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Published on: May 22, 2018
Electrophysiology study for risk stratification in patients with cardiac sarcoidosis and abnormal cardiac imaging
David R Okada1, John Smith1, Arsalan Derakhshan1
1Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, United States of America.
Insights
Electrophysiology study (EPS) effectively predicts ventricular arrhythmias (VA) in cardiac sarcoidosis (CS) patients with abnormal imaging. A negative EPS is valuable for risk stratification, especially in those with preserved ejection fraction.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Imaging
Background:
- Cardiac sarcoidosis (CS) diagnosis relies on clinical findings, cardiac imaging (CMR/PET), and electrophysiology studies (EPS).
- Ventricular arrhythmias (VA) are a significant risk in CS patients, necessitating accurate risk stratification.
- Existing predictors of VA in CS include cardiac magnetic resonance imaging (CMR), positron emission tomography (PET), left ventricular ejection fraction (LVEF), and EPS.
Purpose of the Study:
- To evaluate the utility of EPS in predicting VA in CS patients with abnormal cardiac imaging.
- To specifically assess EPS performance in CS patients with preserved LVEF (>35%) and no prior VA.
Main Methods:
- Retrospective analysis of 25 CS patients (2000-2017) with abnormal CMR (late gadolinium enhancement) or PET (FDG uptake) who underwent EPS.
- Primary endpoint: occurrence of VA during follow-up.
- Subgroup analysis of patients with LVEF >35% and no history of VA.
Main Results:
- 10 (40%) patients had positive EPS; 11 (44%) experienced VA during a mean 4.8-year follow-up.
- EPS demonstrated a 100% positive predictive value (PPV) and 93% negative predictive value (NPV) for VA.
- In patients with LVEF >35% and no prior VA, EPS showed 100% PPV and 90% NPV for future VA events.
Conclusions:
- EPS is a valuable tool for risk stratification in CS patients with abnormal cardiac imaging, particularly those not meeting standard ICD criteria.
- A negative EPS result provides significant reassurance regarding future VA events in CS patients with preserved LVEF and no prior VA history.
Background:
Abnormalities on cardiac imaging (cardiac magnetic resonance imaging [CMR] or positron emission tomography [PET]), left ventricular ejection fraction (LVEF), and electrophysiology study (EPS) all predict ventricular arrhythmias (VA) in patients with cardiac sarcoidosis (CS). We sought to assess the utility of EPS in patients with CS and abnormal cardiac imaging, focusing on those with LVEF >35%.
Methods:
We identified all patients treated at our institution from 2000 to 2017 who: 1.) had probable or definite CS; 2.) had either late gadolinium enhancement (LGE) on CMR or abnormal 18-flourodeoxyglucose (FDG) uptake on PET, and 3.) had undergone EPS. The primary endpoint was VA during follow up.
Results:
Twenty five patients were included, of whom 10 (40%) had positive EPS. During a mean follow-up of 4.8 +/- 3.4 years, 11 (44%) patients had VA. The positive predictive value (PPV) of EPS for VA was 100% and the negative predictive value (NPV) of EPS for VA was 93%. Among 12 patients with LVEF >35% and no prior VA, the PPV of EPS for VA was 100% and the NPV of EPS for VA was 90%.
Conclusion:
EPS may help with risk stratification in patients with CS and abnormal imaging, especially those without conventional indications for ICD placement. Among patients with LVEF >35% and no history of prior VA, a negative EPS has good positive and negative predictive value for future VA events.
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