QRS-based assessment of myocardial damage and adverse events associated with cardiac sarcoidosis

Yoshihiro Sobue, Masahide Harada, Masayuki Koshikawa, Tomohide Ichikawa, Mayumi Yamamoto, Kentaro Okuda, Yasuchika Kato, Masayoshi Sarai, Eiichi Watanabe, Yukio Ozaki

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background Cardiac sarcoidosis (CS) generates myocardial scar and arrhythmogenic substrate. CS diagnosis according to the Japanese Ministry of Health and Welfare guidelines relies, among others, on cardiac magnetic resonance imaging with late gadolinium enhancement (CMR-LGE). However, access to CMR-LGE is limited. The electrocardiography-based Selvester QRS score has been validated for identifying myocardial scar in ischemic/nonischemic cardiomyopathy, but its efficacy has not been tested to evaluate CS. Objective The purpose of this study was to examine whether the QRS score can be applied to CS. Methods CS-associated myocardial scar was assessed by both CMR-LGE and QRS scoring in patients with extra-CS (n = 59). Results Of 59 patients, 35 (59%) were diagnosed with CS according to the Japanese Ministry of Health and Welfare guidelines. QRS-estimated scar mass positively correlated with that quantified by CMR-LGE (signal intensity ≥2SD above the reference; r = 0.68; P <.001). Receiver operating characteristic curves demonstrated optimal cutoffs of 9% CMR-LGE scar and 3-point QRS score to identify patients with CS. The areas under the curves of CMR-LGE and the QRS score were not significantly different (0.83 and 0.78, respectively; P =.27); both methods demonstrated similar diagnostic performance. A QRS score of ≥3 led to a higher incidence of CS-associated adverse events (death/fatal arrhythmia/heart failure hospitalization) than did a QRS score of <3 (35 ± 21 months of follow-up; P =.01). QRS score was an independent predictor of risk in multivariate analysis (P =.03). Conclusion The Selvester QRS scoring estimates CS-associated myocardial damage and identifies patients with CS equally well as CMR-LGE. A higher QRS score is also associated with an increased risk of life-threatening events in CS, indicating its potential use as a risk predictor.

Original languageEnglish
Pages (from-to)2499-2507
Number of pages9
JournalHeart Rhythm
Volume12
Issue number12
DOIs
Publication statusPublished - 01-12-2015

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Sarcoidosis
Gadolinium
Magnetic Resonance Imaging
Cicatrix
Guidelines
Health
Cardiomyopathies
ROC Curve
Area Under Curve
Cardiac Arrhythmias
Electrocardiography
Hospitalization
Multivariate Analysis
Heart Failure

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Sobue, Yoshihiro ; Harada, Masahide ; Koshikawa, Masayuki ; Ichikawa, Tomohide ; Yamamoto, Mayumi ; Okuda, Kentaro ; Kato, Yasuchika ; Sarai, Masayoshi ; Watanabe, Eiichi ; Ozaki, Yukio. / QRS-based assessment of myocardial damage and adverse events associated with cardiac sarcoidosis. In: Heart Rhythm. 2015 ; Vol. 12, No. 12. pp. 2499-2507.
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abstract = "Background Cardiac sarcoidosis (CS) generates myocardial scar and arrhythmogenic substrate. CS diagnosis according to the Japanese Ministry of Health and Welfare guidelines relies, among others, on cardiac magnetic resonance imaging with late gadolinium enhancement (CMR-LGE). However, access to CMR-LGE is limited. The electrocardiography-based Selvester QRS score has been validated for identifying myocardial scar in ischemic/nonischemic cardiomyopathy, but its efficacy has not been tested to evaluate CS. Objective The purpose of this study was to examine whether the QRS score can be applied to CS. Methods CS-associated myocardial scar was assessed by both CMR-LGE and QRS scoring in patients with extra-CS (n = 59). Results Of 59 patients, 35 (59{\%}) were diagnosed with CS according to the Japanese Ministry of Health and Welfare guidelines. QRS-estimated scar mass positively correlated with that quantified by CMR-LGE (signal intensity ≥2SD above the reference; r = 0.68; P <.001). Receiver operating characteristic curves demonstrated optimal cutoffs of 9{\%} CMR-LGE scar and 3-point QRS score to identify patients with CS. The areas under the curves of CMR-LGE and the QRS score were not significantly different (0.83 and 0.78, respectively; P =.27); both methods demonstrated similar diagnostic performance. A QRS score of ≥3 led to a higher incidence of CS-associated adverse events (death/fatal arrhythmia/heart failure hospitalization) than did a QRS score of <3 (35 ± 21 months of follow-up; P =.01). QRS score was an independent predictor of risk in multivariate analysis (P =.03). Conclusion The Selvester QRS scoring estimates CS-associated myocardial damage and identifies patients with CS equally well as CMR-LGE. A higher QRS score is also associated with an increased risk of life-threatening events in CS, indicating its potential use as a risk predictor.",
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QRS-based assessment of myocardial damage and adverse events associated with cardiac sarcoidosis. / Sobue, Yoshihiro; Harada, Masahide; Koshikawa, Masayuki; Ichikawa, Tomohide; Yamamoto, Mayumi; Okuda, Kentaro; Kato, Yasuchika; Sarai, Masayoshi; Watanabe, Eiichi; Ozaki, Yukio.

In: Heart Rhythm, Vol. 12, No. 12, 01.12.2015, p. 2499-2507.

Research output: Contribution to journalArticle

TY - JOUR

T1 - QRS-based assessment of myocardial damage and adverse events associated with cardiac sarcoidosis

AU - Sobue, Yoshihiro

AU - Harada, Masahide

AU - Koshikawa, Masayuki

AU - Ichikawa, Tomohide

AU - Yamamoto, Mayumi

AU - Okuda, Kentaro

AU - Kato, Yasuchika

AU - Sarai, Masayoshi

AU - Watanabe, Eiichi

AU - Ozaki, Yukio

PY - 2015/12/1

Y1 - 2015/12/1

N2 - Background Cardiac sarcoidosis (CS) generates myocardial scar and arrhythmogenic substrate. CS diagnosis according to the Japanese Ministry of Health and Welfare guidelines relies, among others, on cardiac magnetic resonance imaging with late gadolinium enhancement (CMR-LGE). However, access to CMR-LGE is limited. The electrocardiography-based Selvester QRS score has been validated for identifying myocardial scar in ischemic/nonischemic cardiomyopathy, but its efficacy has not been tested to evaluate CS. Objective The purpose of this study was to examine whether the QRS score can be applied to CS. Methods CS-associated myocardial scar was assessed by both CMR-LGE and QRS scoring in patients with extra-CS (n = 59). Results Of 59 patients, 35 (59%) were diagnosed with CS according to the Japanese Ministry of Health and Welfare guidelines. QRS-estimated scar mass positively correlated with that quantified by CMR-LGE (signal intensity ≥2SD above the reference; r = 0.68; P <.001). Receiver operating characteristic curves demonstrated optimal cutoffs of 9% CMR-LGE scar and 3-point QRS score to identify patients with CS. The areas under the curves of CMR-LGE and the QRS score were not significantly different (0.83 and 0.78, respectively; P =.27); both methods demonstrated similar diagnostic performance. A QRS score of ≥3 led to a higher incidence of CS-associated adverse events (death/fatal arrhythmia/heart failure hospitalization) than did a QRS score of <3 (35 ± 21 months of follow-up; P =.01). QRS score was an independent predictor of risk in multivariate analysis (P =.03). Conclusion The Selvester QRS scoring estimates CS-associated myocardial damage and identifies patients with CS equally well as CMR-LGE. A higher QRS score is also associated with an increased risk of life-threatening events in CS, indicating its potential use as a risk predictor.

AB - Background Cardiac sarcoidosis (CS) generates myocardial scar and arrhythmogenic substrate. CS diagnosis according to the Japanese Ministry of Health and Welfare guidelines relies, among others, on cardiac magnetic resonance imaging with late gadolinium enhancement (CMR-LGE). However, access to CMR-LGE is limited. The electrocardiography-based Selvester QRS score has been validated for identifying myocardial scar in ischemic/nonischemic cardiomyopathy, but its efficacy has not been tested to evaluate CS. Objective The purpose of this study was to examine whether the QRS score can be applied to CS. Methods CS-associated myocardial scar was assessed by both CMR-LGE and QRS scoring in patients with extra-CS (n = 59). Results Of 59 patients, 35 (59%) were diagnosed with CS according to the Japanese Ministry of Health and Welfare guidelines. QRS-estimated scar mass positively correlated with that quantified by CMR-LGE (signal intensity ≥2SD above the reference; r = 0.68; P <.001). Receiver operating characteristic curves demonstrated optimal cutoffs of 9% CMR-LGE scar and 3-point QRS score to identify patients with CS. The areas under the curves of CMR-LGE and the QRS score were not significantly different (0.83 and 0.78, respectively; P =.27); both methods demonstrated similar diagnostic performance. A QRS score of ≥3 led to a higher incidence of CS-associated adverse events (death/fatal arrhythmia/heart failure hospitalization) than did a QRS score of <3 (35 ± 21 months of follow-up; P =.01). QRS score was an independent predictor of risk in multivariate analysis (P =.03). Conclusion The Selvester QRS scoring estimates CS-associated myocardial damage and identifies patients with CS equally well as CMR-LGE. A higher QRS score is also associated with an increased risk of life-threatening events in CS, indicating its potential use as a risk predictor.

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