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Toshiyuki Nagai, MD, PhD; Shun Kohsaka, MD, PhD; Keiichi Fukuda, MD, PhD
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From the Department of Cardiovascular Medicine (Dr Nagai), National Cerebral and Cardiovascular Center; and the Department of Cardiology (Drs Kohsaka and Fukuda), Keio University School of Medicine.

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


FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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


Chest. 2015;147(3):e119. doi:10.1378/chest.14-2996
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To the Editor:

We appreciate the correspondence from Dr Alter and colleagues on our article in CHEST.1 Whether left ventricular (LV) volumetric and functional determinants, measured by cardiovascular MRI (CMR), could influence the long-term prognosis of patients with systemic sarcoidosis is a topic of interest, and we analyzed volumetric and functional CMR variables in our study.1 These variables, including LV ejection fraction, LV end-systolic volume, and LV end-diastolic volume, were comparable between patients who experienced adverse events and those who did not, with the exception of LV mass (121.3 ± 32.2 g vs 82.3 ± 18.2 g, respectively, for patients who experienced events and those who did not; P < .001). In addition, there were no significant differences in these variables between the late gadolinium enhancement (LGE)-positive and LGE-negative groups. These findings suggest that, in our study, CMR-measured LV volume and systolic function were not directly associated with LGE and adverse events. However, it should be noted that adverse events occurred in only four patients.

Previous studies showed that > 20% of patients with systemic sarcoidosis had positive LGE, cardiac events occurred in > 10% of patients, and LGE was hypothesized to predict future cardiac events, even in patients with preserved LV systolic function.2-4 Contrary to these findings, our rates of positive LGE and cardiac events were lower, and, importantly, LGE did not predict adverse events.1 These differences can be explained by disease severity, including the extent of LGE. Patients in our study had lower frequencies of receiving immunosuppressants and having ECG abnormalities, no cardiac symptoms or impaired LV systolic function, and smaller extent of LGE compared with those in a previous study.3 Ise et al5 previously reported that smaller extent of LGE (% LGE mass < 20%) could predict a lower rate of cardiac events. Taking these findings together, the clinical implication of adding LV wall stress analysis would be limited in our population with latent and less severity and preserved LV systolic function. We believe that a larger cohort with a higher event rate (eg, greater disease severity, impaired LV function, and larger extent of LGE) is needed to investigate the association between LV volume and functional variables and long-term prognosis in patients with systemic sarcoidosis.

References

Nagai T, Kohsaka S, Okuda S, Anzai T, Asano K, Fukuda K. Incidence and prognostic significance of myocardial late gadolinium enhancement in patients with sarcoidosis without cardiac manifestation. Chest. 2014;146(4):1064-1072. [CrossRef] [PubMed]
 
Greulich S, Deluigi CC, Gloekler S, et al. CMR imaging predicts death and other adverse events in suspected cardiac sarcoidosis. JACC Cardiovasc Imaging. 2013;6(4):501-511. [CrossRef] [PubMed]
 
Patel MR, Cawley PJ, Heitner JF, et al. Detection of myocardial damage in patients with sarcoidosis. Circulation. 2009;120(20):1969-1977. [CrossRef] [PubMed]
 
Patel AR, Klein MR, Chandra S, et al. Myocardial damage in patients with sarcoidosis and preserved left ventricular systolic function: an observational study. Eur J Heart Fail. 2011;13(11):1231-1237. [CrossRef] [PubMed]
 
Ise T, Hasegawa T, Morita Y, et al. Extensive late gadolinium enhancement on cardiovascular magnetic resonance predicts adverse outcomes and lack of improvement in LV function after steroid therapy in cardiac sarcoidosis. Heart. 2014;100(15):1165-1172. [CrossRef] [PubMed]
 

Figures

Tables

References

Nagai T, Kohsaka S, Okuda S, Anzai T, Asano K, Fukuda K. Incidence and prognostic significance of myocardial late gadolinium enhancement in patients with sarcoidosis without cardiac manifestation. Chest. 2014;146(4):1064-1072. [CrossRef] [PubMed]
 
Greulich S, Deluigi CC, Gloekler S, et al. CMR imaging predicts death and other adverse events in suspected cardiac sarcoidosis. JACC Cardiovasc Imaging. 2013;6(4):501-511. [CrossRef] [PubMed]
 
Patel MR, Cawley PJ, Heitner JF, et al. Detection of myocardial damage in patients with sarcoidosis. Circulation. 2009;120(20):1969-1977. [CrossRef] [PubMed]
 
Patel AR, Klein MR, Chandra S, et al. Myocardial damage in patients with sarcoidosis and preserved left ventricular systolic function: an observational study. Eur J Heart Fail. 2011;13(11):1231-1237. [CrossRef] [PubMed]
 
Ise T, Hasegawa T, Morita Y, et al. Extensive late gadolinium enhancement on cardiovascular magnetic resonance predicts adverse outcomes and lack of improvement in LV function after steroid therapy in cardiac sarcoidosis. Heart. 2014;100(15):1165-1172. [CrossRef] [PubMed]
 
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