Highlights
- •Ventricular arrhythmias in patients with cardiac sarcoidosis are predicted by late gadolinium enhancement on cardiac MRI with excellent negative predictive value, and may be the preferred tool for imaging risk stratification in patients with cardiac sarcoidosis.
- •Ventricular arrhythmias in patients with cardiac sarcoidosis without any other indications for device placement were predicted by late gadolinium enhancement on cardiac MRI.
- •Inflammation on PET did not increase the risk of VA in patients with cardiac sarcoidosis who had late gadolinium enhancement on cardiac MRI. FDG Uptake without LGE on initial imaging may not add additional prognostic information regarding VA risk.
Abnormalities on cardiac magnetic resonance imaging (CMR) and positron emission tomography
(PET) predict ventricular arrhythmias (VA) in patients with cardiac sarcoidosis (CS).
Little is known whether concurrent abnormalities on CMR and PET increases the risk
of developing VA. Our aim was to compare the additive utility of CMR and PET in predicting
VA in patients with CS. We included all patients treated at our institution from 2000
to 2018 who (1) had probable or definite CS and (2) had undergone both CMR and PET.
The primary endpoint was VA at follow up, which was defined as sustained ventricular
tachycardia, sudden cardiac death, or any appropriate device tachytherapy. Fifty patients
were included, 88% of whom had a left ventricular ejection fraction >35%. During a
mean follow-up 4.1 years, 7/50 (14%) patients had VA. The negative predictive value
of LGE for VA was 100% and the negative predictive value of FDG for VA was 79%. Among
groups, VA occurred in 4/21 (19%) subjects in the LGE+/FDG+ group, 3/14 (21%) in the
LGE+/FDG− group, and 0/15 (0%) in the FDG+/LGE− group. There were no LGE−/FDG− patients.
In conclusion, CMR may be the preferred initial clinical risk stratification tool
in patients with CS. FDG uptake without LGE on initial imaging may not add additional
prognostic information regarding VA risk.
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Article info
Publication history
Published online: August 15, 2020
Received in revised form:
August 3,
2020
Received:
April 26,
2020
Footnotes
Financial Support: This study was supported by Robert E. Meyerhoff Professorship to Jonathan Chrispin, MD. All authors have reviewed and signed the confidentiality agreement.
Identification
Copyright
© 2020 Published by Elsevier Inc.
