B-PO02-177 INCREASED SUBSTRATE HETEROGENEITY ASSESSED BY LGE-CMR IS ASSOCIATED WITH VENTRICULAR ARRHYTHMIAS AND MORTALITY IN PATIENTS WITH CARDIAC SARCOIDOSIS

Abstract

Patients with cardiac sarcoidosis (CS) are at risk for life-threatening ventricular arrhythmias (VA). Current risk stratification approaches have limited predictive value. Analysis of substrate heterogeneity on LGE-CMR is an emerging technique for prognostication in cardiomyopathy patients. To assess the utility of spatial dispersion analysis of LGE-CMR, as a quantitative measure of substrate heterogeneity, in risk stratifying patients with CS for VA and death. 62 patients with CS had LGE-CMR. We generated biventricular dispersion maps: We categorized each pixel based on signal intensity (SI) as abnormal, intermediate, or normal (SI ≥3SD, SI 1-3 SD, or SI <1SD above the mean respectively); we assigned to each pixel a value of 0-8 based on the number of adjacent pixels of a different category. We calculated average dispersion score (DS, Fig A). The primary endpoint was VA and the secondary endpoint was the composite of VA or death. During 4.7 ± 3.5 years of follow up, 6 patients had VA and 5 non arrhythmic death. DS was significantly higher in patients with VA or events versus those without. Patients at the highest tertile of DS had a higher incidence of VA (HR 11.73, 95%CI: 1.33-103.2, Fig B) and the combination of VA or mortality (HR 5.78, 95%CI: 1.48-22.55, Fig C). DS had a better predictive value compared to percent fibrosis (Harrel’s C: 0.71 and 0.74 vs 0.67 and 0.63 for the primary and secondary endpoints, respectively). Increased substrate heterogeneity, quantified by spatial dispersion analysis of LGE-CMR, may be helpful in risk-stratifying patients with CS for adverse events, including life-threatening arrhythmias.