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Regional Myocardial Remodeling Characteristics Correlates With Cardiac Events in Sarcoidosis
Author(s) -
Lu Chenying,
Chen Jian,
Suksaranjit Promporn,
Menda Yusuf,
Adhaduk Mehul,
Jayanna Manju B.,
Scalzetti Ernest,
Ji Jiansong,
Wei Tiemin,
Feiglin David,
Liu Kan
Publication year - 2020
Publication title -
journal of magnetic resonance imaging
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.563
H-Index - 160
eISSN - 1522-2586
pISSN - 1053-1807
DOI - 10.1002/jmri.27057
Subject(s) - medicine , cardiology , clinical endpoint , interquartile range , ventricular remodeling , heart failure , interventricular septum , surrogate endpoint , univariate analysis , proportional hazards model , population , ventricle , multivariate analysis , clinical trial , environmental health
Background The poor prognosis of cardiac sarcoidosis (CS) underscores the need for risk stratification. Purpose To investigate the prognostic significance of ventricular/myocardial remodeling features in sarcoidosis. Study Type Retrospective. Population In all, 132 biopsy‐proven sarcoidosis patients imaged from 2008 to 2018. The primary endpoint was a composite of cardiac mortality, new onset arrhythmias, hospitalization for heart failure, and device implantation. Field Strength/Sequence No field strength or sequence restrictions. Assessment Global and regional ventricular/myocardial remodeling features were assessed by standard volumetric measurements and automated function imaging postprocessing analysis. Statistical Tests Student's t ‐test or Mann–Whitney test (chi 2 test or Fisher's exact test for categorical variables) were used for comparisons. Cox‐proportional hazards regression model, univariate /multivariate analyses, and receiver operating characteristic were performed to relate clinical/lab data, imaging parameters to the endpoints. Results Over a median follow‐up of 40.7 (interquartile range 18.8–60.5) months, 41 (31.1%) patients developed adverse cardiac events. Abnormal left ventricular (LV) geometric remodeling alterations (measured by LV mass index and relative wall thickness) occurred 3.66‐fold more frequently in patients with endpoints than patients without. The ratio of patients with endpoints increased as ventricular remodeling phenotype progressed. In patients with endpoints, regional myocardial wall thickness (RMWT) was significantly ( P = 0.022) increased in six clustered LV segments located in the middle interventricular septum and basal/middle anterolateral walls. In all of the abnormal ventricular remodeling stages, patients with endpoints constantly had higher mean RMWT than those without. Among clinical, electrocardiographic, and imaging parameters, LV mass index (hazard ratio [HR] 1.010 95% confidence interval [CI] 1.002–1.018, P = 0.017) and mean RMWT (HR 3.482 95% CI 1.679–7.223, P = 0.001) were independently associated with endpoints. Sarcoidosis patients without this RMWT distribution pattern were significantly ( P < 0.001) more likely to be free of the occurrence of subsequent cardiac events. Data Conclusion Regional myocardial remodeling characteristics are associated with subsequent adverse cardiac events in sarcoidosis. Level of Evidence 3 Technical Efficacy Stage 2 J. Magn. Reson. Imaging 2020;52:499–509.