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
N1 - Publisher Copyright:
© 2015 Heart Rhythm Society.
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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U2 - 10.1016/j.hrthm.2015.09.008
DO - 10.1016/j.hrthm.2015.09.008
M3 - Article
C2 - 26362576
AN - SCOPUS:84960094776
SN - 1547-5271
VL - 12
SP - 2499
EP - 2507
JO - Heart Rhythm
JF - Heart Rhythm
IS - 12
ER -