the volumes and ejection fractions of the left and right ventricles, and the thickness of the basal interventricular septum were determined and analyzed for prognostic significance. By April 2015, 23 patients had reached the study's end point, consisting of a composite of cardiac death (n=3), cardiac transplantation (n=1), and occurrence of life-threatening ventricular tachyarrhythmias (n=19; ventricular fibrillation in 5 and sustained ventricular tachycardia in 14 patients). In univariate analysis, myocardial extent of late gadolinium enhancement predicted event-free survival, as did scar-like thinning (<4 mm) of the basal interventricular septum and the ejection fraction of the right ventricle (P<0.05 for all). In multivariate Cox regression analysis, extent of late gadolinium enhancement was the only independent predictor of outcome events on cardiac magnetic resonance imaging, with a hazard ratio of 2.22 per tertile (95% CI 1.07-4.59). An extent of late gadolinium enhancement >22% (third tertile) had positive and negative predictive values for serious cardiac events of 75% and 76%, respectively.
  
  
  
  Findings on cardiac magnetic resonance imaging and the extent of myocardial late gadolinium enhancement in particular help predict serious cardiac events in cardiac sarcoidosis.
authors.affiliation: The Heart and Lung Center, Radiology, Helsinki University Central Hospital, Helsinki, Finland kaj.ekstrom@hus.fi.
authors.forename: Kaj
authors.initials: K
authors.lastname: Ekström
authors.affiliation: The Heart and Lung Center, Radiology, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Jukka
authors.initials: J
authors.lastname: Lehtonen
authors.affiliation: The Heart and Lung Center, Radiology, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Helena
authors.initials: H
authors.lastname: Hänninen
authors.affiliation: The Heart and Lung Center, Radiology, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Riina
authors.initials: R
authors.lastname: Kandolin
authors.affiliation: HUS Medical Imaging Center, Radiology, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Sari
authors.initials: S
authors.lastname: Kivistö
authors.affiliation: The Heart and Lung Center, Radiology, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Markku
authors.initials: M
authors.lastname: Kupari
mesh_terms: D000328:Adult; D001145:Arrhythmias, Cardiac / Q000453:epidemiology*; D002306:Cardiac Volume; D009202:Cardiomyopathies / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D008279:Magnetic Resonance Imaging; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012507:Sarcoidosis / Q000175:diagnosis* / Q000453:epidemiology; D013318:Stroke Volume; D017180:Tachycardia, Ventricular / Q000453:epidemiology; D014693:Ventricular Fibrillation / Q000453:epidemiology
keywords: implanted cardioverter defibrillator; magnetic resonance imaging; sarcoidosis; ventricular tachycardia