Michael Kemal Atalay MD, PhD, Presenter: Nothing to Disclose

Terrance T. Healey MD, Abstract Co-Author: Nothing to Disclose

James R Myers, Abstract Co-Author: Nothing to Disclose

Walter E Donat, Abstract Co-Author: Nothing to Disclose

Lilian P Joventino MD, Abstract Co-Author: Nothing to Disclose

Sudden death is a leading cause of mortality in patients with sarcoidosis, potentially due to unrecognized cardiac involvement. The diagnosis of cardiac sarcoidosis remains challenging, but late gadolinium enhancement cardiac MR (LGE-CMR) has been reported to be more than twice as sensitive for detecting cardiac sarcoid than current consensus criteria. Our goal was to determine whether severity of pulmonary disease correlates with the presence of LGE in patients without known cardiac disease.

Twenty-five consecutive, consented patients with proven extracardiac sarcoidosis were prospectively studied by CMR (15 women; age 50 ± 12 y). None had any known pre-existing cardiac condition. Disease staging was based on chest radiography (CXR) using standard convention: stage 0—normal; stage I—hilar/mediastinal adenopathy; stage II—adenopathy and parenchymal disease; stage III—parenchymal disease only; and stage IV—pulmonary fibrosis. The CMR reader was blinded to the radiographic staging, and the CXR reader was blinded to the CMR results. In addition to routine LGE-CMR, left ventricular (LV) systolic function was assessed using cine imaging.

The numbers of subjects having pulmonary disease stages I-IV were 5 (stage 0), 4 (stage I), 3 (stage II), 8 (stage III), and 5 (stage IV). Five subjects (20%) had evidence of LGE, 4 of whom had stage IV disease. The 5th had stage I disease. The stage IV group had a significantly higher prevalence of LGE (80%) than seen in the other groups combined (5%) (P=0.0002). The pattern of LGE was typically globular and subepicardial and located in the basal or mid-cavity septal or inferolateral segments. No infarcts were seen. LV function was reduced (EF 49%) in only one patient (stage IV).

Patients with sarcoidosis, no prior cardiac history, and stage IV lung disease are significantly more likely to have myocardial damage as reflected by LGE-CMR than patients with other stages of disease. This subset population may benefit from screening CMR.

We have identified a subset of sarcoid patients who demonstrate a significantly higher prevalence of myocardial injury at CMR.

Atalay, M, Healey, T, Myers, J, Donat, W, Joventino, L, Patients with Stage IV Pulmonary Sarcoidosis and No Prior Cardiac History Have Significantly Greater Prevalence of Myocardial Late Gadolinium Enhancement at CMR than Those with Other Stages of Disease.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11010518.html