Hemodynamic Forces: A Novel Cardiac MRI Parameter to Assess Cardiac Involvement in Sarcoidosis Patients

Aïcha Kante¹, Andreea Afana², Damien Sène³, Karine Champion³, Valentin Pagis⁴, William Bigot³, Véronique Delcey⁵, Amanda Lopes³, Abdellatif Tazi⁶, Blanca Amador Borrero⁴, Bruno Crestani⁷, Claire Baladi⁸, Valérie Bousson⁹, Trecy Goncalves¹⁰, Edouard Ballout¹⁰, Solenn Toupin¹⁰, stephane mouly³, Jean-Guillaume Dillinger¹¹, Patrick Henry¹¹, Theo Pezel¹¹ and Cloé Comarmond³, ¹Department of internal medicine, Centre de Compétence Maladies Rares autoimmunes et inflammatoires, Université Paris Cité, Paris, Ile-de-France, France, ²Department of Cardiology, University of Medicine and Pharmacy Craiova, Craiova, Romania, ³Department of internal medicine, Centre de Compétence Maladies Rares autoimmunes et inflammatoires, Lariboisière Hospital, Université Paris Cité, Paris, Ile-de-France, France, ⁴Department of internal medicine, Centre de Compétence Maladies Rares autoimmunes et inflammatoires, Lariboisière Hospital, Université Paris Cité, Paris, France, ⁵Department of Infectious diseases, Lariboisère University Hospital, Paris, Ile-de-France, France, ⁶National Reference Center for Histiocytoses, Department of Pulmonology, AP-HP, Saint-Louis Hospital, Paris, France, ⁷National Reference Center for Rare Pulmonary Diseases, Department of Pulmonology, AP-HP, Bichat Hospital, Paris, Ile-de-France, France, ⁸Université d’Angers, Department of Cardiology, University Hospital of Angers, Angers, France, ⁹Department of Radiology, Lariboisiere Hospital, (Assistance Publique des Hôpitaux de Paris, AP-HP), Paris, Ile-de-France, France, ¹⁰Department of Cardiology, Lariboisiere Hospital, (Assistance Publique des Hôpitaux de Paris, AP-HP), Paris, France, ¹¹Department of Cardiology, Lariboisiere Hospital, (Assistance Publique des Hôpitaux de Paris, AP-HP), Paris, Ile-de-France, France

Meeting: ACR Convergence 2024

Keywords: Autoinflammatory diseases, Cardiovascular, Heart disease, Magnetic resonance imaging (MRI), prevention

Session Information

Date: Monday, November 18, 2024

Title: Imaging of Rheumatic Diseases Poster II

Session Type: Poster Session C

Session Time: 10:30AM-12:30PM

Background/Purpose: Cardiac sarcoidosis (CS) is an underdiagnosed condition characterized by the formation of non-caseating granuloma in the myocardium, potentially leading to arrhythmia, acute heart failure, and sudden cardiac death. Early diagnosis of CS is crucial to optimize treatment and delay disease progression. Hemodynamic forces (HDFs) measure the global force exchanged between blood volume and myocardium during cardiac magnetic resonance imaging (CMR), and are a novel noninvasive parameter for detecting early cardiac dysfunction. However, HDFs have not yet been studied in patients with suspected CS.
In this study, we aim to investigate left ventricle (LV) HDFs in suspected CS compared to healthy controls (HC). Additionally, we will evaluate the diagnostic role of HDFs in differentiating between confirmed CS and non-CS patients within the suspected CS group.

Methods: In a single-center study, patients with suspected CS and biopsy-proven sarcoidosis were included and underwent a 1.5T CMR exam. These patients were matched with healthy controls of the same age and sex who also underwent a CMR exam. HDFs were obtained for the entire cohort using advanced post-processing software (Medis Suite). In sarcoidosis patients, cardiac involvement was confirmed using the WASOG (World Association for Sarcoidosis Other Granulomatous diseases) 2014 criteria, which notably include the presence of late gadolinium enhancement (LGE), patchy uptake on cardiac FDG-positron emission tomography, and perfusion defects on cardiac scintigraphy. The performance of HDFs for diagnosing CS among sarcoidosis patient was assessed using a logistic regression model using 3 HDFs parameters: LV systolic peak, LV longitudinal force and LV impulse and adjusted for the presence of LGE.

Results: Among 45 sarcoidosis patients with suspected CS, 60% had a confirmed-CS using the WASOG criteria (22% had a positive cardiac FDG-PET, 11% had scintigraphy perfusion defects and 85% had LGE) (Figure 1). In this population, systolic and diastolic HDFs were significantly altered compared to HC (LV impulse, p=0.045; LV systolic ratio, p=0.018; LV systolic-diastolic-transition, p=0.012; LV diastolic deceleration, p=0.013) (Figure 2). In sarcoidosis patients, LV strain and LVEF (median [IQR]) were not statistically different between CS (56 [53–60] %) and non-CS patients (60 [55–64] %). However, HDFs parameters LV longitudinal force (p=0.041), LV impulse (p=0.018), and LV systolic peak (p=0.035) were significantly altered in confirmed-CS patients compared to non-CS patients. Furthermore, the combination of LV longitudinal force, LV impulse, and LV systolic peak enabled an accurate diagnosis of CS among sarcoidosis patients, with an AUROC (area under the receiver operating characteristic) of 0.88 (Figure 3).

Conclusion: Sarcoidosis patients with suspected CS had altered hemodynamic forces compared to HC due to altered LV geometry and mechanics. Furthermore, hemodynamic forces were superior to traditional volumetric and functional CMR parameters (LVEF and strain) to predict cardiac involvement in sarcoidosis patients.

Figure 1. Cardiac magnetic resonance imaging (CMR) representation of late gadolinium enhancement (LGE) in sarcoidosis patients with cardiac involvement. The images show myocardial LGE patterns (red arrows): subepicardial LGE involving inferior and lateral walls (A), isolated midmyocardial LGE in the basal anterior wall (B), multifocal LGE involving basal interventricular septum (C), subepicardial LGE at the inferior insertion point (D).

Figure 2. Hemodynamic forces over the entire cardiac cycle comparison between sarcoidosis patietns (blue) and healthy controls (orange). Curves were generated using the average values acquired of the entire cohort.

Area under the curve Receiving Operating Characteristics (AUROC) of Hemodynamic forces parameters Systolic Peak, Left ventricular impulse, and Left ventricular longitudinal force for Cardiac Sarcoidosis diagnosis. The ROC curve was generated using a logistic regression model and adjusted for the presence of LGE.

Disclosures: A. Kante: None; A. Afana: None; D. Sène: None; K. Champion: None; V. Pagis: None; W. Bigot: None; V. Delcey: None; A. Lopes: None; A. Tazi: None; B. Amador Borrero: None; B. Crestani: None; C. Baladi: None; V. Bousson: None; T. Goncalves: None; E. Ballout: None; S. Toupin: None; s. mouly: None; J. Dillinger: None; P. Henry: None; T. Pezel: None; C. Comarmond: None.

To cite this abstract in AMA style:

Kante A, Afana A, Sène D, Champion K, Pagis V, Bigot W, Delcey V, Lopes A, Tazi A, Amador Borrero B, Crestani B, Baladi C, Bousson V, Goncalves T, Ballout E, Toupin S, mouly s, Dillinger J, Henry P, Pezel T, Comarmond C. Hemodynamic Forces: A Novel Cardiac MRI Parameter to Assess Cardiac Involvement in Sarcoidosis Patients [abstract]. Arthritis Rheumatol. 2024; 76 (suppl 9). https://acrabstracts.org/abstract/hemodynamic-forces-a-novel-cardiac-mri-parameter-to-assess-cardiac-involvement-in-sarcoidosis-patients/. Accessed .

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