Specific locations of myocardial inflammation and fibrosis are associated with higher risk of events in cardiac sarcoidosis

Ana Devesa; Philip M Robson; Busra Cangut; Ravi Vazirani; Vittoria Vergani; Gina LaRocca; Angelica M Romero-Daza; Steve Liao; Lévi-Dan Azoulay; Renata Pyzik; Rima A Fayad; Adam Jacobi; Ronan Abgral; Adam S Morgenthau; Marc A Miller; Zahi A Fayad; Maria Giovanna Trivieri

doi:10.1016/j.hrthm.2024.09.011

Specific locations of myocardial inflammation and fibrosis are associated with higher risk of events in cardiac sarcoidosis

Heart Rhythm. 2024 Sep 10:S1547-5271(24)03301-0. doi: 10.1016/j.hrthm.2024.09.011. Online ahead of print.

Authors

Ana Devesa¹, Philip M Robson², Busra Cangut², Ravi Vazirani³, Vittoria Vergani⁴, Gina LaRocca⁵, Angelica M Romero-Daza⁶, Steve Liao⁵, Lévi-Dan Azoulay², Renata Pyzik², Rima A Fayad², Adam Jacobi⁷, Ronan Abgral⁸, Adam S Morgenthau⁹, Marc A Miller¹⁰, Zahi A Fayad², Maria Giovanna Trivieri¹¹

Affiliations

¹ BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York.
² BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
³ BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
⁴ School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
⁵ Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York.
⁶ Department of Cardiology, Hospital La Luz-Quirón Salud, Madrid, Spain.
⁷ Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York.
⁸ Department of Nuclear Medicine, UMR Inserm 1304 GETBO, University Hospital of Brest, Brest, France.
⁹ Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
¹⁰ Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York.
¹¹ BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: Mariagiovanna.trivieri@mountsinai.org.

PMID: 点击这里下载-->> 39260665
DOI: 点击这里下载-->> 10.1016/j.hrthm.2024.09.011

Abstract

Background: ¹⁸F-Fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography (PET)/magnetic resonance (MR) can identify inflammation and fibrosis, which are high-risk features in cardiac sarcoidosis.

Objective: The purpose of this study was to evaluate whether the involvement of certain myocardial segments is associated with higher risk compared to others.

Methods: One hundred twenty-four patients with suspected clinical sarcoidosis underwent ¹⁸F-FDG-PET/MR. Late gadolinium enhancement (LGE) and focal ¹⁸F-FDG uptake were evaluated globally and in the 16 myocardial segments. Presence of LGE was defined when the percentage of LGE exceeded 5.7% globally (relative to myocardial volume) and in each myocardial segment. Patients were followed up for 5.5 years. Events were defined as ventricular arrhythmia (VA) (including sustained ventricular tachycardia, ventricular fibrillation, and appropriate implantable cardioverter-defibrillator discharge), heart failure hospitalization, or all-cause death.

Results: Mean age was 57.1 ± 8.9 years, and 39.5% were female. Twenty-two patients (17.6%) had an event during follow-up, and 9 (7.2%) presented with VA. LGE and ¹⁸F-FDG uptake were more frequent in patients with than without events (36.4% vs 7.8%, P = .001). Presence of LGE and ¹⁸F-FDG in the basal anterior segment were independent predictors for events after adjustment for left ventricular ejection fraction and relative enhanced volume (LGE: odds ratio [1.2-92.4], P = .034;¹⁸F-FDG: odds ratio 5.5 [1.1-27.5], P = .038). LGE presence in basal to mid-anterior, mid-anteroseptal, and basal to mid-inferoseptal segments was an independent predictor of VA. Presence of ¹⁸F-FDG in basal to mid-anterior, mid-inferoseptal and mid-inferior segments was an independent predictor of VA.

Conclusion: Involvement of specific myocardial segments, particularly basal to mid-anterior and mid-septal segments, is associated with higher rates of events in patients with suspected cardiac sarcoidosis.

Keywords: Cardiac sarcoidosis; Fibrosis; Fluorodeoxyglucose positron emission tomography; Inflammation; Magnetic resonance imaging.