Electrophysiology study for risk stratification in patients with cardiac sarcoidosis and abnormal cardiac imaging

David R. Okada, John Smith, Arsalan Derakhshan, Zain Gowani, Stefan Zimmerman, Satish Misra, Ronald D Berger, Hugh Calkins, Harikrishna Tandri, Jonathan Chrispin

Research output: Contribution to journalArticle

Abstract

Background: Abnormalities on cardiac imaging (cardiac magnetic resonance imaging [CMR] or positron emission tomography [PET]), left ventricular ejection fraction (LVEF), and electrophysiology study (EPS) all predict ventricular arrhythmias (VA) in patients with cardiac sarcoidosis (CS). We sought to assess the utility of EPS in patients with CS and abnormal cardiac imaging, focusing on those with LVEF >35%. Methods: We identified all patients treated at our institution from 2000 to 2017 who: 1.) had probable or definite CS; 2.) had either late gadolinium enhancement (LGE) on CMR or abnormal 18-flourodeoxyglucose (FDG) uptake on PET, and 3.) had undergone EPS. The primary endpoint was VA during follow up. Results: Twenty five patients were included, of whom 10 (40%) had positive EPS. During a mean follow-up of 4.8 +/− 3.4 years, 11 (44%) patients had VA. The positive predictive value (PPV) of EPS for VA was 100% and the negative predictive value (NPV) of EPS for VA was 93%. Among 12 patients with LVEF >35% and no prior VA, the PPV of EPS for VA was 100% and the NPV of EPS for VA was 90%. Conclusion: EPS may help with risk stratification in patients with CS and abnormal imaging, especially those without conventional indications for ICD placement. Among patients with LVEF >35% and no history of prior VA, a negative EPS has good positive and negative predictive value for future VA events.

Original languageEnglish (US)
Article number100342
JournalIJC Heart and Vasculature
DOIs
StatePublished - Jan 1 2019

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Electrophysiology
Sarcoidosis
Cardiac Arrhythmias
Stroke Volume
Positron-Emission Tomography
Magnetic Resonance Imaging
Gadolinium

Keywords

  • Cardiac sarcoidosis
  • Electrophysiology study
  • Implantable cardioverter defibrillator
  • Sudden cardiac death
  • Ventricular arrhythmia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{645b55b0ae7341689494be1208af262f,
title = "Electrophysiology study for risk stratification in patients with cardiac sarcoidosis and abnormal cardiac imaging",
abstract = "Background: Abnormalities on cardiac imaging (cardiac magnetic resonance imaging [CMR] or positron emission tomography [PET]), left ventricular ejection fraction (LVEF), and electrophysiology study (EPS) all predict ventricular arrhythmias (VA) in patients with cardiac sarcoidosis (CS). We sought to assess the utility of EPS in patients with CS and abnormal cardiac imaging, focusing on those with LVEF >35{\%}. Methods: We identified all patients treated at our institution from 2000 to 2017 who: 1.) had probable or definite CS; 2.) had either late gadolinium enhancement (LGE) on CMR or abnormal 18-flourodeoxyglucose (FDG) uptake on PET, and 3.) had undergone EPS. The primary endpoint was VA during follow up. Results: Twenty five patients were included, of whom 10 (40{\%}) had positive EPS. During a mean follow-up of 4.8 +/− 3.4 years, 11 (44{\%}) patients had VA. The positive predictive value (PPV) of EPS for VA was 100{\%} and the negative predictive value (NPV) of EPS for VA was 93{\%}. Among 12 patients with LVEF >35{\%} and no prior VA, the PPV of EPS for VA was 100{\%} and the NPV of EPS for VA was 90{\%}. Conclusion: EPS may help with risk stratification in patients with CS and abnormal imaging, especially those without conventional indications for ICD placement. Among patients with LVEF >35{\%} and no history of prior VA, a negative EPS has good positive and negative predictive value for future VA events.",
keywords = "Cardiac sarcoidosis, Electrophysiology study, Implantable cardioverter defibrillator, Sudden cardiac death, Ventricular arrhythmia",
author = "Okada, {David R.} and John Smith and Arsalan Derakhshan and Zain Gowani and Stefan Zimmerman and Satish Misra and Berger, {Ronald D} and Hugh Calkins and Harikrishna Tandri and Jonathan Chrispin",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.ijcha.2019.03.002",
language = "English (US)",
journal = "IJC Heart and Vasculature",
issn = "2352-9067",
publisher = "Elsevier BV",

}

TY - JOUR

T1 - Electrophysiology study for risk stratification in patients with cardiac sarcoidosis and abnormal cardiac imaging

AU - Okada, David R.

AU - Smith, John

AU - Derakhshan, Arsalan

AU - Gowani, Zain

AU - Zimmerman, Stefan

AU - Misra, Satish

AU - Berger, Ronald D

AU - Calkins, Hugh

AU - Tandri, Harikrishna

AU - Chrispin, Jonathan

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Abnormalities on cardiac imaging (cardiac magnetic resonance imaging [CMR] or positron emission tomography [PET]), left ventricular ejection fraction (LVEF), and electrophysiology study (EPS) all predict ventricular arrhythmias (VA) in patients with cardiac sarcoidosis (CS). We sought to assess the utility of EPS in patients with CS and abnormal cardiac imaging, focusing on those with LVEF >35%. Methods: We identified all patients treated at our institution from 2000 to 2017 who: 1.) had probable or definite CS; 2.) had either late gadolinium enhancement (LGE) on CMR or abnormal 18-flourodeoxyglucose (FDG) uptake on PET, and 3.) had undergone EPS. The primary endpoint was VA during follow up. Results: Twenty five patients were included, of whom 10 (40%) had positive EPS. During a mean follow-up of 4.8 +/− 3.4 years, 11 (44%) patients had VA. The positive predictive value (PPV) of EPS for VA was 100% and the negative predictive value (NPV) of EPS for VA was 93%. Among 12 patients with LVEF >35% and no prior VA, the PPV of EPS for VA was 100% and the NPV of EPS for VA was 90%. Conclusion: EPS may help with risk stratification in patients with CS and abnormal imaging, especially those without conventional indications for ICD placement. Among patients with LVEF >35% and no history of prior VA, a negative EPS has good positive and negative predictive value for future VA events.

AB - Background: Abnormalities on cardiac imaging (cardiac magnetic resonance imaging [CMR] or positron emission tomography [PET]), left ventricular ejection fraction (LVEF), and electrophysiology study (EPS) all predict ventricular arrhythmias (VA) in patients with cardiac sarcoidosis (CS). We sought to assess the utility of EPS in patients with CS and abnormal cardiac imaging, focusing on those with LVEF >35%. Methods: We identified all patients treated at our institution from 2000 to 2017 who: 1.) had probable or definite CS; 2.) had either late gadolinium enhancement (LGE) on CMR or abnormal 18-flourodeoxyglucose (FDG) uptake on PET, and 3.) had undergone EPS. The primary endpoint was VA during follow up. Results: Twenty five patients were included, of whom 10 (40%) had positive EPS. During a mean follow-up of 4.8 +/− 3.4 years, 11 (44%) patients had VA. The positive predictive value (PPV) of EPS for VA was 100% and the negative predictive value (NPV) of EPS for VA was 93%. Among 12 patients with LVEF >35% and no prior VA, the PPV of EPS for VA was 100% and the NPV of EPS for VA was 90%. Conclusion: EPS may help with risk stratification in patients with CS and abnormal imaging, especially those without conventional indications for ICD placement. Among patients with LVEF >35% and no history of prior VA, a negative EPS has good positive and negative predictive value for future VA events.

KW - Cardiac sarcoidosis

KW - Electrophysiology study

KW - Implantable cardioverter defibrillator

KW - Sudden cardiac death

KW - Ventricular arrhythmia

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