Objective:
To assess myocardial mechanics by cardiac magnetic resonance (CMR)-derived strain in patients with biopsy-proven systemic sarcoidosis.
Methods:
We included 50 consecutive patients (age 51 ± 11 years old, 30 males) with biopsy-proven systemic sarcoidosis who underwent gadolinium-enhanced CMR for suspected cardiac sarcoid involvement. Late gadolinium enhancement (LGE) was considered positive if showing an intramyocardial/subepicardial location with a nonischemic pattern. From cine images and using dedicated software (TomTec©), we quantified mean left ventricular (LV) longitudinal, radial, and circumferential peak strains as the average of 16 standard myocardial segments. We also randomly selected from our database 15 control subjects without structural heart disease (age 41 ± 11 years old, 5 males).
Results:
Both mean longitudinal strain (LS) and LV ejection fraction (LVEF) were lower in sarcoid patients than controls (-11.8 ± 7.3% vs. -18.1 ± 3.9%, p55%, n=32) mean LS was reduced compared to controls (-12.2 ± 7.8% vs. -18.1 ± 3.9% respectively, p=0.01; Fig 1B). There was no correlation between LVEF and mean LS (r=-0.11, p=0.65). We found no significant differences in circumferential or radial strains.
LGE was present in 16 patients (32%). Sarcoid patients with LGE showed significantly less mean LS than those without (-8.5 ± 8.4% vs. -13.6 ± 6.4%, p<0.001; Fig 1A) although LVEF did not differ significantly (52% vs. 59%, p=0.35). No significant differences in circumferential or radial strains were found.
Conclusions:
In patients with systemic sarcoidosis, evaluation of cardiac mechanics with CMR detects myocardial dysfunction even in the presence of preserved LVEF. This is more pronounced in patients with positive LGE. The potential diagnostic and prognostic significance of CMR-derived myocardial strain in sarcoidosis deserves further investigation.
RARE EXPRESSION OF SYSTEMIC SARCOIDOSIS AFTER A NOVEL RNA VACCINE
