Serviço de Cardiologia Serviço de Cardiologia

Hospital de Santa MariaHospital de Santa MariaCentro Hospitalar Lisboa NorteCentro Hospitalar Lisboa Norte

Subclinical focal fibrosis and abnormal

strain in patients with sarcoidosis

without clinical evidence of cardiac

diseaseGustavo Lima Silva, MD, Ana G. Almeida, MD, PhD, Cláudio David, MD, Ana Rita Francisco, MD, Andreia Magalhães, MD, Rui Plácido, MD, Miguel Menezes, MD,Tatiana Guimarães, MD, Ana Cristina Mendes, MD, A. Nunes Diogo, MD

Cardiology Department

University Hospital Santa Maria/CHLN 

Faculty of Medicine of Lisbon University

• Cardiac involvement in sarcoidosis (SC) occurs in 20-25% of patients and is associated with poor outcome and reduced survival;

• The diagnosis of cardiac SC using conventional methods (including echocardiography) is challenging in asymptomatic patients.

BackgroundBackground

• To determine the role of cardiac magnetic resonance (CMR) in the diagnosis of subclinical cardiac SC in patients with pulmonary SC.

AimAim

• Prospective observational study

• Inclusion criteria:

Consecutive patients with pulmonary SC referred for CMR by a specialized SC clinic, with

pulmonary SC and absence of cardiovascular disease based on clinical data, normal ECG and

normal conventional echocardiography

A control group of 17 healthy individuals was included for myocardial deformation assessment

• Exclusion criteria:

1.Non sinus rhythm;

2.More than mild valvular disease;

3.Ischemic heart disease;

4.General contraindication to CMR and/or gadolinium administration.

MethodsMethods

• CMR - 3.0 Tesla, Phillips Achieva

a) CineCMR SSFP for LV and RV volumes and EF

b) T2-weighted imaging for myocardial edema

c) Late gadolinium enhancement

d) Tagging obtained in 4-chamber and 2-chamber planes longitudinal strain

evaluation

• CMR analysis - cmr42

• Statistical analysis - SPSS 20.0

MethodsMethods

RESULTSRESULTS• CMR data in the population of SC patients

• Focal LGE was found in the midwall and/or subepicardium of the basal septum and inferolateral

myocardial segments.

N 31

Age (years), mean±SD 50±14

Females, N (%) 15 (48)

LV EDV (ml/m2); mean±SD 72±11

EF (%); mean±SD 59±6

T2W increased intensity, N (%) 0 (0)

Presence of LGE, N (%) 9 (29)

SA image of LGE at the infero-lateral wall of a patient with sarcoidosis

2-chamber image of midwall LGE at the inferior wall and apical segment of a patient with sarcoidosis

RESULTSRESULTS

In 18 SC patients (9 patients focal LGE+, 9 LGE-) longitudinal strain values were abnormal, with a mean value of -13.5% ±1.2

• CMR longitudinal strain in the population of SC patients

Mean longitudinal strain % p

SC patients with LGE+ -11.6±1.1 0.003*

All SC patients -13,5±1.2 0.006**

Controls -18.0±1.1

* Patients with LGE vs all patients ** All patients vs controls

Serviço de Cardiologia Serviço de Cardiologia

Hospital de Santa MariaHospital de Santa MariaCentro Hospitalar Lisboa NorteCentro Hospitalar Lisboa Norte

• In patients with sarcoidosis, CMR showed subclinical cardiac involvement in a substantial proportion of patients.

• We found focal LGE and abnormal longitudinal strain in patients probably due to both focal and widespread myocardial disease

• The impact of these findings on the outcome is presently being assessed by our group.

ConclusionCardiology Department

University Hospital Santa Maria/CHLN 

Faculty of Medicine of Lisbon University