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Original Research: Diffuse Lung Disease |

Incidence and Prognostic Significance of Myocardial Late Gadolinium Enhancement in Patients With Sarcoidosis Without Cardiac ManifestationEnhanced MRI in Extracardiac Sarcoidosis

Toshiyuki Nagai, MD, PhD; Shun Kohsaka, MD, PhD; Shigeo Okuda, MD, PhD; Toshihisa Anzai, MD, PhD; Koichiro Asano, MD, PhD; Keiichi Fukuda, MD, PhD
Author and Funding Information

From the Department of Cardiovascular Medicine (Drs Nagai and Anzai), National Cerebral and Cardiovascular Center, Osaka; Department of Cardiology (Drs Kohsaka and Fukuda), Keio University School of Medicine, Tokyo; Department of Diagnostic Radiology (Dr Okuda), Keio University School of Medicine, Tokyo; and the Division of Pulmonary Medicine (Dr Asano), Department of Medicine, Tokai University School of Medicine, Kanagawa, Japan.

CORRESPONDENCE TO: Toshiyuki Nagai, MD, PhD, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan; e-mail: nagai@ncvc.go.jp


Drs Nagai and Kohsaka contributed equally to this work.

FUNDING/SUPPORT: This work was supported by a Grant-in-Aid for Young Scientists [Grant 25860630 to Dr Nagai] from the Japan Society for the Promotion of Science.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(4):1064-1072. doi:10.1378/chest.14-0139
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BACKGROUND:  Cardiac death is the leading cause of mortality associated with sarcoidosis in Japan. However, the involvement of sarcoidosis infiltration often remains undetected. Recently, late gadolinium enhancement with cardiovascular MRI (LGE-CMR) imaging has been introduced for the detection of myocardial infiltrative disease, as it enables the detection of even minor myocardial damage. We investigated the incidence and prognostic value of LGE-CMR in patients with extracardiac sarcoidosis without cardiac manifestations.

METHODS:  Sixty-one consecutive patients who met the histologic and clinical criteria for sarcoidosis, and who did not have signs or symptoms of cardiovascular involvement, were prospectively recruited. LGE-CMR was performed at the time of enrollment, and patients were classified into positive or negative late gadolinium enhancement groups based on the findings. The study end point was a composite of all-cause death, symptomatic arrhythmia, and heart failure necessitating admission.

RESULTS:  Patients were predominantly middle aged (57 ± 15 years) and female (66%), and most had stable disease activity that did not require treatment with immunosuppressants. LGE-CMR detected cardiac involvement in eight patients (13%). Interventricular septal thinning detected by echocardiography was an independent predictor of LGE-CMR-detected cardiac involvement. During the follow-up period of 50 ± 12 months, no significant difference in adverse events was noted between patients in the LGE-CMR-positive and LGE-CMR-negative groups.

CONCLUSIONS:  LGE-CMR detected cardiac involvement in 13% of patients with sarcoidosis without cardiac manifestation, but both patients with and without LGE had relatively low event rates.

TRIAL REGISTRY:  Japan Primary Registries Network; No.: UMIN000001549; URL: www.umin.ac.jp

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