CHEST Guidelines-Response_chest

Response_chest_7 (1)

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In a response to Dr. Alter and colleagues, Dr. Toshiyuki Nagai and team address their findings on the prognostic significance of cardiovascular MRI (CMR) parameters in patients with systemic sarcoidosis published in "CHEST". Their study analyzed left ventricular (LV) ejection fraction, LV end-systolic volume, and LV end-diastolic volume, finding these measures similar in patients experiencing cardiac events and those who did not, except for LV mass, which was significantly larger in those who experienced adverse events. The study also found no significant differences in these measures between groups with and without late gadolinium enhancement (LGE), suggesting the volume and systolic function measured by CMR were not directly associated with adverse events or LGE.<br /><br />Contrary to previous studies, their research found lower rates of LGE and cardiac events, with LGE not predicting adverse outcomes. These differences may be attributed to the lower severity of disease among their study participants, characterized by fewer patients receiving immunosuppressants, fewer ECG abnormalities, no cardiac symptoms, and a smaller extent of LGE. Previous research, such as Ise et al., supports that smaller extents of LGE predict lower rates of cardiac events.<br /><br />The authors suggest a larger study cohort, inclusive of patients with greater disease severity and impaired LV function, is needed to better understand the relationship between LV measurements and long-term prognosis in systemic sarcoidosis. <br /><br />The team from Osaka and Tokyo also noted no conflicts of interest, and they highlight the need for further studies to confirm these implications, linking CMR findings to outcomes in sarcoidosis with more severe cardiac involvement.

Keywords

cardiovascular MRI

systemic sarcoidosis

left ventricular ejection fraction

LV mass

late gadolinium enhancement

cardiac events

immunosuppressants

prognostic significance

cardiac involvement

long-term prognosis