Rapid Fire Abstracts
Nicoleta Nita, MD, PhD, MRT
Cardiologist
University Clinic of Ulm, Germany
Nicoleta Nita, MD, PhD, MRT
Cardiologist
University Clinic of Ulm, Germany
Dominik Felbel, MD
Cardiologist
University Clinic of Ulm, Germany
Michael Paukovitsch, MD
Cardiologist
University Clinic of Ulm, Germany
Wolfgang Rottbauer, MD, PhD
Physician
University of Ulm, Departement of Internal Medicine II, Ulm, Germany, Germany
Dominik Buckert, MD
University Hospital of Ulm, Germany
Phasic atrial dysfunction by Cardiac Magnetic Resonance (CMR) is acknowledged as a prognostic marker in various cardiac diseases, but its significance in different phenotypes of cardiac sarcoidosis (CS) is not well known. We aimed to study patterns of left atrial (LA) dysfunction in patients with CS and to assess their prognostic implications regarding new-onset atrial fibrillation (AF) in clinically silent and clinically manifest CS.
Methods:
67 patients with AF-naive CS, of whom 31 had clinically silent CS and 36 had clinically manifest CS, were studied using CMR feature tracking. Clinically silent CS was defined as CS in patients with biopsy-proven extracardiac sarcoidosis with minimal or no cardiac symptoms but typical abnormalities on screening imaging by CMR or positron emission tomography (PET). Over a follow-up period of 4 years, AF was documented by Holter monitoring, 12-lead electrocardiogram and interrogation of intracardiac devices.
Results:
Patients with clinically manifest CS were younger (mean age 56 vs 51 years, p=0.41), had poorer ventricular function and significantly lower LA reservoir, conduit and booster function compared to patients with clinically silent CS. Compared to healthy controls, patients with clinically silent CS had significantly lower LA reservoir and conduit function but preserved LA booster function. Over a 4-year follow-up period, 35.5 % of patients with clinically silent CS and 47.2% of patients with clinically manifest CS developed AF. In cause-specific Cox regression analysis, age (HR 1.13, 95% CI 1.10-1.19, P=0.038) and LA reservoir strain (HR 0.57, 95% CI 0.54-0.68, P = 0.026) were independent predictors of AF in patients with clinically silent CS, whereas in patients with clinically manifest CS, baseline NT-proBNP (HR 1.02, 95% CI 1.00-1.08, P = 0.014) and baseline atrial late gadolinium enhancement and/or atrial 18F-FDG uptake (HR 5.23, 95%CI 1.78-9.91, P=0.016) predicted AF. LA strain parameters were not predictive in patients with clinically manifest CS.
Conclusion:
Phasic atrial dysfunction by CMR feature tracking is a relevant phenotype in patients with cardiac sarcoidosis but its prognostic significance regarding new-onset atrial fibrillation is limited to patients with clinically silent cardiac sarcoidosis.
