Late gadolinium enhancement in cardiac sarcoidosis predicts ICD implantation and appropriate discharge
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BioMed Central
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Oral presentation
Late gadolinium enhancement in cardiac sarcoidosis predicts ICD implantation and appropriate discharge Joyce L Wong*1, Francisco Alpendurada1, Masliza Mahmod1, Elisabeth Burman1, Monica Deac1, Dana Dawson1, Rory O'Hanlon2,1, Athol Wells3, Dudley Pennell1 and Sanjay Prasad1 Address: 1CMR Unit, Royal Brompton and Harefield Foundation Trust, London, UK, 2CMR Unit, Royal Brompton and Harefield Foundation Trust, London, UK and 3Royal Brompton Hospital, London, UK * Corresponding author
from 13th Annual SCMR Scientific Sessions Phoenix, AZ, USA. 21-24 January 2010 Published: 21 January 2010 Journal of Cardiovascular Magnetic Resonance 2010, 12(Suppl 1):O1
doi:10.1186/1532-429X-12-S1-O1
Abstracts of the 13th Annual SCMR Scientific Sessions - 2010
Meeting abstracts - A single PDF containing all abstracts in this Supplement is available here. http://www.biomedcentral.com/content/files/pdf/1532-429X-11-S1-infoThis abstract is available from: http://jcmr-online.com/content/12/S1/O1 © 2010 Wong et al; licensee BioMed Central Ltd.
Introduction
Results
Cardiac sarcoidosis is associated with sudden arrhythmic death, conduction abnormalities and heart failure. Occult disease is frequently found at autopsy although its significance remains unclear. Late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) imaging permits detection of granulomatous cardiac infiltration and myocardial fibrosis.
LGE was observed in 31 out of 96 (32%) patients. No significant difference was seen in all-cause death or hospitalisation for a cardiovascular event between the LGE+ and LGE- cohort. The LGE+ cohort had a significantly greater rate of ICD implantation (7 vs 1, p < 0.0005) and appropriate ICD discharge (4 vs 0, p < 0.005). Notably, only four patients had right ventricular LGE+; all required defibrillator (ICD) implantation and sustained appropriate ICD discharge. There was no difference in other secondary outcomes such as pre-ICD implantation sustained ventricular tachycardia, pacemaker implantation rate or escalation of heart failure therapy. Amongst LGE+ individuals, there was a significant reduction in biventricular EF (LVEF 50 ± 13.0% vs. 64 ± 10%, p < 0.05; RVEF 49 ± 13 vs. 58 ± 9%, p < 0.05). RVEDV was also significantly greater (173 ± 14 vs.137 ± 5 mls, p < 0.0065), although not LVEDV (105 ± 5.9 vs. 132 ± 7.9 mls, p < 0.0066). The distribution of LGE did not appear to correlate with outcome. The two groups did not differ in the incidence of biopsy-proven sarcoidosis (48/96 cases), pre-referral cardiac symptoms or duration of follow-up. Within this cohort, only five patients had STIR imaging clearly suggestive of active cardiac sarcoidosis.
Purpose We sought to establish whether CMR diagnosis of cardiac sarcoidosis correlates with clinical outcome in this complex disease.
Methods 96 consecutive patients with sarcoidosis were referred to our centre for CMR between 2002 and 2007 (46 M, 50 F; mean age 57 years). Outcomes in two cohorts distinguished by evidence o
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