Abstract 18780: Prognostic Value of Cardiovascular Magnetic Resonance Feature Tracking Strain in Patients With Suspected Cardiac Sarcoidosis

Abstract

Background: Cardiac sarcoidosis (CS) is associated with a high risk of ventricular arrhythmia (VA) and heart failure (HF). Cardiovascular magnetic resonance imaging (CMR) is often used for the diagnosis and prognostication of suspected CS. Small studies have shown promise for ventricular strain as a marker of adverse outcomes in suspected CS. Aim: We aimed to investigate the prognostic value of CMR global longitudinal strain (GLS) in patients with suspected CS. Methods: Using a retrospective cohort design, we studied consecutive patients with histologically proven sarcoidosis who underwent CMR for the evaluation of suspected CS from 2004 to 2021. Feature-tracking GLS was assessed for the left and right ventricles (LV and RV). Kaplan-Meier and Cox proportional hazards regression analyses were used to determine the association between GLS, and VA and HF composite endpoints. Results: Among 557 patients (mean age 54 years, 47% women), the median LVGLS was -14.8% and the median RVGLS was -16.2%. Over a median follow-up of 5.8 years, 39 patients reached the VA endpoint, and 63 reached the HF endpoint. On Kaplan-Meier analyses, patients with either LVGLS or RVGLS worse than the median had a higher estimated cumulative incidence of both endpoints compared with patients with GLS better than the median (log-rank P<0.001 for all comparisons). On multivariable regression analyses, LVGLS was not associated with the VA endpoint [hazard ratio (HR) 0.93 per 1% worsening; 95% confidence interval (CI) 0.83-1.05; P=0.25], but RVGLS was independently associated (HR 1.13 per 1% worsening; 95% CI 1.02-1.25; P=0.015) in a model that included the extent of late gadolinium enhancement (LGE) and the presence of the high-risk CMR phenotype. Neither LVGLS (HR 1.08, 95% CI 0.98-1.12; P=0.11) nor RVGLS (HR 1.04, 95% CI 0.96-1.13; P=0.31) were independently associated with the HF endpoint in a model that included age, pulmonary hypertension, and the high-risk CMR phenotype. Conclusions: In patients with suspected CS, RVGLS was independently associated with long-term VA but not HF outcomes, while LVGLS was not independently associated with either. Research is warranted into the role of CMR RVGLS to aid clinical decision-making regarding implantable cardioverter-defibrillators.