Role of magnetic resonance in the detection of cardiac involvement in patients with newly diagnosed extracardiac sarcoidosis: Single center experience

Abstract

Background: Sarcoidosis is a systemic inflammatory disease of unknown etiology, which can affect almost any organ. Cardiac involvement determines the prognosis of the affected individuals. Its prevalence in patients with extracardiac sarcoidosis with the absence of cardiac symptoms remains unclear. Cardiac magnetic resonance (CMR) provides excellent diagnostic accuracy in the detection of heart involvement by sarcoidosis. Aim:We sought to determine the prevalence of cardiac sarcoidosis in asymptomatic individuals with newly diagnosed extracardiac sarcoidosis using CMR. Methods:We prospectively evaluated 55 consecutive patients including 23 women with newly diagnosed extracardiac sarcoidosis who underwent contrast-enhanced CMR and had no symptoms of heart disease. The mean (standard deviation) age of patients was 43 (11) years. The presence of myocardial late gadolinium enhancement (LGE) of non-ischemic etiology on CMR examination was considered diagnostic for cardiac sarcoidosis. Results:In 3 (6%) patients, the LGE pattern consistent with cardiac sarcoidosis was detected. In all patients, preserved left ventricular systolic regional and global function was present, and in none of them, the elevation of blood biomarkers of myocardial injury or overload was found. Conclusions:Our study suggests that the prevalence of cardiac involvement in patients with newly diagnosed extracardiac sarcoidosis and no symptoms of heart disease is very low as assessed by CMR. However, CMR may be considered as part of routine evaluation of patients with extracardiac sarcoidosis due to its higher diagnostic yield in comparison with echocardiography and electrocardiography, respectively.

Cardiac magnetic resonance imaging as screening for cardiac sarcoidosis or not?

“…What becomes crucial is identifying which suspected sarcoidosis patients should undergo CMR. Kysperska et al [12] showed that it is unlikely to detect CS in the asymptomatic population without ECG or echocardiographic abnormalities, supporting the current guideline recommendations. However, we should acknowledge that the authors performed a comprehensive baseline assessment with all conventional tests such as 12-lead ECG, Holter monitoring, and echocardiography, as well as biomarker testing outside the guideline recommendations.…”

“…In addition, regional wall motion abnormalities appear to be strongly associated with CS, which should be part of the routine echocardiographic assessment [15]. Finally, there was a weak association between elevated angiotensin converting enzyme levels and CS detection in the latest study presented in this issue of the Kardiol Pol [12]. This would raise suspicion as to whether the clinical impression of disease activity should be included in the screening strategy, and it should indicate the performance of CMR as a screening test.…”

“…In this issue of the Kardiologia Polska (Polish Heart Journal), we read with interest the article regarding the role of CMR in the asymptomatic sarcoidosis population, which aims to shine light on the use of CMR in a subclinical setting [12]. In a cohort of 55 sarcoidosis patients with evidence of extra-cardiac disease, CMR managed to detect only 6% of cardiac involvement when used as a screening tool.…”