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Utility of Cardiac Magnetic Resonance Imaging Versus Cardiac Positron Emission Tomography for Risk Stratification for Ventricular Arrhythmias in Patients With Cardiac Sarcoidosis

      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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