Abstract 10664: Quantitative T2 Mapping to Diagnose Cardiac Sarcoidosis and Predict Incident Heart Failure

Abstract

Introduction/Hypothesis: Myocardial native T2 quantification using cardiac magnetic resonance (CMR) may be helpful to diagnose active cardiac sarcoidosis and predict prognosis without the need for IV gadolinium. Methods: At a large academic institution, 66 consecutive patients with biopsy-proven pulmonary sarcoidosis underwent CMR for evaluation of active cardiac sarcoidosis (CS) from January 2017 to January 2020. Of these, 56 patients were identified who fit inclusion criteria. Active clinical CS was defined according to the Japanese Ministry of Health and Welfare criteria for diagnosis of CS. Quantitative T2 mapping of all AHA myocardial segments was evaluated and incident heart failure (HF) was recorded. A power calculation was performed beforehand which suggested n > 50 was adequate. Results: The best fit model to identify active clinical CS was the mean T2 value of the basal segments (AUC 0.902, 95% CI 0.821-0.983; see Figure 1). Mean basal T2 >51 ms was the optimal cutoff with accuracy of 91.1%, sensitivity of 71.4%, and specificity of 97.6%. T2 >49 ms was the most sensitive cutoff (92.9%) with a negative predictive value of 96.2%. The best fit model to predict incident HF was the average T2 value of the basal segments (AUC 0.830, 95% 0.702-0.959). For every 1 ms increase in T2 value, there was a 41% increased risk for incident HF (odds ratio 1.41 95% CI 1.12-1.92, p=0.013). Conclusion: Measurement of mean basal myocardial T2 values efficiently identified patients with active clinical cardiac sarcoidosis and predicted incident heart failure. Quantitative T2 mapping is highly sensitive and specific for the diagnosis.