Right Ventricular Abnormalities on Cardiovascular Magnetic Resonance Imaging in Patients With Sarcoidosis

Pratik S. Velangi, Ko Hsuan Amy Chen, Felipe Kazmirczak, Osama Okasha, Lisa von Wald, Henri Roukoz, Afshin Farzaneh-Far, Jeremy Markowitz, Prabhjot S. Nijjar, Maneesh Bhargava, David Perlman, Mehmet Akçakaya, Chetan Shenoy

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OBJECTIVES: This study aimed to determine the prevalence on cardiac magnetic resonance (CMR) of right ventricular (RV) systolic dysfunction and RV late gadolinium enhancement (LGE), their determinants, and their influences on long-term adverse outcomes in patients with sarcoidosis.

BACKGROUND: In patients with sarcoidosis, RV abnormalities have been described on many imaging modalities. On CMR, RV abnormalities include RV systolic dysfunction quantified as an abnormal right ventricular ejection fraction (RVEF), and RV LGE.

METHODS: Consecutive patients with biopsy-proven sarcoidosis who underwent CMR for suspected cardiac involvement were studied. They were followed for 2 endpoints: all-cause death, and a composite arrhythmic endpoint of sudden cardiac death or significant ventricular arrhythmia.

RESULTS: Among 290 patients, RV systolic dysfunction (RVEF <40% in men and <45% in women) and RV LGE were present in 35 (12.1%) and 16 (5.5%), respectively. The median follow-up time was 3.2 years (interquartile range [IQR]: 1.6 to 5.7 years) for all-cause death and 3.0 years (IQR: 1.4, 5.5 years) for the arrhythmic endpoint. On Cox proportional hazards regression multivariable analyses, only RVEF was independently associated with all-cause death (hazard ratio [HR]: 1.05 for every 1% decrease; 95% confidence interval [CI]: 1.01 to 1.09; p = 0.022) after adjustment for left ventricular EF, left ventricular LGE extent, and the presence of RV LGE. RVEF was not associated with the arrhythmic endpoint (HR: 1.01; 95% CI: 0.96 to 1.06; p = 0.67). Conversely, RV LGE was not associated with all-cause death (HR: 2.78; 95% CI: 0.36 to 21.66; p = 0.33), while it was independently associated with the arrhythmic endpoint (HR: 5.43; 95% CI: 1.25 to 23.47; p = 0.024).

CONCLUSIONS: In this study of patients with sarcoidosis, RV systolic dysfunction and RV LGE had distinct prognostic associations; RV systolic dysfunction but not RV LGE was independently associated with all-cause death, whereas RV LGE but not RV systolic dysfunction was independently associated with sudden cardiac death or significant ventricular arrhythmia. These findings may indicate distinct implications for the management of RV abnormalities in sarcoidosis.

Original languageEnglish (US)
Pages (from-to)1395-1405
Number of pages11
JournalJACC. Cardiovascular imaging
Issue number6
Early online dateJan 15 2020
StatePublished - Jun 2020

Bibliographical note

Funding Information:
Dr. Velangi was supported by a travel grant from the Foundation for Sarcoidosis Research (FSR), Chicago, Illinois, to present these data at the 2019 Americas Association of Sarcoidosis and Other Granulomatous Disorders (AASOG) Annual Conference. Dr. Roukoz has received consulting fees from Boston Scientific; and speaking honoraria from Medtronic. Dr. Ak?akaya was supported by National Institutes of Health (NIH) grant R00HL111410. Dr. Shenoy was supported by NIH grant K23HL132011, a University of Minnesota Clinical and Translational Science Institute KL2 Scholars Career Development Program Award (NIH grant KL2TR000113-05), and NIH grant UL1TR000114. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Publisher Copyright:
© 2020 American College of Cardiology Foundation


  • cardiovascular magnetic resonance
  • late gadolinium enhancement
  • outcomes
  • right ventricle
  • sarcoidosis
  • systolic dysfunction

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't


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