Advertisement

Association between right ventricular longitudinal strain and cardiovascular events in patients with cardiac sarcoidosis

Published:August 16, 2022DOI:https://doi.org/10.1016/j.jjcc.2022.07.015

      Highlights

      • RVFWLS was associated with MACEs and active RV involvement in patients with CS.
      • Patients with MACEs showed a worsening in RVFWLS after steroid therapy.
      • RVFWLS could be a surrogate of poor prognosis and active CS involvement.

      Abstract

      Background

      While right ventricular (RV) involvement is commonly observed in patients with cardiac sarcoidosis (CS), the utility of strain imaging to detect RV involvement is unclear. We aimed to investigate the association between RV free wall longitudinal strain (RVFWLS) and cardiovascular events in patients with CS.

      Methods

      We studied 51 patients with CS who were diagnosed between 2012 and 2020. All patients underwent comprehensive echocardiographic evaluation, and RVFWLS was assessed using 2-dimensional speckle tracking echocardiography. The primary outcome was major adverse cardiovascular events (MACEs).

      Results

      During a median follow-up duration of 548 days, 11 patients exhibited MACEs. In the univariable Cox proportional hazards model, the baseline RVFWLS was associated with MACEs (hazard ratio: 1.29, p = 0.008). The addition of RVFWLS to the conventional echocardiographic parameters exhibited a significant incremental value associated with MACEs. Patients with reduced RVFWLS showed a higher prevalence of late gadolinium enhancement on cardiac magnetic resonance imaging in RV wall (p = 0.02) and trends toward higher prevalence of fluorodeoxyglucose uptake in RV (p = 0.06). A serial echocardiographic evaluation revealed that patients with events showed a worsening in RVFWLS, while others showed a trend toward improvement.

      Conclusions

      Impaired RVFWLS at baseline was associated with MACEs in patients with CS. RVFWLS could be an important surrogate of disease activity and prognosis by detecting active RV involvement in CS.

      Graphical abstract

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Birnie D.H.
        • Nery P.B.
        • Ha A.C.
        • Beanlands R.S.
        Cardiac sarcoidosis.
        J Am Coll Cardiol. 2016; 68: 411-421
        • Terasaki F.
        • Azuma A.
        • Anzai T.
        • Ishizaka N.
        • Ishida Y.
        • Isobe M.
        • et al.
        JCS 2016 guideline on diagnosis and treatment of cardiac sarcoidosis - digest version.
        Circ J. 2019; 83: 2329-2388
        • Writing group
        • Document reading group
        EACVI Reviewers: This document was reviewed by members of the EACVI Scientific Documents Committee for 2014–2016 and 2016–2018. A joint procedural position statement on imaging in cardiac sarcoidosis: from the Cardiovascular and Inflammation & Infection Committees of the European Association of Nuclear Medicine, the European Association of Cardiovascular Imaging, and the American Society of Nuclear Cardiology.
        Eur Heart J Cardiovasc Imaging. 2017; 18: 1073-1089
        • Chiu C.Z.
        • Nakatani S.
        • Zhang G.
        • Tachibana T.
        • Ohmori F.
        • Yamagishi M.
        • et al.
        Prevention of left ventricular remodeling by long-term corticosteroid therapy in patients with cardiac sarcoidosis.
        Am J Cardiol. 2005; 95: 143-146
        • Velangi P.S.
        • Chen K.A.
        • Kazmirczak F.
        • Okasha O.
        • von Wald L.
        • Roukoz H.
        • et al.
        Right ventricular abnormalities on cardiovascular magnetic resonance imaging in patients with sarcoidosis.
        JACC Cardiovasc Imaging. 2020; 13: 1395-1405
        • Crawford T.
        • Mueller G.
        • Sarsam S.
        • Prasitdumrong H.
        • Chaiyen N.
        • Gu X.
        • et al.
        Magnetic resonance imaging for identifying patients with cardiac sarcoidosis and preserved or mildly reduced left ventricular function at risk of ventricular arrhythmias.
        Circ Arrhythm Electrophysiol. 2014; 7: 1109-1115
        • Smedema J.P.
        • van Geuns R.J.
        • Ainslie G.
        • Ector J.
        • Heidbuchel H.
        • Crijns H.
        Right ventricular involvement in cardiac sarcoidosis demonstrated with cardiac magnetic resonance.
        ESC Heart Fail. 2017; 4: 535-544
        • Blankstein R.
        • Osborne M.
        • Naya M.
        • Waller A.
        • Kim C.K.
        • Murthy V.L.
        • et al.
        Cardiac positron emission tomography enhances prognostic assessments of patients with suspected cardiac sarcoidosis.
        J Am Coll Cardiol. 2014; 63: 329-336
        • Patel M.B.
        • Mor-Avi V.
        • Murtagh G.
        • Bonham C.A.
        • Laffin L.J.
        • Hogarth D.K.
        • et al.
        Right heart involvement in patients with sarcoidosis.
        Echocardiography. 2016; 33: 734-741
        • Kusunose K.
        • Fujiwara M.
        • Yamada H.
        • Nishio S.
        • Saijo Y.
        • Yamada N.
        • et al.
        Deterioration of biventricular strain is an early marker of cardiac involvement in confirmed sarcoidosis.
        Eur Heart J Cardiovasc Imaging. 2020; 21: 796-804
        • Rudski L.G.
        • Lai W.W.
        • Afilalo J.
        • Hua L.
        • Handschumacher M.D.
        • Chandrasekaran K.
        • et al.
        Guidelines for the echocardiographic assessment of the right heart in adults: a report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography.
        J Am Soc Echocardiogr. 2010; 23: 685-713
        • Badano L.P.
        • Kolias T.J.
        • Muraru D.
        • Abraham T.P.
        • Aurigemma G.
        • Edvardsen T.
        • et al.
        Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: a consensus document of the EACVI/ASE/Industry task force to standardize deformation imaging.
        Eur Heart J Cardiovasc Imaging. 2018; 19: 591-600
        • Carluccio E.
        • Biagioli P.
        • Lauciello R.
        • Zuchi C.
        • Mengoni A.
        • Bardelli G.
        • et al.
        Superior prognostic value of right ventricular free wall compared to global longitudinal strain in patients with heart failure.
        J Am Soc Echocardiogr. 2019; 32 (836-44.e1)
        • Lang R.M.
        • Badano L.P.
        • Mor-Avi V.
        • Afilalo J.
        • Armstrong A.
        • Ernande L.
        • et al.
        Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.
        Eur Heart J Cardiovasc Imaging. 2015; 16: 233-270
        • Galiè N.
        • Humbert M.
        • Vachiery J.L.
        • Gibbs S.
        • Lang I.
        • Torbicki A.
        • et al.
        2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: the joint task force for the diagnosis and treatment of pulmonary hypertension of the european Society of Cardiology (ESC) and the European Respiratory Society (ERS): endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT).
        Eur Heart J. 2016; 37: 67-119
        • Asami M.
        • Stortecky S.
        • Praz F.
        • Lanz J.
        • Räber L.
        • Franzone A.
        • et al.
        Prognostic value of right ventricular dysfunction on clinical outcomes after transcatheter aortic valve replacement.
        JACC Cardiovasc Imaging. 2019; 12: 577-587
        • Ishida Y.
        • Yoshinaga K.
        • Miyagawa M.
        • Moroi M.
        • Kondoh C.
        • Kiso K.
        • et al.
        Recommendations for (18)F-fluorodeoxyglucose positron emission tomography imaging for cardiac sarcoidosis: Japanese Society of Nuclear Cardiology recommendations.
        Ann Nucl Med. 2014; 28: 393-403
        • Pencina M.J.
        • D'Agostino Sr., R.B.
        • D'Agostino Jr., R.B.
        • Vasan R.S.
        Evaluating the added predictive ability of a new marker: from area under the ROC curve to reclassification and beyond.
        Stat Med. 2008; 27: 157-172
        • Kagioka Y.
        • Yasuda M.
        • Okune M.
        • Kakehi K.
        • Kawamura T.
        • Kobuke K.
        • et al.
        Right ventricular involvement is an important prognostic factor and risk stratification tool in suspected cardiac sarcoidosis: analysis by cardiac magnetic resonance imaging.
        Clin Res Cardiol. 2020; 109: 988-998
        • Buckberg G.
        • Hoffman J.I.
        Right ventricular architecture responsible for mechanical performance: unifying role of ventricular septum.
        J Thorac Cardiovasc Surg. 2014; 148 (3166-71.e1-4)
        • Hamada-Harimura Y.
        • Seo Y.
        • Ishizu T.
        • Nishi I.
        • Machino-Ohtsuka T.
        • Yamamoto M.
        • et al.
        Incremental prognostic value of right ventricular strain in patients with acute decompensated heart failure.
        Circ Cardiovasc Imaging. 2018; 11e007249
        • Haddad F.
        • Doyle R.
        • Murphy D.J.
        • Hunt S.A.
        Right ventricular function in cardiovascular disease, part II: pathophysiology, clinical importance, and management of right ventricular failure.
        Circulation. 2008; 117: 1717-1731
        • Dobarro D.
        • Schreiber B.E.
        • Handler C.
        • Beynon H.
        • Denton C.P.
        • Coghlan J.G.
        Clinical characteristics, haemodynamics and treatment of pulmonary hypertension in sarcoidosis in a single centre, and meta-analysis of the published data.
        Am J Cardiol. 2013; 111: 278-285
        • Wang T.K.M.
        • Grimm R.A.
        • Rodriguez L.L.
        • Collier P.
        • Griffin B.P.
        • Popović Z.B.
        Defining the reference range for right ventricular systolic strain by echocardiography in healthy subjects: a meta-analysis.
        PLoS One. 2021; 16e0256547