Improved detection of myocardial damage in sarcoidosis using longitudinal strain in patients with preserved left ventricular ejection fraction

Abstract

Background Cardiac infiltration is an important cause of death in sarcoidosis. Tran-sthoracic echocardiography (TTE) has limited sensitivity for the detection of cardiac sarcoidosis (CS). Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) is used to diagnose CS but has limitations of cost and availability. We sought to determine whether TTE- derived global longitudinal strain (GLS) may be used to identify individuals with CS, despite preserved left ventricular ejection fraction (LVEF), and whether abnormal GLS is associated with major cardiovascular events (MCE). Methods We studied 31 patients with biopsy- proven extra- cardiac sarcoidosis, LVEF>50% and LGE on CMR (CS+ group), and 31 patients without LGE (CS−group), matched by age, sex, and severity of lung disease. GLS was measured using vendor- independent speckle tracking software. Parameters of left and right ventricular systolic and diastolic function were also studied. Receiver- operating characteristic curves were used to identify GLS cutoff for CS detection, and Kaplan–Meier plots to determine the ability of GLS to predict MCE. Results LGE was associated with reduced GLS (−19.6±1.9% in CS− vs −14.7±2.4% in CS+, P<.01) and with reduced E/A ratio (1.1±0.3 vs 0.9±0.3, respectively, P =.01). No differences were noted in other TTE parameters. GLS magnitude inversely correlated with LGE burden (r=−.59). GLS cutoff of −17% showed sensitivity and specificity 94% for detecting CS. Patients who experienced MCE had worse GLS than those who did not (−13.4±0.9% vs −17.7±0.4%, P=.0003). Conclusions CS is associated with significantly reduced GLS in the presence of preserved LVEF. GLS measurements may become part of the TTE study performed to screen for CS.

Global longitudinal strain and long‐term outcomes in asymptomatic extracardiac sarcoid patients with no apparent cardiovascular disease

“…With regard to strain analysis, we chose not measure radial strain as this is more cumbersome to do and also the method has significant variability. Moving forward, various authors have attempted to assess circumferential strain with somehow conflicting results . On the other hand, most studies universally agree that longitudinal strain is impaired in patients with sarcoid, even in the preclinical stage.…”

“…Moving forward, various authors have attempted to assess circumferential strain with somehow conflicting results. 13 On the other hand, most studies universally agree that longitudinal strain is impaired in patients with sarcoid, even in the preclinical stage. Therefore, we reported only the GLS results.…”

“…Regarding the predictive ability of strain, this has been previously demonstrated by other research teams. Murtagh et al 10,13 showed that sarcoidosis patient with low values of GLS experienced more deaths or ventricular tachycardia. Interestingly, there was a linear correlation between the amount of LGE and reduction of GLS.…”

Subclinical involvement of the heart and its associated factors in patients with sarcoidosis with normal systolic function using 2D speckle tracking

“…Schouver et al showed that the total left ventricular strain or LV GLS in the sarcoidosis patients was reduced compared to the control group,19 which was consistent with our results. According to this study, the GLS cut point for diagnosis of cardiac sarcoidosis was −17%, with a sensitivity and specificity of 94% to diagnose the disease 20. In the study of Murtagh et al, the GLS value remarkably changed in speckle tracking in patients with sarcoidosis.…”

Noninvasive imaging in cardiac deposition diseases

“…Less frequent findings include increased myocardial wall thickness, LV and/or RV systolic and diastolic dysfunction, aneurysms, and regional wall motion abnormalities (usually in a noncoronary distribution) . In the recent years, LV speckle tracking GLS has been shown to be reduced in patients with cardiac sarcoidosis even in the presence of preserved LVEF, and this is associated with poorer outcomes (mortality, heart failure, arrhythmias) in these patients …”