sarcoidosis CLINICAL PERSPECTIVE
Patients with cardiac sarcoidosis are at risk of ventricular arrhythmias and death, leading to a class IIa indication for implantable cardioverter defibrillator implantation according to expert consensus in the ACC/AHA/HRS guidelines for prevention of sudden cardiac death. However, implantable cardioverter defibrillators are associated with life-long device-related morbidity and may not be beneficial in many patients, especially those with relatively preserved left ventricular function. The relation of scar burden assessed from delayed gadolinium enhancement (DE) on cardiac MRI to ventricular tachycardia (VT) and mortality was studied in 51 patients with cardiac sarcoidosis and left ventricular ejection fraction of >35%. Among 40 patients with no prior history of VT, 3 developed VT and 2 died; all but 1 had DE, and the extent and right ventricular DE appeared to be associated with greatest risk. All patients with a history of VT had DE and 10 of 11 had recurrent VT. The presence of a low scar burden determined by DE was not associated with adverse outcomes. These findings suggest that DE-MRI may be useful for risk stratification in patients with cardiac sarcoidosis.
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With that latest indication (Sarcoidosis), they clearly now have 2 solid selling arguments in our favors to have cardiology sites buy their technology:
- MRI equivalent accuracy for the whole heart
- ability to diagnose Sarcoidosis
That should sells like hotcakes.
This 2014 paper showed that back then, they had to rely on MRI for patients with Sacroidosis condition. Knowing that we have MRI-equivalent accuracy and that are operational costs are much lower ... investing in VPT technology sounds like a no-brainer.
Magnetic Resonance Imaging for Identifying Patients With Cardiac Sarcoidosis and Preserved or Mildly Reduced Left Ventricular Function at Risk of Ventricular Arrhythmias
2014
Background—The purpose of this study was to assess whether delayed enhancement (DE) on MRI is associated with ventricular tachycardia (VT)/ventricular fibrillation or death in patients with cardiac sarcoidosis and left ventricular ejection fraction >35%.
Methods and Results—Fifty-one patients with cardiac sarcoidosis and left ventricular ejection fraction >35% underwent DE-MRI. DE was assessed by visual scoring and quantified with the full-width at half-maximum method. The patients were followed for 48.0±20.2 months. Twenty-two of 51 patients (63%) had DE. Forty patients had no prior history of VT (primary prevention cohort). Among those, 3 patients developed VT and 2 patients died. DE was associated with risk of VT/ventricular fibrillation or death (P=0.0032 for any DE and P<0.0001 for right ventricular DE). The positive predictive values of the presence of any DE, multifocal DE, and right ventricular DE for death or VT/ventricular fibrillation at mean follow-up of 48 months were 22%, 48%, and 100%, respectively. Among the 11 patients with a history of VT before the MRI, 10 patients had subsequent VTs, 1 of whom died.
Conclusions—RV DE in patients with cardiac sarcoidosis is associated with a risk of adverse events in patients with cardiac sarcoidosis and preserved ejection fraction in the absence of a prior history of VT. Patients with DE and a prior history of VT have a high VT recurrence rate. Patients without DE on MRI have a low risk of VT. (Circ Arrhythm Electrophysiol. 2014;7:1109-1115.)
MRI and Outcomes in Cardiac Sarcoidosis
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Methods:
Multicenter Registry for Cardiac Sarcoidosis:
A multicenter registry for the purpose of research collaboration of this rare disease was established, with the University of Michigan serving as the coordinating center for this study
Cardiac MRI:
All patients underwent cardiac MRI ...
Data Analysis:
All DE-MRI images were analyzed off-line
AI
