• Takayuki Ise, Takuya Hasegawa, Yoshiaki Morita, Naoaki Yamada, Akira Funada, Hiroyuki Takahama, Makoto Amaki, Hideaki Kanzaki, Hideo Okamura, Shiro Kamakura, Wataru Shimizu, Toshihisa Anzai, and Masafumi Kitakaze.
• Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
• Heart. 2014 Aug 1;100(15):1165-72.

BackgroundGadolinium-enhanced cardiovascular magnetic resonance is an emerging tool for the diagnosis of cardiac sarcoidosis (CS); however, the correlations between extent of late gadolinium enhancement (LGE) and efficacy of steroid therapy and adverse outcomes in patients with CS remain unclear.ObjectiveWe aimed to clarify the prognostic impact of extent of LGE in patients with CS.MethodsBefore the start of steroid therapy, 43 consecutive LGE-positive patients with CS were divided into two groups based on the extent of LGE by a median value: small-extent LGE (LGE mass <20% of LV mass; n=21) and large-extent LGE (LGE mass ≥20% of LV mass; n=22). We examined the correlations between extent of LGE and outcomes after steroid therapy.ResultsAmong the 6 patients who died from heart disorders, 11 patients who were hospitalised because of heart failure and 6 patients who suffered life-threatening arrhythmia during the follow-up period, large-extent LGE predicted higher incidences of cardiac mortality and hospitalisation for heart failure. Multivariate Cox regression analysis showed that large-extent LGE was independently associated with combined adverse outcomes including cardiac death, hospitalisation for heart failure, and life-threatening arrhythmias. In the small-extent LGE group, LV end-diastolic volume index significantly decreased and LVEF significantly increased after steroid therapy, whereas in the large-extent LGE group, neither LV volume nor LVEF changed substantially.ConclusionsLarge-extent LGE correlates with absence of LV functional improvement and high incidence of adverse outcomes in patients with CS after steroid therapy.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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