Prognostic Value of Late Gadolinium Enhancement Detected on Cardiac Magnetic Resonance in Cardiac Sarcoidosis

Diagnosis and Management of Cardiac Sarcoidosis: A Scientific Statement From the American Heart Association

“…Similarly, the presence and extent of myocardial granulomatous scar are strongly associated with the occurrence of VA, with right ventricular (RV) involvement being associated with increased VA risk. 16 A substantial proportion of patients diagnosed with CS will present with cardiac manifestations as their presenting organ of involvement, with ≈49% to 65% initially presenting without clinically evident extracardiac involvement. 12,17 On comprehensive evaluation, the majority of individuals with CS will demonstrate systemic involvement, underscoring the need to perform a thorough organ assessment.…”

“…28 It is important to note that myocardial LGE also carries significant prognostic value as the strongest predictor for all-cause mortality and sustained VA among individuals with known or suspected CS. 16 Myocardial LGE can occur because of sarcoidosisrelated inflammation or fibrosis/scar. In a systematic review and meta-analysis of gross pathological heart images of individuals with histologically diagnosed CS, certain common locations of CS involvement were identified (Figure 1): LV subepicardial, septal, LV multifocal, or RV free wall involvement was observed in >90% of cases (pathology-frequent features); other features such as the absence of gross myocardial involvement, isolated LV midmyocardial involvement, isolated LV subendocardial involvement, and the absence of septal involvement were rare or absent (pathology-rare features).…”

An Elderly Woman With Ventricular Tachycardia

“…Second, determining individual patient prognosis and assessment of immunosuppression response in patients with CS using cardiac imaging remains challenging. It has been demonstrated that patients without LGE are at an extremely low risk of arrhythmic events . However, although there is increased risk of arrhythmic events in patients with cardiac involvement identified by LGE, only a fraction of these patients experience arrhythmic events.…”

“…However, although there is increased risk of arrhythmic events in patients with cardiac involvement identified by LGE, only a fraction of these patients experience arrhythmic events. Patients with both RV and LV LGE are at elevated risk of cardiovascular events compared with patients with only LV enhancement . Last, while CS is extremely rare after 70 years of age, as the oldest patient reported in the literature was 80 years old, this patient presented with CS in her 90s, reminding us that CS remains on the differential diagnosis in patients with sustained ventricular arrythmias regardless of age.…”

The role of primary care in sarcoidosis

“…Patients with cardiac symptoms and/or ECG abnormalities should undergo a cardiac MRI for the exclusion of cardiac sarcoidosis. Apart from the accurate assessment of the cardiac structure and tissue characterization, cardiac MRI offers significant prognostic information for patients with suspected/known cardiac sarcoidosis [16 ▪▪ ,17,18]. Fluro-deoxy-glucose (FDG)-PET is an alternative advanced imaging modality used to identify myocardial (and body) inflammation and has a complementary role to cardiac MRI in the diagnostic pathway [19].…”