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Quantitative myocardial T2 mapping adds value to Japanese circulation society diagnostic criteria for active cardiac sarcoidosis

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Abstract

Noninvasive identification of active myocardial inflammation in patients with cardiac sarcoidosis plays a key role in management but remains elusive. T2 mapping is a proposed solution, but the added value of quantitative myocardial T2 mapping for active cardiac sarcoidosis is unknown. Retrospective cohort analysis of 56 sequential patients with biopsy-confirmed extracardiac sarcoidosis who underwent cardiac MRI for myocardial T2 mapping. The presence or absence of active myocardial inflammation in patients with CS was defined using a modified Japanese circulation society criteria within one month of MRI. Myocardial T2 values were obtained for the 16 standard American Heart Association left ventricular segments. The best model was selected using logistic regression. Receiver operating characteristic curves and dominance analysis were used to evaluate the diagnostic performance and variable importance. Of the 56 sarcoidosis patients included, 14 met criteria for active myocardial inflammation. Mean basal T2 value was the best performing model for the diagnosis of active myocardial inflammation in CS patients (pR2 = 0.493, AUC = 0.918, 95% CI 0.835–1). Mean basal T2 value > 50.8 ms was the most accurate threshold (accuracy = 0.911). Mean basal T2 value + JCS criteria was significantly more accurate than JCS criteria alone (AUC = 0.981 vs. 0.887, p = 0.017). Quantitative regional T2 values are independent predictors of active myocardial inflammation in CS and may add additional discriminatory capability to JCS criteria for active disease.

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The data underlying this article cannot be shared publicly due the use of patient-level clinical and imaging data. The data may be available upon reasonable request to the corresponding author.

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The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Division of Cardiothoracic Imaging, Department of Radiology, Medical University of South Carolina, Charleston, SC, USA

    Jordan H. Chamberlin, Madison R. Kocher, Gilberto Aquino, Austin Fullenkamp, Jeffrey Waltz, Natalie Stringer, Andrew Wortham, Akos Varga-Szemes, William J. Rieter, Andrew D. Hardie, Ismail Kabakus, Dhiraj Baruah & Jeremy R. Burt

  2. Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, SC, USA

    D. Jameson Dennis & W. Ennis James

  3. Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA

    Brian A. Houston

  4. Susan Pearlstine Sarcoidosis Center of Excellence, Medical University of South Carolina, Charleston, SC, USA

    W. Ennis James

  5. Division of Cardiology, University of Utah School of Medicine, Salt Lake City, UT, USA

    Line Kemeyou

  6. Division of Cardiothoracic Imaging, Department of Radiology, University of Utah School of Medicine, Salt Lake City, UT, USA

    Jeremy R. Burt

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Jordan H. Chamberlin MD, Madison R. Kocher MD, Gilberto Aquino MD, Austin Fullenkamp MD, Natalie Stringer MD, Andrew Wortham BS, Akos Varga-Szemes, MD, PhD, and Jeremy R. Burt MD. The first draft of the manuscript was written by Jordan Chamberlin and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Jeremy R. Burt.

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The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

This is an observational study without inclusion of protected health information (PHI). The Medical University of South Carolina Research Ethics Committee has confirmed that no ethical approval is required.

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Supplementary Information

Below is the link to the electronic supplementary material.—Supplemental Figure 1 T2 mapping values sorted by diagnosis of cardiac sarcoidosis with active myocardial inflammation for each AHA left ventricular segment. All segments from patients with active myocardial inflammation were significantly elevated (p < 0.05 for all).

10554_2023_2863_MOESM1_ESM.jpg

Supplementary file1 (JPG 306 kb)—Supplemental Figure 1 T2 mapping values sorted by diagnosis of cardiac sarcoidosis with active myocardial inflammation for each AHA left ventricular segment. All segments from patients with active myocardial inflammation were significantly elevated (p < 0.05 for all).

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Chamberlin, J.H., Kocher, M.R., Aquino, G. et al. Quantitative myocardial T2 mapping adds value to Japanese circulation society diagnostic criteria for active cardiac sarcoidosis. Int J Cardiovasc Imaging 39, 1535–1546 (2023). https://doi.org/10.1007/s10554-023-02863-5

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