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ArticleCirculation. Arrhythmia and electrophysiology2025

Magnetic Resonance Imaging in the Assessment of the Risk of Sudden Death in Cardiac Sarcoidosis: What Is Extensive or Significant Late Gadolinium Enhancement?

Pauli Pöyhönen, Jukka Lehtonen, Suvi Syväranta, Diana Velikanova, Henriikka Mälkönen, Piia Simonen, Hanna-Kaisa Nordenswan, Valtteri Uusitalo, Tapani Vihinen, Kari Kaikkonen and 7 more

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In one paragraph

Article in Circulation. Arrhythmia and electrophysiology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed.

  1. Redefining Cardiac Sarcoidosis with Advanced Imaging and Therapeutic Strategies.American journal of cardiovascular drugs : drugs, devices, and other interventions · 2026
    Review
  2. Article
  3. Article
  4. Article
  5. Article
  6. Article
  7. Left Ventricular Ring-like Pattern: The Arrhythmic Tale of a Scarred Heart.Journal of cardiovascular development and disease · 2025
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors.

Pauli PöyhönenHeart and Lung Center, Helsinki University Hospital and University of Helsinki, Finland (P.P., J.L., D.V., H.M., P.S., H.-K.N., M.K.).ORCID 0000-0002-3031-5391
Jukka LehtonenHeart and Lung Center, Helsinki University Hospital and University of Helsinki, Finland (P.P., J.L., D.V., H.M., P.S., H.-K.N., M.K.).ORCID 0000-0001-7637-6061
Suvi SyvärantaRadiology, Helsinki University Hospital and University of Helsinki, Finland (P.P., S.S., V.U.).ORCID 0000-0003-1889-3858
Diana VelikanovaHeart and Lung Center, Helsinki University Hospital and University of Helsinki, Finland (P.P., J.L., D.V., H.M., P.S., H.-K.N., M.K.).ORCID 0009-0001-9688-4458
Henriikka MälkönenHeart and Lung Center, Helsinki University Hospital and University of Helsinki, Finland (P.P., J.L., D.V., H.M., P.S., H.-K.N., M.K.).ORCID 0009-0002-7698-0896
Piia SimonenHeart and Lung Center, Helsinki University Hospital and University of Helsinki, Finland (P.P., J.L., D.V., H.M., P.S., H.-K.N., M.K.).ORCID 0000-0002-3394-6420
Hanna-Kaisa NordenswanHeart and Lung Center, Helsinki University Hospital and University of Helsinki, Finland (P.P., J.L., D.V., H.M., P.S., H.-K.N., M.K.).ORCID 0000-0003-0114-114X
Valtteri UusitaloRadiology, Helsinki University Hospital and University of Helsinki, Finland (P.P., S.S., V.U.).ORCID 0000-0001-7345-7122
Tapani VihinenHeart Center, Turku University Hospital, Finland (T.V.).
Kari KaikkonenMedical Research Center Oulu, University and University Hospital of Oulu, Finland (K.K.).ORCID 0000-0002-4939-0105
Petri HaatajaHeart Hospital, Tampere University Hospital, Finland (P.H.).
Tuomas KerolaDepartment of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland (T.K.).
Tuomas T RissanenHeart Center, North Karelia Central Hospital, Joensuu, Finland (T.T.R.).ORCID 0000-0002-1914-2282
Ville VepsäläinenHeart Centre, Kuopio University Hospital, Finland (V.V.).ORCID 0000-0001-7712-2506
Aleksi AlataloSouth Ostrobothnia Central Hospital, Seinäjoki, Finland (A.A.).ORCID 0009-0001-5813-8489
Päivi Pietilä-EffatiVaasa Central Hospital, Finland (P.P.-E.).ORCID 0000-0002-4502-8934
Markku KupariHeart and Lung Center, Helsinki University Hospital and University of Helsinki, Finland (P.P., J.L., D.V., H.M., P.S., H.-K.N., M.K.).ORCID 0000-0002-5813-3477

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCardiac sarcoidosis involves a significant but difficult-to-define risk of sudden cardiac death (SCD). Current guidelines recommend consideration of an implantable cardioverter defibrillator for patients with extensive or significant myocardial late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging. However, extensive/significant LGE is not defined.

methodsA nationwide cardiac sarcoidosis registry was screened for patients entered before 2020 with cardiac magnetic resonance imaging done before or <3 months after diagnosis. Available studies were re-analyzed for LGE mass as a percentage of left ventricular (LV) mass and the number of LGE-positive LV segments in a 17-segment model. The occurrence of fatal or aborted SCD and ventricular tachycardia (VT) prompting therapy was recorded until the end of 2020 and subjected to cumulative incidence analyses, including competing events (LV assist device implantations, heart transplantations, and fatalities other than SCD). The predictors of SCD/VT were assessed using Fine and Gray modeling and time-dependent receiver operating characteristic analysis.

resultsAltogether, 305 patients (66% women, median age 51) with clinically manifest, definite (45%) or probable cardiac sarcoidosis (55%) were analyzed. On follow-up (median, 4.0 years), 21 SCDs, 60 VTs, and 14 competing events were noted. Both LGE mass and the number of LGE segments predicted the composite of SCD/VT (

conclusionsIn cardiac sarcoidosis, myocardial LGE making up ≥9.9% of LV mass or affecting ≥6 LV segments may suggest prognostically significant LV involvement and a high risk of SCD. However, prospective validation of the thresholds is needed.

Indexed as

CardiomyopathiesContrast MediaDeath, Sudden, CardiacGadoliniumMagnetic Resonance Imaging, CineMyocardiumSarcoidosisAdultDefibrillators, ImplantableFemaleHumansIncidenceMaleMiddle AgedPredictive Value of TestsRegistriesContrast MediaGadoliniumcontrast mediagadoliniumincidencemagnetic resonance imagingsarcoidosissudden death

Identifiers

PMID39704049
PMCPMC11753451

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.