Extent and Features of Late Gadolinium Enhancement Stratify Arrhythmic Risk in Patients With Biopsy-Proven Sarcoidosis

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging Pub Date : 2025-07-01 DOI:10.1016/j.jcmg.2025.02.012

Alessia Azzu MD, PhD , Alexios S. Antonopoulos MD, PhD , Joseph Okafor MD , Marco Morosin MD , Emmanuel Androulakis MD, PhD , Suzan Hatipoglu MD , Batool Almogheer MD , Raheel Ahmed MD , Raad Mohiaddin MD, PhD , Francisco Alpendurada MD, PhD , Cemil Izgi MD , Amrit Lota MD, PhD , Kshama Wechalekar MD , Rajdeep Khattar MD, PhD , Athol Wells MD, PhD , John Baksi MD, PhD , Rakesh Sharma MD, PhD , Vasileios Kouranos MD, PhD , Dudley J. Pennell MD

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Abstract

Background

Risk assessment in cardiac sarcoidosis remains challenging.

Objectives

This study explored the prognostic value of myocardial late gadolinium enhancement (LGE) in sarcoidosis patients.

Methods

The study cohort included 324 patients with biopsy-proven sarcoidosis. LGE extent, pattern, and location were analyzed. The primary endpoint was ventricular tachycardia (VT) or ventricular fibrillation (VF) or appropriate device therapy. Secondary endpoints were hospitalization for heart failure (HF) or heart transplantation (HTx) and all-cause mortality.

Results

Over a 4.6-year follow-up, 30 patients (9.3%) reached the primary endpoint. HF/HTx occurred in 15 patients (4.6%) and all-cause mortality in 41 (12.7%). LGE extent was independently predictive of the primary endpoint (per SD change: HR: 1.03 [95% CI: 1.00-1.06]; P = 0.047), but not of HF/HTx (P = 0.30) or all-cause mortality (P = 0.50). Further to LGE extent, LGE on the right ventricular (RV) septum (HR: 5.43 [95% CI: 2.61-11.30]; P < 0.001), RV free wall (HR: 4.30 [95% CI: 1.99-9.27]; P < 0.001), and multifocal LGE (HR: 4.62 [95% CI: 2.19-9.72]; P < 0.001) were strongly predictive of the arrhythmia endpoint. Based on these findings, we propose an algorithm that identifies 4 patient subgroups and stratifies well the arrhythmia risk in biopsy-proven sarcoidosis patients (cumulative event rates: 1%, 11%, 23%, and 44%, respectively; chi-square = 44.7; P = 1.084 × 10⁻⁹). Compared with the Heart Rhythm Society classification system, this approach significantly enhanced model performance (chi-square = 8.02; P = 0.046) and risk discrimination (ΔAUC = 0.082; P = 0.019), and reclassified 43% of the population (9% to higher and 34% to lower risk categories).

Conclusions

The authors propose a new risk stratification approach based on LGE features for assessing the risk of life-threatening ventricular arrhythmias in patients with biopsy-proven sarcoidosis.

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活检证实的结节病患者晚期钆增强分层心律失常风险的程度和特征

背景：心脏结节病的风险评估仍然具有挑战性。目的探讨心肌晚期钆增强（LGE）对结节病患者的预后价值。方法纳入324例经活检证实的结节病患者。分析了LGE的范围、模式和位置。主要终点是室性心动过速（VT）或心室颤动（VF）或适当的器械治疗。次要终点是因心力衰竭（HF）或心脏移植（HTx）住院和全因死亡率。结果在4.6年的随访中，30例患者（9.3%）达到了主要终点。HF/HTx发生15例（4.6%），全因死亡41例（12.7%）。LGE程度是主要终点的独立预测指标(每标准差变化：HR: 1.03 [95% CI: 1.00-1.06]；P = 0.047)，但与HF/HTx （P = 0.30）或全因死亡率（P = 0.50）无关。进一步观察LGE程度，右心室间隔LGE (HR: 5.43 [95% CI: 2.61-11.30]；P & lt;0.001)，右心室游离壁(HR: 4.30 [95% CI: 1.99-9.27]；P & lt;0.001)和多灶性LGE (HR: 4.62 [95% CI: 2.19-9.72]；P & lt;0.001)强烈预测心律失常终点。基于这些发现，我们提出了一种算法，该算法可识别4个患者亚组，并对活检证实的结节病患者的心律失常风险进行分层(累积事件发生率分别为1%、11%、23%和44%；卡方= 44.7；P = 1.084 × 10−9)。与Heart Rhythm Society分类系统相比，该方法显著提高了模型性能(卡方= 8.02；P = 0.046)和风险辨别(ΔAUC = 0.082；P = 0.019)，并将43%的人群重新分类（9%为高风险类别，34%为低风险类别）。结论作者提出了一种新的基于LGE特征的风险分层方法，用于评估活检证实的结节病患者发生危及生命的室性心律失常的风险。

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来源期刊

JACC. Cardiovascular imaging CARDIAC & CARDIOVASCULAR SYSTEMS-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

24.90

自引率

5.70%

发文量

330

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Imaging, part of the prestigious Journal of the American College of Cardiology (JACC) family, offers readers a comprehensive perspective on all aspects of cardiovascular imaging. This specialist journal covers original clinical research on both non-invasive and invasive imaging techniques, including echocardiography, CT, CMR, nuclear, optical imaging, and cine-angiography. JACC. Cardiovascular imaging highlights advances in basic science and molecular imaging that are expected to significantly impact clinical practice in the next decade. This influence encompasses improvements in diagnostic performance, enhanced understanding of the pathogenetic basis of diseases, and advancements in therapy. In addition to cutting-edge research,the content of JACC: Cardiovascular Imaging emphasizes practical aspects for the practicing cardiologist, including advocacy and practice management.The journal also features state-of-the-art reviews, ensuring a well-rounded and insightful resource for professionals in the field of cardiovascular imaging.