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Introduction: Appropriate referral of patients to advanced imaging for suspected cardiac sarcoidosis (CS), and prognosis of patients based on imaging results is not well understood. We sought to define clinical predictors associated with an imaging diagnosis of CS and compare outcomes in the CS group, based on imaging characteristics Methods: Study population comprised 164 consecutive patients, referred for FDG-PET or MRI imaging based on clinical suspicion for CS. Imaging diagnosis of CS was based on prior MRI results or current FDG-PET results, classified as scar+ inflammation (group1), scar-only (group2) and inflammation-only (group3). Follow-up was 2.3±1.3 years Results: Among 164 patients, 61% were male (mean age 59±10 years, 82% white) and 86 (52%) were diagnosed as CS (68 by PET and 18 by MRI). Clinical presentation of VT (32/86-37% vs 7/78-10%) and conduction system disease i.e. AV block and sinus node dysfunction (14/86-16% vs 6/78-6%) was more likely in CS (p<0.05). Prior diagnosis of extracardiac sarcoid was less frequent in CS (49% vs 69% p=0.03). LVEF was similar in both groups (45±18 in CS vs 51±19 in controls). In a multivariable model including the above variables, presentation with VT (OR5.64; CI-1.98-16.10) and conduction system disease (OR 2.13; CI-1.03-9.94) remained significant predictors of imaging diagnosis of CS. The distribution of FDG-PET results was: Group 1 (29%), Group 2 (32%) and Group 3 (38%). Group 1 had the highest incidence of VT at presentation (55% vs 41% vs 19%). Mean LVEF was 44±14, 23±14 and 52±12 across 3 groups respectively (p<0.003). Steroids and immunosuppressants were more commonly used in Groups 1 and 3 vs 2 (75%, 69% vs 18% p<0.0001). In a multivariable model that included LVEF and presentation with VT/conduction system disease, use of immunosuppressants (OR 2.57; CI 1.05-6.25) and LVEF (OR 0.97; CI 0.94-0.99) significantly predicted the outcome of death or recurrent VT (chi-sq 9.57; p=0.008) Conclusions: In a population being referred for imaging diagnosis of CS, presentation with VT or conduction system disease is more likely to identify those with disease. Among those with imaging diagnosis of CS by FDG-PET, presence of inflammation and therefore use of immunosuppressants and low LVEF were predictive of death or VT.

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