Prognostic value of late-gadolinium enhancement on cardiac magnetic resonance in patients with cardiac sarcoidosis

Background: Late-gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) is a predictor of adverse events in patients with cardiac sarcoidosis (CS), but available studies had small sample sizes and did not consider all relevant endpoints. Objective: To evaluate the association between LGE on CMR in patients with CS and mortality, ventricular arrhythmias (VA) and sudden cardiac death (SCD), and heart failure (HF) hospitalization. Methods: A literature search was conducted for studies reporting the association between LGE in CS and the study endpoints. The endpoints were mortality, VA and SCD, and HF hospitalization. The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. The minimum follow-up duration was 1 year. Results: A total of 17 studies and 1915 CS patients (595 with LGE vs. 1320 without LGE) were included; mean follow-up was 3.3 years (ranging between 17 and 84 months). LGE was associated with increased all-cause mortality (OR 6.05, 95% CI 3.16–11.58; p <.01), cardiovascular mortality (OR 5.83, 95% CI 2.89–11.77; p <.01), and VA and SCD (OR 16.48, 95% CI 8.29–32.73; p <.01). Biventricular LGE was associated with increased VA and SCD (OR 6.11, 95% CI 1.14–32.68; p =.035). LGE was associated with an increased HF hospitalization (OR 17.47, 95% CI 5.54–55.03; p <.01). Heterogeneity was low: df = 7 (p =.43), I2 = 0%. Conclusions: LGE in CS patients is associated with increased mortality, VA and SCD, and HF hospitalization. Biventricular LGE is associated with an increased risk of VA and SCD.