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Comprehensive Cardiovascular Magnetic Resonance Assessment in Patients With Sarcoidosis and Preserved Left
Simon Greulich1, Daniel Kitterer1, Joerg Latus1
1From the Division of Cardiology (S.G., H.S., P.K., A.P., U.S., H.M.) and Division of Nephrology, Department of Internal Medicine (D.K., J.L., N.B., M.D.A.), Robert-Bosch-Medical Center Stuttgart, Germany; Philips Medical Solutions, Best, The Netherlands (E.A.); Siemens Healthcare GmbH, Erlangen, Germany (A.G., S.G.); and Division of Radiology, University Hospital Innsbruck, Austria (A.M.).
Insights
New cardiovascular magnetic resonance mapping techniques show promise for diagnosing cardiac sarcoidosis (CS) in patients with preserved ejection fraction. These advanced techniques detect differences in T1 and T2 values, potentially identifying CS earlier than traditional methods.
Area of Science:
- Cardiology
- Medical Imaging
- Sarcoidosis Research
Background:
- Cardiac sarcoidosis (CS) presents diagnostic challenges due to nonspecific symptoms and normal cardiac function.
- Existing diagnostic tools like late gadolinium enhancement (LGE) have limitations in detecting early-stage CS.
- A need exists for advanced cardiovascular magnetic resonance (CMR) techniques to improve CS diagnosis.
Purpose of the Study:
- To evaluate a comprehensive CMR protocol, including LGE and novel mapping sequences.
- To assess the diagnostic utility of these techniques in sarcoidosis patients with preserved left ventricular ejection fraction (LVEF) and subtle symptoms.
Main Methods:
- Prospective enrollment of 61 sarcoidosis patients and 26 healthy controls.
- Utilized a comprehensive CMR protocol featuring LGE and T1/T2 mapping sequences.
- Analyzed native T1, post-contrast T1, extracellular volume (ECV), and T2 values.
Main Results:
- Sarcoidosis patients exhibited significantly higher native T1, expanded ECV, and higher T2 values compared to controls.
- LGE was present only in sarcoidosis patients, but mapping techniques revealed significant differences even in LGE-negative cases.
- Native T1 and T2 values showed the most significant differences between groups.
Conclusions:
- Advanced CMR mapping techniques, particularly native T1 and T2, can identify myocardial tissue changes in sarcoidosis patients.
- These findings suggest potential for earlier CS diagnosis, even in patients with preserved LVEF and no LGE.
- Further research is needed to establish the clinical significance of these mapping techniques for early CS diagnosis and treatment.
Background:
Cardiac sarcoidosis (CS) may manifest as arrhythmia or even sudden cardiac death. Because patients with CS often present with nonspecific symptoms, normal electrocardiography, and preserved left ventricular ejection fraction, a reliable diagnostic tool for the work-up of CS is needed. Late gadolinium enhancement-cardiovascular magnetic resonance has proven diagnostic value in CS but has some limitations that may be overcome by adding newer cardiovascular magnetic resonance mapping techniques. The aim of our study was to evaluate a comprehensive cardiovascular magnetic resonance protocol, including late gadolinium enhancement and mapping sequences in sarcoid patients with no symptoms or unspecific symptoms and preserved left ventricular ejection fraction.
Methods And Results:
Sixty-one sarcoid patients were prospectively enrolled and underwent comprehensive cardiovascular magnetic resonance imaging. Twenty-six healthy volunteers served as control group. Mean left ventricular ejection fraction was 65%; late gadolinium enhancement was only present in sarcoid patients (n=15). Sarcoid patients had a higher median native T1 (994 versus 960 ms; P<0.001), lower post contrast T1 (491 versus 526 ms; P=0.001), expanded extracellular volume (28 versus 25%; P=0.001), and higher T2 values (52 versus 49 ms; P<0.001) compared with controls. Among patients with values higher than the 95% percentile of healthy controls, most significant differences were observed for native T1 and T2 values. Most of these patients were late gadolinium enhancement negative.
Conclusions:
Patients with sarcoidosis demonstrate higher T1, extracellular volume, and T2 values compared with healthy controls, with most significant differences for native T1 and T2. While promising, the clinical significance of the newer mapping techniques with respect to early diagnosis and therapy of CS will have to be determined in future studies.
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