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Detection of Myocardial Damage in Patients With Sarcoidosis

Circulation (New York, N.Y.), 2009-11, Vol.120 (20), p.1969-1977 [Peer Reviewed Journal]

2015 INIST-CNRS ;ISSN: 0009-7322 ;EISSN: 1524-4539 ;DOI: 10.1161/CIRCULATIONAHA.109.851352 ;PMID: 19884472 ;CODEN: CIRCAZ

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Title:
Detection of Myocardial Damage in Patients With Sarcoidosis
Author: PATEL, Manesh R ; CAWLEY, Peter J ; JUDD, Robert M ; KIM, Raymond J ; HEITNER, John F ; KLEM, Igor ; PARKER, Michele A ; JAROUDI, Wael A ; MEINE, Trip J ; WHITE, James B ; ELLIOTT, Michael D ; KIM, Han W
Subjects: Adult ; Biological and medical sciences ; Blood and lymphatic vessels ; Cardiology. Vascular system ; Chronic Disease ; Coronary heart disease ; Death ; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous ; Female ; Follow-Up Studies ; Heart ; Heart Diseases - diagnostic imaging ; Heart Diseases - etiology ; Heart Diseases - mortality ; Heart Diseases - physiopathology ; Humans ; Magnetic Resonance Imaging ; Male ; Medical sciences ; Middle Aged ; Radiography ; Sarcoidosis - complications ; Sarcoidosis - diagnostic imaging ; Sarcoidosis - mortality ; Sarcoidosis - physiopathology ; Stroke Volume
Is Part Of: Circulation (New York, N.Y.), 2009-11, Vol.120 (20), p.1969-1977
Description: In patients with sarcoidosis, sudden death is a leading cause of mortality, which may represent unrecognized cardiac involvement. Delayed-enhancement cardiovascular magnetic resonance (DE-CMR) can detect minute amounts of myocardial damage. We sought to compare DE-CMR with standard clinical evaluation for the identification of cardiac involvement. Eighty-one consecutive patients with biopsy-proven extracardiac sarcoidosis were prospectively recruited for a parallel and masked comparison of cardiac involvement between (1) DE-CMR and (2) standard clinical evaluation with the use of consensus criteria (modified Japanese Ministry of Health [JMH] guidelines). Standard evaluation included 12-lead ECG and at least 1 dedicated non-CMR cardiac study (echocardiography, radionuclide scintigraphy, or cardiac catheterization). Patients were followed for 21+/-8 months for major adverse events (death, defibrillator shock, or pacemaker requirement). Patients were predominantly middle-aged (46+/-11 years), female (62%), and black (73%) and had chronic sarcoidosis (median, 7 years) and preserved left ventricular ejection fraction (median, 56%). DE-CMR identified cardiac involvement in 21 patients (26%) and JMH criteria in 10 (12%, 8 overlapping), a >2-fold higher rate for DE-CMR (P=0.005). All patients with myocardial damage on DE-CMR had coronary disease excluded by x-ray angiography. Pathology evaluation in 15 patients (19%) identified 4 with cardiac sarcoidosis; all 4 were positive by DE-CMR, whereas 2 were JMH positive. On follow-up, 8 had adverse events, including 5 cardiac deaths. Patients with myocardial damage on DE-CMR had a 9-fold higher rate of adverse events and an 11.5-fold higher rate of cardiac death than patients without damage. In patients with sarcoidosis, DE-CMR is more than twice as sensitive for cardiac involvement as current consensus criteria. Myocardial damage detected by DE-CMR appears to be associated with future adverse events including cardiac death, but events were few, and this needs confirmation in a larger cohort.
Publisher: Hagerstown, MD: Lippincott Williams & Wilkins
Language: English
Identifier: ISSN: 0009-7322
EISSN: 1524-4539
DOI: 10.1161/CIRCULATIONAHA.109.851352
PMID: 19884472
CODEN: CIRCAZ
Source: GFMER Free Medical Journals
MEDLINE

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Detection of Myocardial Damage in Patients With Sarcoidosis

2015 INIST-CNRS ;ISSN: 0009-7322 ;EISSN: 1524-4539 ;DOI: 10.1161/CIRCULATIONAHA.109.851352 ;PMID: 19884472 ;CODEN: CIRCAZ

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