CHEST Guidelines-Late-Gadolinium-Enhancement-in-Sarcoidosis

Late-Gadolinium-Enhancement-in-Sarcoidosis_chest

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The letter to the editor discusses a study by Nagai et al., published in CHEST in October 2014, which investigated the occurrence of late gadolinium enhancement (LGE) observed via cardiovascular MRI in sarcoidosis patients. The study reported that 13% of the 61 patients exhibited varied patterns of LGE and identified interventricular septum thinning as an independent predictor of LGE. This raises questions regarding the pathophysiological reasoning behind the association of LGE with septal thinning, and the need for further exploration into potential morphological or functional substrates of LGE in sarcoidosis.<br /><br />The correspondence notes that LGE results from prolonged interstitial contrast-agent deposition during imaging, with established accuracy for delineating scarring post-myocardial infarction, though its diagnostic reliability for non-infarct cardiac conditions remains less clear. In dilated cardiomyopathy, LGE commonly appears in septal or hinge point patterns, often hypothesized to indicate fibrosis, despite histology showing a mismatch in pattern distribution.<br /><br />Highlighting findings from 300 cardiomyopathy patients, the letter links LGE presence with increased ventricular wall stress, driven by altered ventricular volumes, mass, and transmural pressure gradients. As Nagai et al. indicated septum thinning as an LGE predictor, implying reduced myocardial mass and increased wall stress, there's a suggestion for further studying this relationship using CMR-based myocardial mass and wall stress calculations in sarcoidosis. <br /><br />The potential of increased wall stress to elevate arrhythmia risk and cause adverse remodeling prompts consideration of it as a causative factor in sarcoidosis patients exhibiting LGE. The authors call for deeper evaluation to clarify wall stress's impact on such patients, emphasizing its implications for prognosis and treatment strategies.

Keywords

sarcoidosis

late gadolinium enhancement

cardiovascular MRI

interventricular septum thinning

myocardial mass

wall stress

arrhythmia risk

cardiomyopathy

fibrosis

prognosis