Regional abnormalities on cardiac magnetic resonance imaging and arrhythmic events in patients with cardiac sarcoidosis

David R. Okada, Eric Xie, Fabrizio Assis, John Smith, Arsalan Derakhshan, Zain Gowani, Bharath Ambale Venkatesh, Nisha Gilotra, Stefan Zimmerman, Ronald D Berger, Hugh Calkins, Joao Lima, Harikrishna Tandri, Jonathan Chrispin

Research output: Contribution to journalArticle

Abstract

Background: Patients with cardiac sarcoidosis (CS) may present with arrhythmic events (AE): atrioventricular block (AVB) and/ or ventricular arrhythmias (VA). We sought to: (a) use regional analysis of cardiac magnetic resonance imaging (CMR) to describe anatomic and functional phenotypes of patients with CS and AE; (b) Assess the association of regional CMR abnormalities with the combined endpoint of death, heart transplantation (HT) and AE; and (c) use machine learning (ML) to predict the combined endpoint based on CMR features. Methods: we included 76 patients with CS and CMR. We analyzed cine images to determine regional longitudinal (LS) and radial strain (RS); and late gadolinium enhancement imaging to determine regional scar burden (%scar). Results: Patients with AVB (n = 7), compared with those without, had higher %scar in the anterior (21.8 ± 27.4 vs 5.1 ± 8.9; P = 0.0005) and anteroseptal (19.3 ± 24.5 vs 3.5 ± 5.5; P <.0001) walls. Patients with VA (n = 12), compared with those without, had higher %scar in the basal inferoseptum (20.4 ± 30.8 vs 8.3 ± 13.4; P =.03). During mean follow-up of 4.4 ± 3.3 years, four patients died or underwent HT; eight had VA; and zero developed AVB. Multiple regional abnormalities were associated with the combined endpoint, including scar in the anteroseptal wall (HR 1.06 [1.02-1.09] per 1%scar increase, P =.002). The ML algorithm predicted the combined endpoint with a C-statistic of 0.91. Conclusion: Regional CMR abnormalities are associated with AE in patients with CS.

Original languageEnglish (US)
JournalJournal of cardiovascular electrophysiology
DOIs
StatePublished - Jan 1 2019

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Sarcoidosis
Magnetic Resonance Imaging
Cicatrix
Atrioventricular Block
Cardiac Arrhythmias
Heart Transplantation
Multiple Abnormalities
Gadolinium
Phenotype

Keywords

  • AV node disease
  • cardiac magnetic resonance imaging
  • cardiac sarcoidosis
  • heart block
  • sudden cardiac death
  • ventricular arrhythmia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

@article{6e235ae0124a4e40b62e8632c134d41b,
title = "Regional abnormalities on cardiac magnetic resonance imaging and arrhythmic events in patients with cardiac sarcoidosis",
abstract = "Background: Patients with cardiac sarcoidosis (CS) may present with arrhythmic events (AE): atrioventricular block (AVB) and/ or ventricular arrhythmias (VA). We sought to: (a) use regional analysis of cardiac magnetic resonance imaging (CMR) to describe anatomic and functional phenotypes of patients with CS and AE; (b) Assess the association of regional CMR abnormalities with the combined endpoint of death, heart transplantation (HT) and AE; and (c) use machine learning (ML) to predict the combined endpoint based on CMR features. Methods: we included 76 patients with CS and CMR. We analyzed cine images to determine regional longitudinal (LS) and radial strain (RS); and late gadolinium enhancement imaging to determine regional scar burden ({\%}scar). Results: Patients with AVB (n = 7), compared with those without, had higher {\%}scar in the anterior (21.8 ± 27.4 vs 5.1 ± 8.9; P = 0.0005) and anteroseptal (19.3 ± 24.5 vs 3.5 ± 5.5; P <.0001) walls. Patients with VA (n = 12), compared with those without, had higher {\%}scar in the basal inferoseptum (20.4 ± 30.8 vs 8.3 ± 13.4; P =.03). During mean follow-up of 4.4 ± 3.3 years, four patients died or underwent HT; eight had VA; and zero developed AVB. Multiple regional abnormalities were associated with the combined endpoint, including scar in the anteroseptal wall (HR 1.06 [1.02-1.09] per 1{\%}scar increase, P =.002). The ML algorithm predicted the combined endpoint with a C-statistic of 0.91. Conclusion: Regional CMR abnormalities are associated with AE in patients with CS.",
keywords = "AV node disease, cardiac magnetic resonance imaging, cardiac sarcoidosis, heart block, sudden cardiac death, ventricular arrhythmia",
author = "Okada, {David R.} and Eric Xie and Fabrizio Assis and John Smith and Arsalan Derakhshan and Zain Gowani and {Ambale Venkatesh}, Bharath and Nisha Gilotra and Stefan Zimmerman and Berger, {Ronald D} and Hugh Calkins and Joao Lima and Harikrishna Tandri and Jonathan Chrispin",
year = "2019",
month = "1",
day = "1",
doi = "10.1111/jce.14082",
language = "English (US)",
journal = "Journal of Cardiovascular Electrophysiology",
issn = "1045-3873",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Regional abnormalities on cardiac magnetic resonance imaging and arrhythmic events in patients with cardiac sarcoidosis

AU - Okada, David R.

AU - Xie, Eric

AU - Assis, Fabrizio

AU - Smith, John

AU - Derakhshan, Arsalan

AU - Gowani, Zain

AU - Ambale Venkatesh, Bharath

AU - Gilotra, Nisha

AU - Zimmerman, Stefan

AU - Berger, Ronald D

AU - Calkins, Hugh

AU - Lima, Joao

AU - Tandri, Harikrishna

AU - Chrispin, Jonathan

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Patients with cardiac sarcoidosis (CS) may present with arrhythmic events (AE): atrioventricular block (AVB) and/ or ventricular arrhythmias (VA). We sought to: (a) use regional analysis of cardiac magnetic resonance imaging (CMR) to describe anatomic and functional phenotypes of patients with CS and AE; (b) Assess the association of regional CMR abnormalities with the combined endpoint of death, heart transplantation (HT) and AE; and (c) use machine learning (ML) to predict the combined endpoint based on CMR features. Methods: we included 76 patients with CS and CMR. We analyzed cine images to determine regional longitudinal (LS) and radial strain (RS); and late gadolinium enhancement imaging to determine regional scar burden (%scar). Results: Patients with AVB (n = 7), compared with those without, had higher %scar in the anterior (21.8 ± 27.4 vs 5.1 ± 8.9; P = 0.0005) and anteroseptal (19.3 ± 24.5 vs 3.5 ± 5.5; P <.0001) walls. Patients with VA (n = 12), compared with those without, had higher %scar in the basal inferoseptum (20.4 ± 30.8 vs 8.3 ± 13.4; P =.03). During mean follow-up of 4.4 ± 3.3 years, four patients died or underwent HT; eight had VA; and zero developed AVB. Multiple regional abnormalities were associated with the combined endpoint, including scar in the anteroseptal wall (HR 1.06 [1.02-1.09] per 1%scar increase, P =.002). The ML algorithm predicted the combined endpoint with a C-statistic of 0.91. Conclusion: Regional CMR abnormalities are associated with AE in patients with CS.

AB - Background: Patients with cardiac sarcoidosis (CS) may present with arrhythmic events (AE): atrioventricular block (AVB) and/ or ventricular arrhythmias (VA). We sought to: (a) use regional analysis of cardiac magnetic resonance imaging (CMR) to describe anatomic and functional phenotypes of patients with CS and AE; (b) Assess the association of regional CMR abnormalities with the combined endpoint of death, heart transplantation (HT) and AE; and (c) use machine learning (ML) to predict the combined endpoint based on CMR features. Methods: we included 76 patients with CS and CMR. We analyzed cine images to determine regional longitudinal (LS) and radial strain (RS); and late gadolinium enhancement imaging to determine regional scar burden (%scar). Results: Patients with AVB (n = 7), compared with those without, had higher %scar in the anterior (21.8 ± 27.4 vs 5.1 ± 8.9; P = 0.0005) and anteroseptal (19.3 ± 24.5 vs 3.5 ± 5.5; P <.0001) walls. Patients with VA (n = 12), compared with those without, had higher %scar in the basal inferoseptum (20.4 ± 30.8 vs 8.3 ± 13.4; P =.03). During mean follow-up of 4.4 ± 3.3 years, four patients died or underwent HT; eight had VA; and zero developed AVB. Multiple regional abnormalities were associated with the combined endpoint, including scar in the anteroseptal wall (HR 1.06 [1.02-1.09] per 1%scar increase, P =.002). The ML algorithm predicted the combined endpoint with a C-statistic of 0.91. Conclusion: Regional CMR abnormalities are associated with AE in patients with CS.

KW - AV node disease

KW - cardiac magnetic resonance imaging

KW - cardiac sarcoidosis

KW - heart block

KW - sudden cardiac death

KW - ventricular arrhythmia

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DO - 10.1111/jce.14082

M3 - Article

JO - Journal of Cardiovascular Electrophysiology

JF - Journal of Cardiovascular Electrophysiology

SN - 1045-3873

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