Prognostic Value of Myocardial Scarring on CMR in Patients With Cardiac Sarcoidosis

Coleman, Cameron; Shaw, P.W.; Balfour, Pelbreton C.; González, Jorge A.; Kramer, Christopher M.; Patel, Amit R.; Salerno, Michael

doi:10.1016/j.jcmg.2016.05.009

Cited by 198 publications

(118 citation statements)

References 43 publications

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“…The presence of LGE is associated with an increased risk of death or significant ventricular arrhythmia even in patients with preserved LVEF and the risk of adverse outcomes is modulated by the burden of myocardial damage and the presence of RV dysfunction (53). A recent meta-analysis (54) of 11 studies evaluating the role of CMR in patients with sarcoidosis revealed that the presence of LGE had an odds ratio of 7.4 for identifying patients at risk for a composite endpoint that included all-cause mortality and ventricular arrhythmogenic events. Furthermore, the absence of LGE is associated with a low risk of major cardiovascular events even when the LVEF is severely impaired (55).…”

Section: Inflammatory Cardiomyopathiesmentioning

confidence: 99%

Role of Cardiac Magnetic Resonance in the Diagnosis and Prognosis of Nonischemic Cardiomyopathy

Patel

Kramer

2017

JACC: Cardiovascular Imaging

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Cardiac magnetic resonance (CMR) is a valuable tool for the evaluation of patients with, or at risk for, heart failure and has a growing impact on diagnosis, clinical management, and decision-making. Through its ability to characterize the myocardium using multiple different imaging parameters, it provides insight into the etiology of the underlying heart failure and its prognosis. CMR is widely accepted as the reference standard for quantifying chamber size and ejection fraction. Additionally, tissue characterization techniques such as late gadolinium enhancement (LGE) and other quantitative parameters such as T1-mapping, both native and with measurement of extracellular volume fraction, T2-mapping, and T2-* mapping have been validated against histology in a wide range of clinical scenarios. In particular, the pattern of LGE in the myocardium can help determine the underlying etiology of the heart failure. The presence and extent of LGE determines prognosis in many of the non-ischemic cardiomyopathies. The use of CMR should increase as its utility in characterization and assessment of prognosis in cardiomyopathies is increasingly recognized. Cardiovascular magnetic resonance, cardiomyopathy, heart failure, hypertrophic cardiomyopathy, sarcoidosis, amyloidosis

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Section: Inflammatory Cardiomyopathiesmentioning

confidence: 99%

Role of Cardiac Magnetic Resonance in the Diagnosis and Prognosis of Nonischemic Cardiomyopathy

Patel

Kramer

2017

JACC: Cardiovascular Imaging

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“…In particular, the late gadolinium enhancement (LGE) technique allows visualization of regions of myocardial injury due to cardiac sarcoidosis (7). These are most commonly observed in a noncoronary distribution and associated with an adverse prognosis (8,9). However, LGE cannot differentiate between active disease and chronic scarring.…”

mentioning

confidence: 99%

Hybrid Magnetic Resonance Imaging and Positron Emission Tomography With Fluorodeoxyglucose to Diagnose Active Cardiac Sarcoidosis

Dweck

Abgral

Trivieri

et al. 2018

JACC: Cardiovascular Imaging

165

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OBJECTIVES The purpose of this study was to explore the diagnostic usefulness of hybrid cardiac magnetic resonance (CMR) and positron emission tomography (PET) using 18F-fluorodeoxyglucose (FDG) for active cardiac sarcoidosis. BACKGROUND Active cardiac sarcoidosis (aCS) is underdiagnosed and has a high mortality. METHODS Patients with clinical suspicion of aCS underwent hybrid CMR/PET with late gadolinium enhancement (LGE) and FDG to assess the pattern of injury and disease activity, respectively. Patients were categorized visually as magnetic resonance (MR)+PET+ (characteristic LGE aligning exactly with increased FDG uptake), MR+PET− (characteristic LGE but no increased FDG), MR−PET− (neither characteristic LGE nor increased FDG), and MR−PET+ (increased FDG uptake in absence of characteristic LGE) and further characterized as aCS+ (MR+PET+) or aCS− (MR+PET−, MR−PET−, MR−PET+). FDG uptake was quantified using maximum target-to-normal-myocardium ratio and the net uptake rate (Ki) from dynamic Patlak analysis. Receiver-operating characteristic methods were used to identify imaging biomarkers for aCS. FDG PET was assessed using computed tomography/PET in 19 control subjects with healthy myocardium. RESULTS A total of 25 patients (12 males; 54.9 ± 9.8 years of age) were recruited prospectively; 8 were MR+PET+, suggestive of aCS; 1 was MR+PET−, consistent with inactive cardiac sarcoidosis; and 8 were MR−PET−, with no imaging evidence of cardiac sarcoidosis. Eight patients were MR−PET+ (6 with global myocardial FDG uptake, 2 with focal-on-diffuse uptake); they demonstrated distinct Ki values and hyperintense maximum standardized uptake value compared with MR+PET+ patients. Similar hyperintense patterns of global (n = 9) and focal-on-diffuse (n = 2) FDG uptake were also observed in control patients, suggesting physiological myocardial uptake. Maximum target-to-normal-myocardium ratio values were higher in the aCS+ group (p < 0.001), demonstrating an area under the curve of 0.98 on receiver-operating characteristic analysis for the detection of aCS, with an optimal maximum target-to-normal myocardium ratio threshold of 1.2 (Youden index: 0.94). CONCLUSIONS CMR/PET imaging holds major promise for the diagnosis of aCS, providing incremental information about both the pattern of injury and disease activity in a single scan. (In Vivo Molecular Imaging [MRI] of Atherothrombotic Lesions; NCT01418313)

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“…In addition to the diagnosis of cardiac sarcoidosis based on the presence of LGE, CMR can also predict SCD or ICD-aborted cardiac death in patients who underwent CMR on the suspicion of cardiac involvement of sarcoidosis [74,75]. Although those studies were single center studies involving a small number of patients, a recent meta-analysis showed the presence of LGE on CMR imaging is associated with increased risk of both all-cause mortality and arrhythmogenic events [76].…”

Section: Cviamentioning

confidence: 99%

Evaluation of Sudden Cardiac Death Risk Using Cardiac Magnetic Resonance

Choi

Yoon

2017

Cardiovasc Imaging Asia

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Sudden cardiac death (SCD) is not uncommon event worldwide. In a report from the Unites States, age-adjusted nationwide incidence of SCD was estimated at 60 per 100000 residents, and the public health burden of SCD is greater than individual cancer [1]. Moreover, the survival to discharge in out-of-hospital cardiac arrest is only 6.4% in patients who required emergency medical services [2]. To prevent this devastating consequence and improve survival, implantable cardioverter-defibrillator (ICD) is considered as the treatment of choice for patients who survive SCD or have a high risk of SCD. However, the decision whether to implant ICD is not straightforward. In a series of major trials, only 20−35% of patients experienced appropriate shock delivery in 1 to 3 years after ICD implantation [3]. Simultaneously, the cumulative incidence of inappropriate shock during 5 years of follow-up was 18%, which is associated with the increased risk of all-cause mortality [4]. In addition, in the pooled analysis of randomized clinical trials, 9.1% of patients experienced complications associated with ICD over 16 months [5]. Given the expense and risks of ICDs, accurately differentiating patients at higher risk of SCD is important.Based on current guidelines, ICD for primary prevention is recommended in symptomatic patients with left ventricular ejection fraction (LVEF) <35% who did not respond to medical treatment (Table 1) [6][7][8]. Therefore, to date, transthoracic echocardiography (TTE) has played a major role for identifying patients with severe left ventricular (LV) dysfunction and higher risk of SCD. However, the issue on the selection of patients for ICD implantation based on LVEF using TTE has been raised constantly [8,9]. First, although two-dimensional (2D) TTE remains the most commonly used technique for the measurement of LVEF, it is based on geometric assumptions and is often limited by the sonic window. Second, use of LVEF alone showed a lack of sensitivity and specificity for the prediction of SCD. Although patients with severe LV dysfunction were shown to be at higher risk, they constitute less than one third of SCD cases [10,11]. In many instances, SCDs occur as the first manifestation of heart disease or in patients with a heart disease but with no or mild LV systolic dysfunction [12]. In a community-based prospective study entitled Oregon Sudden Unexpected Death Study, only 20% of patients who experienced SCD were eligible for ICD implantation based on the current guidelines that included LVEF and symptoms [13].Recently, great technical advances and diminished scan times have been achieved in the field of cardiac magnetic resocc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/bync/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Sudden cardiac death (SCD) is a significant problem worldwide and the risk strati...

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Prognostic Value of Myocardial Scarring on CMR in Patients With Cardiac Sarcoidosis

Cited by 198 publications

References 43 publications

Role of Cardiac Magnetic Resonance in the Diagnosis and Prognosis of Nonischemic Cardiomyopathy

Role of Cardiac Magnetic Resonance in the Diagnosis and Prognosis of Nonischemic Cardiomyopathy

Hybrid Magnetic Resonance Imaging and Positron Emission Tomography With Fluorodeoxyglucose to Diagnose Active Cardiac Sarcoidosis

Evaluation of Sudden Cardiac Death Risk Using Cardiac Magnetic Resonance

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