Cardiovascular magnetic resonance-guided diagnosis of cardiac affection in a Caucasian sarcoidosis population

Background: Clinically evidenced cardiac involvement in systemic sarcoidosis occurs in approximately  5% of patients, whereas post-mortem examinations identify cardiac sarcoidosis in over 60% of cases. Objective:  Given the inconsistency of diagnostic approaches, we took aim at prospectively investigating the prevalence of  cardiac sarcoidosis by cardiovascular magnetic resonance (CMR) in a primary Caucasian population and at correlating  the results with standard clinical parameters. Methods: 188 patients with histologically proven sarcoidosis  were included, provenient from the local pneumological department and a national sarcoidosis self-help association.  All of them underwent CMR-imaging. Complementary 12-lead ECG, Holter monitoring, laboratory  and pulmonary function testing were performed. Results: CMR-based diagnosis of cardiac sarcoidosis was  made in 29 patients (15.4%), of whom 17 patients (9% of total cohort) exhibited increased relative gadolinium  enhancement – reflecting acute inflammatory processes -, while 11 patients (5.9% of total cohort) showed late  gadolinium enhancement as a marker for nonviable tissue damage. Both abnormalities were present in 1 patient  (0.5%). Correlation analysis evinced significant association between CMR-diagnosed cardiac sarcoidosis and reduction  in LVEF, increase in diastolic interventricular septal thickness, diastolic dysfunction as well as limited  electrocardiographic abnormalities. Neither laboratory values nor pulmonary function parameters correlated with  presence or activity of cardiac sarcoidosis. Conclusions: Among our predominantly Caucasian sarcoidosis study  population, CMR-detected cardiac affection occurred in 15.4% and was missed by internationally valid standard  clinical testing in all but one case. It reinforces CMR’s diagnostic value as modality of choice to evaluate cardiac  sarcoidosis. The estimation of its prognostic potential and its value in assessing the incidence of cardiac sarcoidosis  however requires further longitudinal investigation. (Sarcoidosis Vasc Diffuse Lung Dis 2015; 32: 325-335)