Arrhythmias & electrophysiology
Extent and Features of Late Gadolinium Enhancement Stratify Arrhythmic Risk in Patients With Biopsy-Proven Sarcoidosis
Authors' conclusion
The authors propose a new risk stratification approach based on LGE features for assessing the risk of life-threatening ventricular arrhythmias in patients with biopsy-proven sarcoidosis.
Study context
- Population
- Patients with biopsy-proven sarcoidosis
- Participants
- 324 patients
- Outcome
- Ventricular tachycardia (VT) or ventricular fibrillation (VF) or appropriate device therapy
Performance
As reported in the abstract
VT/VF or appropriate device therapy · 4.6-year follow-up
Hazard ratio (95% CI)P value
LGE extent (per SD change)independent predictor
1.03(1.00–1.06)
P = 0.047LGE on RV septum
5.43(2.61–11.30)
P < 0.001LGE on RV free wall
4.30(1.99–9.27)
P < 0.001Multifocal LGE
4.62(2.19–9.72)
P < 0.001Per SD change, as printed
- Patients reaching primary endpoint
- 30 (9.3%)
Secondary outcomes
Heart failure (HF) hospitalization/HTx and all-cause mortality
- HF/HTx
- 15 (4.6%)
- All-cause mortality
- 41 (12.7%)
- Late gadolinium enhancement (LGE) extent not predictive of HF/HTx
- P = 0.30
- LGE extent not predictive of all-cause mortality
- P = 0.50
Proposed LGE-based algorithm: arrhythmia risk in 4 subgroups
- Cumulative event rates
- 1%, 11%, 23%, and 44%
- Chi-square
- 44.7; P = 1.084 × 10-9
- Model performance vs Heart Rhythm Society classification (chi-square)
- 8.02; P = 0.046
- Risk discrimination vs Heart Rhythm Society classification (ΔAUC)
- 0.082; P = 0.019
- Reclassified (9% to higher, 34% to lower risk)
- 43%
Original publication
Extent and Features of Late Gadolinium Enhancement Stratify Arrhythmic Risk in Patients With Biopsy-Proven Sarcoidosis. JACC Cardiovasc Imaging. Published July 2025. doi:10.
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