Abstract
Background: Although the combined assessment of late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) and 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) was useful for the detection of cardiac sarcoidosis (CS), its prognostic value remains unclear. Methods: We examined 90 consecutive CS patients diagnosed by both CMR and FDG-PET before prednisolone (PSL) therapy between September 2008 and April 2023 in our hospital. We calculated the overlap rate of FDG uptake area in the LGE-positive area to evaluate the association between concordance of FDG/LGE areas and adverse events. Patients were divided into two groups according to the median concordance ratio (overlap rate) between FDG and LGE areas (70 %). The primary outcome was a composite of sustained ventricular tachycardia/fibrillation (VT/VF), worsening heart failure, and sudden cardiac death. Results: Median interval between CMR and FDG-PET was 6.5 (IQR 3.0-24.0) days. There are no significant differences on age, sex, left ventricular ejection fraction (LVEF), brain natriuretic peptide (BNP) level, and extent of LGE between the groups. During a median follow-up period of 3.2 (IQR 1.0-6.2) years, the primary outcome occurred in 25 (28%) patients. Patients with lower concordance showed a higher incidence of the primary outcome (Figure A), and lower improvement in LVEF after PSL therapy (Figure B) compared to those with higher concordance. In multivariable Cox regressions, lower concordance was significantly associated with the primary outcome adjusted for history of VT/VF (HR 7.37, P = 0.001), LVEF (HR 7.75, P = 0.001), log BNP (HR 5.62, P = 0.006), and extent of LGE (HR 11.75, P = 0.017). Conclusions: Lower concordance ratio of FDG/LGE before PSL therapy was associated with higher incidence of adverse events and lower improvement of LVEF. Assessment of active inflammation in the extent of LGE might be useful for risk stratification and prediction of the response to PSL in patients with CS.
Published Version
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