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Meta-Analysis
. 2016 Sep;9(9):e005001.
doi: 10.1161/CIRCIMAGING.116.005001.

Presence of Late Gadolinium Enhancement by Cardiac Magnetic Resonance Among Patients With Suspected Cardiac Sarcoidosis Is Associated With Adverse Cardiovascular Prognosis: A Systematic Review and Meta-Analysis

Edward Hulten  1 , Vikram Agarwal  1 , Michael Cahill  1 , Geoff Cole  1 , Tomas Vita  1 , Scott Parrish  1 , Marcio Sommer Bittencourt  1 , Venkatesh L Murthy  1 , Raymond Kwong  1 , Marcelo F Di Carli  1 , Ron Blankstein  2
Affiliations
Meta-Analysis

Presence of Late Gadolinium Enhancement by Cardiac Magnetic Resonance Among Patients With Suspected Cardiac Sarcoidosis Is Associated With Adverse Cardiovascular Prognosis: A Systematic Review and Meta-Analysis

Edward Hulten et al. Circ Cardiovasc Imaging. 2016 Sep.

Abstract

Background: Individuals with cardiac sarcoidosis have an increased risk of ventricular arrhythmia and death. Several small cohort studies have evaluated the ability of late gadolinium enhancement (LGE) by cardiac magnetic resonance imaging (MRI) to predict adverse cardiovascular events. However, studies have yielded inconsistent results, and some analyses were underpowered. Therefore, we sought to systematically review and perform meta-analysis of the prognostic value of cardiac MRI for patients with known or suspected cardiac sarcoidosis.

Methods and results: We systematically searched for cohort studies of patients with known sarcoidosis with suspected cardiac involvement who underwent cardiac MRI with LGE with at least 12 months of either prospective or retrospective follow-up data regarding post-MRI adverse cardiovascular outcomes. We identified 7 studies of 694 subjects (mean age 53; 42% men).One hundred and ninety-nine patients (29%) were LGE positive. All-cause mortality occurred in 19 LGE-positive versus 17 LGE-negative subjects (annualized incidence, 3.1% versus 0.6%). The pooled relative risk was 3.38 (95% confidence interval, 1.07-10.7; P=0.04). Cardiovascular mortality occurred in 10 LGE-positive versus 2 LGE-negative subjects (annualized incidence, 1.9% versus 0.3%; relative risk 10.7 [95% confidence interval, 1.34-86.3]; P=0.03). Ventricular arrhythmia occurred in 41 LGE-positive versus 0 LGE-negative subjects (annualized incidence, 5.9% versus 0%; relative risk 19.5 [95% confidence interval, 2.68-143]; P=0.003). A combined end point of death or ventricular arrhythmia occurred in 64 LGE-positive versus 18 LGE-negative subjects (annualized incidence, 8.8% versus 0.6%; relative risk 6.20 [95% confidence interval, 2.47-15.6]; P<0.001). There was no significant heterogeneity for any outcomes.

Conclusions: LGE is associated with future cardiovascular death and ventricular arrhythmia among patients referred to MRI for known or suspected cardiac sarcoidosis.

Keywords: cardiac arrhythmia; cardiomyopathies; heart conduction system; magnetic resonance imaging; sarcoidosis.

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Figures

Figure 1
Figure 1
Literature search results. PET indicates positron emission tomography.
Figure 2
Figure 2
Annualized event rates according to late gadolinium enhancement (LGE) positive vs negative. CV indicates cardiovascular.
Figure 3
Figure 3
Pooled relative risk (RR) for all-cause mortality according to late gadolinium enhancement (LGE) positive vs negative. CI indicates confidence interval and MRI, magnetic resonance imaging.
Figure 4
Figure 4
Pooled relative risk (RR) for cardiovascular mortality according to late gadolinium enhancement (LGE) positive vs negative. CI indicates confidence interval and MRI, magnetic resonance imaging.
Figure 5
Figure 5
Pooled relative risk (RR) for ventricular arrhythmia according to late gadolinium enhancement (LGE) positive vs negative. CI indicates confidence interval and MRI, magnetic resonance imaging.
Figure 6
Figure 6
Pooled relative risk (RR) for combined death or ventricular arrhythmia according to late gadolinium enhancement (LGE) positive vs negative. CI indicates confidence interval and MRI, magnetic resonance imaging.
See this image and copyright information in PMC

Comment in

References

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