Presence of Late Gadolinium Enhancement by Cardiac Magnetic Resonance Among Patients With Suspected Cardiac Sarcoidosis Is Associated With Adverse Cardiovascular Prognosis: A Systematic Review and Meta-Analysis.
BACKGROUND
Individuals with cardiac sarcoidosis have an increased risk of ventricular arrhythmia and death. Several small cohort studies have evaluated the ability of late gadolinium enhancement (LGE) by cardiac magnetic resonance imaging (MRI) to predict adverse cardiovascular events. However, studies have yielded inconsistent results, and some analyses were underpowered. Therefore, we sought to systematically review and perform meta-analysis of the prognostic value of cardiac MRI for patients with known or suspected cardiac sarcoidosis.


RESULTS
We systematically searched for cohort studies of patients with known sarcoidosis with suspected cardiac involvement who underwent cardiac MRI with LGE with at least 12 months of either prospective or retrospective follow-up data regarding post-MRI adverse cardiovascular outcomes. We identified 7 studies of 694 subjects (mean age 53; 42% men).One hundred and ninety-nine patients (29%) were LGE positive. All-cause mortality occurred in 19 LGE-positive versus 17 LGE-negative subjects (annualized incidence, 3.1% versus 0.6%). The pooled relative risk was 3.38 (95% confidence interval, 1.07-10.7; P=0.04). Cardiovascular mortality occurred in 10 LGE-positive versus 2 LGE-negative subjects (annualized incidence, 1.9% versus 0.3%; relative risk 10.7 [95% confidence interval, 1.34-86.3]; P=0.03). Ventricular arrhythmia occurred in 41 LGE-positive versus 0 LGE-negative subjects (annualized incidence, 5.9% versus 0%; relative risk 19.5 [95% confidence interval, 2.68-143]; P=0.003). A combined end point of death or ventricular arrhythmia occurred in 64 LGE-positive versus 18 LGE-negative subjects (annualized incidence, 8.8% versus 0.6%; relative risk 6.20 [95% confidence interval, 2.47-15.6]; P<0.001). There was no significant heterogeneity for any outcomes.


CONCLUSIONS
LGE is associated with future cardiovascular death and ventricular arrhythmia among patients referred to MRI for known or suspected cardiac sarcoidosis.
From the Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.H., V.A., T.V., R.K., M.F.D.C., R.B.); Cardiology Service (E.H., M.C., G.C.) and Pulmonology Service (S.P.), Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD; Center for Clinical and Epidemiological Research, University Hospital and São Paulo State Cancer Institute-University of São Paulo, Brazil (M.S.B.); Preventive Medicine Center-Hospital Israelita Albert Einstein, São Paulo, Brazil (M.S.B); Frankel Cardiovascular Center, Department of Internal Medicine, Division of Cardiovascular Medicine and Department of Radiology, Division of Nuclear Medicine and Cardiothoracic Imaging, University of Michigan, Ann Arbor (V.L.M.).
Edward
E
Hulten
From the Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.H., V.A., T.V., R.K., M.F.D.C., R.B.); Cardiology Service (E.H., M.C., G.C.) and Pulmonology Service (S.P.), Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD; Center for Clinical and Epidemiological Research, University Hospital and São Paulo State Cancer Institute-University of São Paulo, Brazil (M.S.B.); Preventive Medicine Center-Hospital Israelita Albert Einstein, São Paulo, Brazil (M.S.B); Frankel Cardiovascular Center, Department of Internal Medicine, Division of Cardiovascular Medicine and Department of Radiology, Division of Nuclear Medicine and Cardiothoracic Imaging, University of Michigan, Ann Arbor (V.L.M.).
Vikram
V
Agarwal
From the Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.H., V.A., T.V., R.K., M.F.D.C., R.B.); Cardiology Service (E.H., M.C., G.C.) and Pulmonology Service (S.P.), Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD; Center for Clinical and Epidemiological Research, University Hospital and São Paulo State Cancer Institute-University of São Paulo, Brazil (M.S.B.); Preventive Medicine Center-Hospital Israelita Albert Einstein, São Paulo, Brazil (M.S.B); Frankel Cardiovascular Center, Department of Internal Medicine, Division of Cardiovascular Medicine and Department of Radiology, Division of Nuclear Medicine and Cardiothoracic Imaging, University of Michigan, Ann Arbor (V.L.M.).
Michael
M
Cahill
From the Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.H., V.A., T.V., R.K., M.F.D.C., R.B.); Cardiology Service (E.H., M.C., G.C.) and Pulmonology Service (S.P.), Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD; Center for Clinical and Epidemiological Research, University Hospital and São Paulo State Cancer Institute-University of São Paulo, Brazil (M.S.B.); Preventive Medicine Center-Hospital Israelita Albert Einstein, São Paulo, Brazil (M.S.B); Frankel Cardiovascular Center, Department of Internal Medicine, Division of Cardiovascular Medicine and Department of Radiology, Division of Nuclear Medicine and Cardiothoracic Imaging, University of Michigan, Ann Arbor (V.L.M.).
Geoff
G
Cole
From the Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.H., V.A., T.V., R.K., M.F.D.C., R.B.); Cardiology Service (E.H., M.C., G.C.) and Pulmonology Service (S.P.), Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD; Center for Clinical and Epidemiological Research, University Hospital and São Paulo State Cancer Institute-University of São Paulo, Brazil (M.S.B.); Preventive Medicine Center-Hospital Israelita Albert Einstein, São Paulo, Brazil (M.S.B); Frankel Cardiovascular Center, Department of Internal Medicine, Division of Cardiovascular Medicine and Department of Radiology, Division of Nuclear Medicine and Cardiothoracic Imaging, University of Michigan, Ann Arbor (V.L.M.).
Tomas
T
Vita
From the Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.H., V.A., T.V., R.K., M.F.D.C., R.B.); Cardiology Service (E.H., M.C., G.C.) and Pulmonology Service (S.P.), Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD; Center for Clinical and Epidemiological Research, University Hospital and São Paulo State Cancer Institute-University of São Paulo, Brazil (M.S.B.); Preventive Medicine Center-Hospital Israelita Albert Einstein, São Paulo, Brazil (M.S.B); Frankel Cardiovascular Center, Department of Internal Medicine, Division of Cardiovascular Medicine and Department of Radiology, Division of Nuclear Medicine and Cardiothoracic Imaging, University of Michigan, Ann Arbor (V.L.M.).
Scott
S
Parrish
From the Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.H., V.A., T.V., R.K., M.F.D.C., R.B.); Cardiology Service (E.H., M.C., G.C.) and Pulmonology Service (S.P.), Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD; Center for Clinical and Epidemiological Research, University Hospital and São Paulo State Cancer Institute-University of São Paulo, Brazil (M.S.B.); Preventive Medicine Center-Hospital Israelita Albert Einstein, São Paulo, Brazil (M.S.B); Frankel Cardiovascular Center, Department of Internal Medicine, Division of Cardiovascular Medicine and Department of Radiology, Division of Nuclear Medicine and Cardiothoracic Imaging, University of Michigan, Ann Arbor (V.L.M.).
Marcio Sommer
MS
Bittencourt
From the Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.H., V.A., T.V., R.K., M.F.D.C., R.B.); Cardiology Service (E.H., M.C., G.C.) and Pulmonology Service (S.P.), Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD; Center for Clinical and Epidemiological Research, University Hospital and São Paulo State Cancer Institute-University of São Paulo, Brazil (M.S.B.); Preventive Medicine Center-Hospital Israelita Albert Einstein, São Paulo, Brazil (M.S.B); Frankel Cardiovascular Center, Department of Internal Medicine, Division of Cardiovascular Medicine and Department of Radiology, Division of Nuclear Medicine and Cardiothoracic Imaging, University of Michigan, Ann Arbor (V.L.M.).
Venkatesh L
VL
Murthy
From the Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.H., V.A., T.V., R.K., M.F.D.C., R.B.); Cardiology Service (E.H., M.C., G.C.) and Pulmonology Service (S.P.), Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD; Center for Clinical and Epidemiological Research, University Hospital and São Paulo State Cancer Institute-University of São Paulo, Brazil (M.S.B.); Preventive Medicine Center-Hospital Israelita Albert Einstein, São Paulo, Brazil (M.S.B); Frankel Cardiovascular Center, Department of Internal Medicine, Division of Cardiovascular Medicine and Department of Radiology, Division of Nuclear Medicine and Cardiothoracic Imaging, University of Michigan, Ann Arbor (V.L.M.).
Raymond
R
Kwong
From the Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.H., V.A., T.V., R.K., M.F.D.C., R.B.); Cardiology Service (E.H., M.C., G.C.) and Pulmonology Service (S.P.), Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD; Center for Clinical and Epidemiological Research, University Hospital and São Paulo State Cancer Institute-University of São Paulo, Brazil (M.S.B.); Preventive Medicine Center-Hospital Israelita Albert Einstein, São Paulo, Brazil (M.S.B); Frankel Cardiovascular Center, Department of Internal Medicine, Division of Cardiovascular Medicine and Department of Radiology, Division of Nuclear Medicine and Cardiothoracic Imaging, University of Michigan, Ann Arbor (V.L.M.).
Marcelo F
MF
Di Carli
From the Non-Invasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (E.H., V.A., T.V., R.K., M.F.D.C., R.B.); Cardiology Service (E.H., M.C., G.C.) and Pulmonology Service (S.P.), Division of Medicine, Walter Reed National Military Medical Center and Uniformed Services University of Health Sciences, Bethesda, MD; Center for Clinical and Epidemiological Research, University Hospital and São Paulo State Cancer Institute-University of São Paulo, Brazil (M.S.B.); Preventive Medicine Center-Hospital Israelita Albert Einstein, São Paulo, Brazil (M.S.B); Frankel Cardiovascular Center, Department of Internal Medicine, Division of Cardiovascular Medicine and Department of Radiology, Division of Nuclear Medicine and Cardiothoracic Imaging, University of Michigan, Ann Arbor (V.L.M.). rblankstein@partners.org.
Ron
R
Blankstein
D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000401:mortality; D009202:Cardiomyopathies / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000503:physiopathology; D016009:Chi-Square Distribution; D003287:Contrast Media / Q000008:administration & dosage*; D016757:Death, Sudden, Cardiac / Q000209:etiology; D018450:Disease Progression; D005260:Female; D005682:Gadolinium / Q000008:administration & dosage*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D012507:Sarcoidosis / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000503:physiopathology; D016276:Ventricular Function
D003287:Contrast Media; D005682:Gadolinium
cardiac arrhythmia; cardiomyopathies; heart conduction system; magnetic resonance imaging; sarcoidosis