Agoston-Coldea Lucia, Kouaho Sylvain, Sacre Karim, Dossier Antoine, Escoubet Brigitte, Chillon Sylvie, Laissy Jean-Pierre, Rouzet François, Kutty Shelby, Extramiana Fabrice, Leenhardt Antoine, Borie Raphael, Crestani Bruno, Ou Phalla
Service de Radiologie, Hopital Bichat, APHP, University Paris Diderot, France.
Service de Médecine Interne, Hopital Bichat, APHP, University Paris Diderot, France.
Int J Cardiol. 2016 Nov 1;222:950-956. doi: 10.1016/j.ijcard.2016.07.233. Epub 2016 Jul 30.
Cardiac involvement is the most important cause of mortality in patients with systemic sarcoidosis. Late gadolinium enhancement (LGE) on cardiovascular magnetic resonance imaging (CMR) has been shown to be a predictor of major cardiovascular adverse events (MACE) in the setting of systemic sarcoidosis. We sought to evaluate the relationship between LGE mass and adverse long-term outcome in patients with biopsy-proven extracardiac sarcoidosis.
Between 2001 and 2013, 197 consecutive patients with suspected cardiac sarcoidosis were identified in our institution database. Of them, 56 patients have had biopsy-proven extracardiac sarcoidosis and represented our studied population. Patients were divided into two groups based on LGE mass by a median value (mild LGE<18g, high LGE>18g) for comparison of MACE.
Twenty-eight patients had a high mass of LGE. Of them, 15 (54%) experienced MACE (OR=31.15, 95% CI 3.7-262). Except for 1 patient, no patient with mild LGE presented with any MACE during follow-up (median of 32months). Patients with high LGE had lower CMR-derived left (53.6±14.9 vs. 62.2±6.7, p<0.01) and right (49.1±11.5 vs. 56.4±9.2, p<0.05) ventricular ejection fractions. LGE mass of 18g discriminated patients with and without MACE (93% sensitivity, 88% specificity, AUC=0.972). LGE mass was the only independent predictor of MACE on multivariate Cox analysis adjusted (OR=1.7, 95% CI 1.06 to 2.72, p=0.03).
In biopsy-proven extracardiac sarcoidosis patients, a high mass of LGE >18g was associated with MACE.
心脏受累是系统性结节病患者死亡的最重要原因。心血管磁共振成像（CMR）上的延迟钆增强（LGE）已被证明是系统性结节病患者主要心血管不良事件（MACE）的预测指标。我们试图评估活检证实的心脏外结节病患者中LGE质量与不良长期预后之间的关系。
2001年至2013年期间，在我们机构的数据库中识别出197例连续的疑似心脏结节病患者。其中，56例患者经活检证实患有心脏外结节病，构成了我们的研究人群。根据LGE质量的中位数将患者分为两组（轻度LGE<18g，重度LGE>18g），以比较MACE。
28例患者有大量LGE。其中，15例（54%）发生MACE（OR=31.15，95%CI 3.7-262）。除1例患者外，轻度LGE患者在随访期间（中位时间32个月）均未出现任何MACE。重度LGE患者的CMR衍生左心室射血分数（53.6±14.9对62.2±6.7，p<0.01）和右心室射血分数（49.1±11.5对56.4±9.2，p<0.05）较低。18g的LGE质量可区分有和无MACE的患者（敏感性93%，特异性88%，AUC=0.972）。在多变量Cox分析调整后，LGE质量是MACE的唯一独立预测因子（OR=1.7，95%CI 1.06至2.72，p=0.03）。
在活检证实的心脏外结节病患者中，大量LGE>18g与MACE相关。
