Diagnostic Value of Cardiac Magnetic Resonance Strain Analysis for Detection of Cardiac Sarcoidosis

Abstract

Purpose The aim of this study was to investigate the diagnostic value of cardiac magnetic resonance (CMR)-derived strain parameters in patients with sarcoidosis, and to compare results to standard CMR markers of sarcoidosis (edema/T2 ratio, early gadolinium enhancement, late gadolinium enhancement) for prediction of disease outcome.

Materials and Methods 61 patients with biopsy-proven sarcoidosis underwent CMR examination. According to CMR results, patients were divided into two different groups: patients with (CMR+; n = 23) and without (CMR–; n = 38) findings consistent with cardiac sarcoidosis. In addition, a group of healthy age-matched volunteers (controls; n = 22) served as controls. Left ventricular functional parameters as well as left ventricular longitudinal and circumferential strain were evaluated in all three groups.

Results Compared to controls, global longitudinal strain (GLS) was significantly impaired in patients with sarcoidosis, irrespective of cardiac involvement. No significant differences in GLS could be revealed between CMR+ and CMR– patients. Circumferential strain parameters were significantly impaired in CMR+ patients in comparison to CMR– patients and controls, while no significant differences could be revealed between CMR– patients and controls. GLS was significantly lower in patients with a negative outcome compared to controls. Compared to the rest of the CMR+ and CMR– patients, the GLS in patients with a negative outcome was further reduced but did not reach statistical significance.

Conclusion GLS is the only strain parameter detecting left ventricular functional impairment in sarcoidosis patients with otherwise unsuspicious CMR and controls. GLS is further reduced in patients with a negative outcome. Thus, GLS may have the potential to serve as a marker for early cardiac involvement in sarcoidosis.

Key points 

• GLS is significantly impaired in sarcoidosis patients with an otherwise inconspicuous CMR, compared to controls

• GLS is reduced in patients with a negative outcome

• GLS may serve as a marker for early cardiac involvement in sarcoidosis

Citation Format

• Dabir D, Meyer D, Kuetting D et al. Diagnostic Value of Cardiac Magnetic Resonance Strain Analysis for Detection of Cardiac Sarcoidosis. Fortschr Röntgenstr 2018; 190: 712 – 721

Zusammenfassung

Ziel Ziel dieser Studie war es, die diagnostische Wertigkeit der MRT-basierten Strain-Analyse zum Nachweis einer kardialen Beteiligung bei Patienten mit systemischer Sarkoidose zu ermitteln. Darüber hinaus wurden die Strainwerte mit Standard MRT-Parametern (Ödem/T2-ratio, relatives enhancement, late gadolinium enhancement) bezüglich des Outcomes verglichen.

Material und Methoden 61 Patienten mit bioptisch gesicherter extrakardialer Sarkoidose wurden mittels Herz-MRT untersucht. Entsprechend der MRT-Ergebnisse wurden die Patienten in 2 Gruppen unterteilt: Patienten mit (CMR+; n = 23) und ohne (CMR–; n = 38) sarkoidosetypische Veränderungen des Herzens. Als Kontrollgruppe dienten 22 altersgematchte Herzgesunde. Linksventrikuläre Funktionsparameter sowie longitudinaler und zirkumferentieller Strain wurden in allen drei Gruppen gemessen.

Ergebnisse Sarkoidosepatienten wiesen im Vergleich zu Herzgesunden einen signifikant eingeschränkten longitudinalen Strain (GLS) auf, während keine signifikanten Unterschiede zwischen den beiden Patientengruppen festgestellt werden konnten. CMR+ Patienten wiesen im Vergleich zu CMR– Patienten und Herzgesunden signifikant eingeschränkte zirkumferentielle Strainwerte auf. Zwischen CMR– Patienten und Herzgesunden konnten keine signifikanten Unterschiede bezüglich zirkumferentiellem Strain festgestellt werden. Patienten mit negativem Outcome wiesen im Vergleich zu Herzgesunden einen signifikant niedrigeren GLS auf. Darüber hinaus war der GLS in Patienten mit negativem Outcome auch gegenüber den übrigen CMR+ und CMR– Patienten eingeschränkt, jedoch ohne statistische Signifikanz zu erreichen.

Schlussfolgerung GLS ist der einzige Strainparameter, der einen signifikanten Unterschied zwischen Sarkoidosepatienten mit ansonsten unauffälligem MRT (CMR–) und Herzgesunden aufweist und darüber hinaus bei Patienten mit negativem Outcome eingeschränkt ist. Folglich könnte GLS als potentieller Indikator für eine frühe kardiale Beteiligung dienen.

Kernaussagen 

• GLS ist bei Sarkoidosepatienten mit ansonsten unauffälligem Herz-MRT signifikant eingeschränkt im Vergleich zu Herzgesunden

• GLS ist bei Patienten mit negativem Outcome eingeschränkt

• GLS könnte als potentieller Indikator für eine frühe kardiale Beteiligung dienen

Key words

cardiac - sarcoidosis - strain - feature-tracking

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