Author + information
- Received March 21, 2016
- Revision received May 20, 2016
- Accepted May 25, 2016
- Published online April 3, 2017.
- G. Cameron Coleman, MDa,
- Peter W. Shaw, MDa,
- Pelbreton C. Balfour Jr., MD, ScMa,
- Jorge A. Gonzalez, MDa,
- Christopher M. Kramer, MDa,b,
- Amit R. Patel, MDc,d and
- Michael Salerno, MD, PhD, MSa,e,∗ ()
- aDepartment of Medicine, University of Virginia, Charlottesville, Virginia
- bDepartment of Radiology and Medical Imaging, University of Virginia, Charlottesville, Virginia
- cDepartment of Medicine, University of Chicago Medicine, Chicago, Illinois
- dDepartment of Radiology, University of Chicago Medicine, Chicago, Illinois
- eDepartment of Biomedical Engineering, University of Virginia, Charlottesville, Virginia
- ↵∗Address for correspondence:
Dr. Michael Salerno, Department of Medicine, Cardiovascular Division, University of Virginia Health System, 1215 Lee Street, Box 800158, Charlottesville, Virginia 22908.
Objectives This study sought to perform a systematic review and meta-analysis to understand the prognostic value of myocardial scarring as evidenced by late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) imaging in patients with known or suspected cardiac sarcoidosis.
Background Although CMR is increasingly used for the diagnosis of cardiac sarcoidosis, the prognostic value of CMR has been less well described in this population.
Methods PubMed, Cochrane CENTRAL, and metaRegister of Controlled Trials were searched for CMR studies with ≥1 year of prognostic data. Primary endpoints were all-cause mortality and a composite outcome of arrhythmogenic events (ventricular arrhythmia, implantable cardioverter-defibrillator shock, sudden cardiac death) plus all-cause mortality during follow-up. Summary effect estimates were generated with random-effects modeling.
Results Ten studies were included, involving a total of 760 patients with a mean follow-up of 3.0 ± 1.1 years. Patients had a mean age of 53 years, 41% were male, 95.3% had known extracardiac sarcoidosis, and 21.6% had known cardiac sarcoidosis. The average ejection fraction was 57.8 ± 9.1%. Patients with LGE had higher odds for all-cause mortality (odds ratio [OR]: 3.06; p < 0.03) and higher odds of the composite outcome (OR: 10.74; p < 0.00001) than those without LGE. Patients with LGE had an increased annualized event rate of the composite outcome (11.9% vs. 1.1%; p < 0.0001).
Conclusions In patients with known or suspected cardiac sarcoidosis, the presence of LGE on CMR imaging is associated with increased odds of both all-cause mortality and arrhythmogenic events.
Drs. Shaw, Balfour, and Gonzalez has received grant support from the National Institutes of Health (T32 5T32EB003841). Dr. Patel has received research support from Philips Healthcare, Astellas Pharma, and the American Society of Echocardiography. Dr. Salerno has received grant support from the National Institutes of Health (K23 HL112910); and research support from Siemens Healthcare. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Coleman and Shaw contributed equally to this work. David Bluemke, MD, served as Guest Editor for this paper.
- Received March 21, 2016.
- Revision received May 20, 2016.
- Accepted May 25, 2016.
- 2017 American College of Cardiology Foundation