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Myocardial contractile patterns predict future cardiac events in sarcoidosis

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Abstract

The poor prognosis of cardiac sarcoidosis (CS) underscores the need for risk stratification. We evaluated 84 consecutive sarcoidosis patients who were referred for echocardiographic studies for cardiac symptoms or abnormal electrocardiograms. In 54 patients without previous diagnosis of CS or other known structural heart disease, 13 reached endpoints during (median) 24 months follow up. Significantly impaired peak systolic longitudinal strain in their original echocardiograms were identified in 13 of 17 left ventricular segments, clustering in the free wall, interventricular septum and apex. The regional (including 13 clustered segments) peak systolic longitudinal strain (RPSLS) were significantly impaired in patients with endpoints, compared with those without [(−11.4 ± 4.45) vs. (−18.7 ± 3.76) %, P < 0.00001]. Cox multivariate regression analysis revealed that RPSLS was independently associated with endpoints (HR 1.24; 95% CI 1.08–1.42, P = 0.002). Receiver operating characteristic curve suggested a cut-off RPSLS value of −15.0% (84.6% sensitivity and 86.8% specificity) to predict the occurrence of endpoints. Impaired RPSLS correlates with risk of adverse cardiac events in patients with extra-cardiac sarcoidosis.

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Abbreviations

A:

Late peak diastolic velocities across mitral valve

AUC:

Area under the receiver operating characteristic curve

CAD:

Coronary artery disease

CMR:

Cardiac magnetic resonance imaging

CS:

Cardiac sarcoidosis

E:

Early peak diastolic velocities across mitral valve

e′:

Early diastolic mitral annulus (myocardial) velocity

ECG:

Electrocardiography

FDG-PET:

18F-2-Fluoro-2-Deoxyglucose positron emission tomography

HRS:

Heart Rhythm Society

IVSd:

Interventricular septal dimensions

JMHW:

Japanese Ministry of Health and Welfare

LV:

Left ventricular

LVEDD:

Left ventricular end diastolic dimensions

LVEDV:

Left ventricular end diastolic volumes

LVEF:

Left ventricular ejection fraction

LVESD:

Left ventricular end systolic dimensions

LVESV:

Left ventricular end systolic volumes

RPSLS:

Regional peak systolic longitudinal strain

PWd:

Posterior wall diameters

ROC:

Receiver operating characteristic

s′:

Systolic mitral annulus (myocardial) velocity

TDI:

Tissue Doppler imaging

2D:

2-dimensional

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Author notes

    Authors and Affiliations

    1. Division of Cardiology, State University of New York, Upstate Medical University Hospital, 90 Presidential Plaza, Syracuse, NY, 13202, USA

      Jian Chen, Juan Lei, Robert Voelker & Kan Liu

    2. Department of Cardiology, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, China

      Jian Chen

    3. Department of Cardiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China

      Juan Lei & Jingfeng Wang

    4. Department of Radiology, State University of New York, Upstate Medical University Hospital, Syracuse, USA

      Ernest Scalzetti, Mary McGrath & David Feiglin

    5. Department of Internal Medicine, State University of New York, Upstate Medical University Hospital, 750 E. Adams St., Syracuse, NY, 13210, USA

      Michael C. Iannuzzi

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    1. Jian Chen
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    Contributions

    KL, MCI, and JFW: Conception and design of the study; JC, JL, ES, MM, DF, RV: acquisition and analysis of data; JC, JL, ES, MM, DF: interpretation of data; KL, MCI, JFW, JL: drafting the work.

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    Correspondence to Michael C. Iannuzzi or Kan Liu.

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    The authors declare that they have no conflict of interests.

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    This study is approved by institutional research board of Human Subjects Committee of State University of New York Upstate Medical University.

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    Not applicable.

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    Drs. Jian Chen and Juan Lei have equally contributed to this article.

    Availability of data and material: Please contact author for data requests.

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    Chen, J., Lei, J., Scalzetti, E. et al. Myocardial contractile patterns predict future cardiac events in sarcoidosis. Int J Cardiovasc Imaging 34, 251–262 (2018). https://doi.org/10.1007/s10554-017-1233-9

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    • DOI: https://doi.org/10.1007/s10554-017-1233-9

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