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Methods 96 consecutive patients with sarcoidosis were referred to our centre for CMR between 2002 and 2007 (46 M, 50 F; mean age 57 years). Outcomes in two cohorts distinguished by evidence of LGE were retrospectively assessed (mean follow-up 3.5 years). Left ventricular (LV) volumes, ejection fraction (EF) and mass were evaluated using semi-automated analysis software and indexed to body surface area. Continuous variables were reported as mean ± standard deviation; groups (based on the presence or absence of LGE) were compared using a t-test or Fisher's exact test. Results LGE was observed in 31 out of 96 (32%) patients. No significant difference was seen in all-cause death or hospitalisation for a cardiovascular event between the LGE+ and LGEcohort. The LGE+ cohort had a significantly greater rate of ICD implantation (7 vs 1, p < 0.0005) and appropriate ICD discharge (4 vs 0, p < 0.005). Notably, only four patients had right ventricular LGE+; all required defibrillator (ICD) implantation and sustained appropriate ICD discharge. There was no difference in other secondary outcomes such as pre-ICD implantation sustained ventricular tachycardia, pacemaker implantation rate or escalation of heart failure therapy. Amongst LGE+ individuals, there was a significant reduction in biventricular EF (LVEF 50 ± 13.0% vs. 64 ± 10%, p < 0.05; RVEF 49 ± 13 vs. 58 ± 9%, p < 0.05). RVEDV was also significantly greater (173 ± 14 vs.137 ± 5 mls, p < 0.0065), although not LVEDV (105 ± 5.9 vs. 132 ± 7.9 mls, p < 0.0066). The distribution of LGE did not appear to correlate with outcome. The two groups did not differ in the incidence of biopsy-proven sarcoidosis (48/96 cases), pre-referral cardiac symptoms or duration of follow-up. Within this cohort, only five patients had STIR imaging clearly suggestive of active cardiac sarcoidosis.

Late gadolinium enhancement in cardiac sarcoidosis predicts ICD implantation and appropriate discharge