TY - JOUR
T1 - Prediction of ventricular arrhythmic outcomes in suspected cardiac sarcoidosis
T2 - a comparison of cardiovascular magnetic resonance phenotyping vs. societal recommendations for implantable cardioverter-defibrillator placement
AU - Mathijssen, Harold
AU - Bawaskar, Parag H
AU - Rochlani, Yogita
AU - Georgy, Issac
AU - Athwal, Pal Satyajit Singh
AU - Guo, Yugene
AU - Pollmann, Daniel
AU - Markowitz, Jeremy
AU - Von Wald, Lisa
AU - Roukoz, Henri
AU - Perlman, David
AU - Bhargava, Maneesh
AU - Slipczuk, Leandro
AU - Filtz, Annalisa
AU - Ramos, Julio Andres Ovalle
AU - Samant, Saurabhi
AU - Chhikara, Sanya
AU - Castagna, Francesco
AU - Veltkamp, Marcel
AU - Akdim, Fatima
AU - Bakker, Annelies L M
AU - Post, Marco C
AU - Shenoy, Chetan
N1 - Publisher Copyright:
© 2025 The Author(s). Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site - for further information please contact [email protected].
PY - 2025/9/21
Y1 - 2025/9/21
N2 - BACKGROUND AND AIMS: Implementing societal recommendations for primary prevention implantable cardioverter-defibrillators (ICDs) in cardiac sarcoidosis requires an accurate diagnosis. However, cardiac sarcoidosis diagnostic schemes are inconsistent and often produce conflicting results. This study aimed to compare the discriminative accuracy of cardiovascular magnetic resonance imaging (CMR) phenotyping with the societal recommendations for predicting long-term ventricular arrhythmic outcomes in patients with suspected cardiac sarcoidosis, regardless of their diagnostic status.METHODS: This multicentre study included patients with histology-supported sarcoidosis who underwent CMR for suspected cardiac involvement and were ineligible for secondary prevention ICDs. The study outcome was a composite of fatal or life-threatening ventricular arrhythmias. Outcomes were compared based on eligibility for ICDs by societal recommendations and CMR phenotyping.RESULTS: Among 1514 patients, 84 experienced the study outcome during a median follow-up of 4.5 years and a maximum follow-up of 10 years. The high-risk CMR phenotype was associated with higher 5- and 10-year incidences of the outcome (24.0% and 35.0%, respectively) compared with those who met societal recommendations. Patients with low-risk phenotypes had lower incidences (0.7% and 2.6%). Cardiovascular magnetic resonance imaging phenotyping outperformed societal recommendations in discriminative accuracy, with areas under the curve of 0.861 and 0.776 for 5- and 10-year outcomes, respectively. Additionally, CMR phenotyping had the highest adjusted subdistribution hazard ratio (19.8) for the study outcome.CONCLUSIONS: In patients with suspected cardiac sarcoidosis, CMR phenotyping showed greater discriminative accuracy than societal recommendations for predicting fatal or life-threatening ventricular arrhythmias, suggesting that it may be more effective at identifying candidates for primary prevention ICDs.
AB - BACKGROUND AND AIMS: Implementing societal recommendations for primary prevention implantable cardioverter-defibrillators (ICDs) in cardiac sarcoidosis requires an accurate diagnosis. However, cardiac sarcoidosis diagnostic schemes are inconsistent and often produce conflicting results. This study aimed to compare the discriminative accuracy of cardiovascular magnetic resonance imaging (CMR) phenotyping with the societal recommendations for predicting long-term ventricular arrhythmic outcomes in patients with suspected cardiac sarcoidosis, regardless of their diagnostic status.METHODS: This multicentre study included patients with histology-supported sarcoidosis who underwent CMR for suspected cardiac involvement and were ineligible for secondary prevention ICDs. The study outcome was a composite of fatal or life-threatening ventricular arrhythmias. Outcomes were compared based on eligibility for ICDs by societal recommendations and CMR phenotyping.RESULTS: Among 1514 patients, 84 experienced the study outcome during a median follow-up of 4.5 years and a maximum follow-up of 10 years. The high-risk CMR phenotype was associated with higher 5- and 10-year incidences of the outcome (24.0% and 35.0%, respectively) compared with those who met societal recommendations. Patients with low-risk phenotypes had lower incidences (0.7% and 2.6%). Cardiovascular magnetic resonance imaging phenotyping outperformed societal recommendations in discriminative accuracy, with areas under the curve of 0.861 and 0.776 for 5- and 10-year outcomes, respectively. Additionally, CMR phenotyping had the highest adjusted subdistribution hazard ratio (19.8) for the study outcome.CONCLUSIONS: In patients with suspected cardiac sarcoidosis, CMR phenotyping showed greater discriminative accuracy than societal recommendations for predicting fatal or life-threatening ventricular arrhythmias, suggesting that it may be more effective at identifying candidates for primary prevention ICDs.
KW - Cardiac sarcoidosis
KW - Cardiovascular magnetic resonance imaging
KW - ICD decision-making
KW - Primary prevention
KW - Risk stratification
UR - https://www.scopus.com/pages/publications/105016645099
U2 - 10.1093/eurheartj/ehaf338
DO - 10.1093/eurheartj/ehaf338
M3 - Article
C2 - 40400457
SN - 0195-668X
VL - 46
SP - 3583
EP - 3596
JO - European heart journal
JF - European heart journal
IS - 36
ER -