Oral Abstract Session
SCMR 22nd Annual Scientific Sessions
Shiro Nakamori, MD
Research fellow
Beth Israel Deaconess Medical Center
Ulf Neisius, MD, PhD
Research Fellow
Beth Israel Deaconess Medical Center and Harvard Medical School
Maryam Nezafat, PhD
Research Fellow
Beth Israel Deacones Medical Center
Jihye Jang, MSc
Research Fellow
Beth Israel Deaconess Medical Center and Harvard Medical School
Long Ngo, PhD
Associate professor
Beth Israel Deaconess Medical Center
Warren Manning, MD
Professor
Beth Israel Deaconess Medical Center
Reza Nezafat, PhD
Associate Professor of Medicine
Department of Medicine (Cardiovascular Division) Beth Israel Deaconess Medical Center
Background: The accurate diagnosis of cardiac sarcoidosis (CS) remains challenging; cardiovascular magnetic resonance (CMR) based myocardial tissue characterization may provide incremental information for improved non-invasive diagnosis of subclinical and overt CS. We sought to characterize the myocardial tissue composition in systemic sarcoidosis patients with and without CS using CMR whole-heart myocardial native T1 and T2 mapping and investigate the association of native T1 and T2 with myocardial strain and electrocardiogram (ECG).
Methods: Fifty-eight consecutive patients with biopsy-proven systemic sarcoidosis and clinical suspicion of CS and 58 age-gender matched control subjects were studied. Cine, late gadolinium enhancement CMR, and whole-heart T1 and T2 mapping were performed at 1.5T [1,2]. Cardiac involvement was considered as positive if >2SD from the mean native T1 and T2 in the controls using 16-segment model. Left ventricular global longitudinal strain (LV GLS) was determined by CMR feature tracking.
Results:
Based on the HRS Expert Consensus Statement, 48 patients (83%) were identified without CS. Non CS patients had higher global native T1 and T2 compared with healthy controls (1082 ± 32, 52 ± 6 ms vs. 1064 ± 22, 46 ± 3 ms, p<0.05 for both). In non CS patients, global native T1was lower than that in CS patients (p=0.004) with similar T2 (p=0.61). Cardiac involvement was predominantly localized in the basal slice in systemic sarcoidosis irrespective of patients with and without CS. (native T1; 50%, and T2; 44%). Global T2 but not T1increase correlated well with impaired LV GLS (r=0.53, p<0.05) and predicted PR and QRS interval prolongation on the follow-up ECG in non CS (r=0.44 and 0.40, both p<0.05).
Conclusion:
Global T2 was associated with subclinical LV systolic dysfunction and adverse electrical remodeling in non CS. Whole-heart T2 mapping may be useful to identify patients with early stages of CS before the development of myocardial scarring. Future studies are warranted to confirm whether early diagnosis, and medical treatment based on native T1 and T2 parameters can provide better risk stratification beyond the current guidelines.