title: High mass (>18g) of late gadolinium enhancement on CMR imaging is associated with major cardiac events on long-term outcome in patients with biopsy-proven extracardiac sarcoidosis.
abstract: BACKGROUND
  Cardiac involvement is the most important cause of mortality in patients with systemic sarcoidosis. Late gadolinium enhancement (LGE) on cardiovascular magnetic resonance imaging (CMR) has been shown to be a predictor of major cardiovascular adverse events (MACE) in the setting of systemic sarcoidosis. We sought to evaluate the relationship between LGE mass and adverse long-term outcome in patients with biopsy-proven extracardiac sarcoidosis.
  
  
  METHODS
  Between 2001 and 2013, 197 consecutive patients with suspected cardiac sarcoidosis were identified in our institution database. Of them, 56 patients have had biopsy-proven extracardiac sarcoidosis and represented our studied population. Patients were divided into two groups based on LGE mass by a median value (mild LGE<18g, high LGE>18g) for comparison of MACE.
  
  
  RESULTS
  Twenty-eight patients had a high mass of LGE. Of them, 15 (54%) experienced MACE (OR=31.15, 95% CI 3.7-262). Except for 1 patient, no patient with mild LGE presented with any MACE during follow-up (median of 32months). Patients with high LGE had lower CMR-derived left (53.6±14.9 vs. 62.2±6.7, p<0.01) and right (49.1±11.5 vs. 56.4±9.2, p<0.05) ventricular ejection fractions. LGE mass of 18g discriminated patients with and without MACE (93% sensitivity, 88% specificity, AUC=0.972). LGE mass was the only independent predictor of MACE on multivariate Cox analysis adjusted (OR=1.7, 95% CI 1.06 to 2.72, p=0.03).
  
  
  CONCLUSIONS
  In biopsy-proven extracardiac sarcoidosis patients, a high mass of LGE >18g was associated with MACE.
authors.affiliation: Service de Radiologie, Hopital Bichat, APHP, University Paris Diderot, France.
authors.forename: Lucia
authors.initials: L
authors.lastname: Agoston-Coldea
authors.affiliation: Service de Radiologie, Hopital Bichat, APHP, University Paris Diderot, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Kouaho
authors.affiliation: Service de Médecine Interne, Hopital Bichat, APHP, University Paris Diderot, France.
authors.forename: Karim
authors.initials: K
authors.lastname: Sacre
authors.affiliation: Service de Médecine Interne, Hopital Bichat, APHP, University Paris Diderot, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Dossier
authors.affiliation: Service d'Explorations Fonctionnelles, Hospital Bichat, APHP, University Paris Diderot, France.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Escoubet
authors.affiliation: Service de Radiologie, Hopital Bichat, APHP, University Paris Diderot, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Chillon
authors.affiliation: Service de Radiologie, Hopital Bichat, APHP, University Paris Diderot, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Laissy
authors.affiliation: Service de Medecine Nucleaire, Hopital Bichat, APHP, University Paris Diderot, France.
authors.forename: François
authors.initials: F
authors.lastname: Rouzet
authors.affiliation: Service de Radiologie, Hopital Bichat, APHP, University Paris Diderot, France.
authors.forename: Shelby
authors.initials: S
authors.lastname: Kutty
authors.affiliation: Service de Cardiologie, Hopital Bichat, APHP, University Paris Diderot, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Extramiana
authors.affiliation: Service de Cardiologie, Hopital Bichat, APHP, University Paris Diderot, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Leenhardt
authors.affiliation: Service de Pneumologie, Hopital Bichat, APHP; University Paris Diderot, France.
authors.forename: Raphael
authors.initials: R
authors.lastname: Borie
authors.affiliation: Service de Pneumologie, Hopital Bichat, APHP; University Paris Diderot, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Crestani
authors.affiliation: Service de Radiologie, Hopital Bichat, APHP, University Paris Diderot, France; Service de Radiologie, Hopital Bichat, APHP, University Paris Diderot, and Inserm 1148, Paris, France. Electronic address: phalla.ou@aphp.fr.
authors.forename: Phalla
authors.initials: P
authors.lastname: Ou
mesh_terms: D001706:Biopsy; D009202:Cardiomyopathies / Q000175:diagnosis*; D003287:Contrast Media / Q000494:pharmacology; D005260:Female; D005500:Follow-Up Studies; D005682:Gadolinium / Q000494:pharmacology*; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012507:Sarcoidosis / Q000175:diagnosis*; D013997:Time Factors
chemical_list: D003287:Contrast Media; D005682:Gadolinium
keywords: Cardiac magnetic resonance imaging; Cardiac sarcoidosis; Late gadolinium enhancement