POS0308 HEMODYNAMIC FORCES: A NOVEL CARDIAC MRI PARAMETER TO ASSESS CARDIAC INVOLVEMENT IN SARCOIDOSIS PATIENTS

Background: 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 [1, 2]. 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 [3]. However, HDFs have not yet been studied in patients with suspected CS. Objectives: To investigate left ventricle (LV) HDFs in suspected CS compared to healthy controls (HC). Additionally, to 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. In sarcoidosis patients, cardiac involvement was confirmed using the WASOG (World Association for Sarcoidosis Other Granulomatous diseases) 2014 criteria [4], 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 (Figure 1); 22% had a positive cardiac FDG-PET, 11% had scintigraphy perfusion defects and 85% had LGE. 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. REFERENCES: [1] Lehtonen J, Uusitalo V, Pöyhönen P, Mäyränpää MI, Kupari M. Cardiac sarcoidosis: phenotypes, diagnosis, treatment, and prognosis. European Heart Journal 2023; 44 :1495–1510. [2] Cheng RK, Kittleson MM, Beavers CJ, Birnie DH, Blankstein R, Bravo PE et al, on behalf of the American Heart Association Heart Failure and Transplantation Committee of the Council on Clinical Cardiology, and Council on Cardiovascular and Stroke Nursing. Diagnosis and Management of Cardiac Sarcoidosis: A Scientific Statement From the American Heart Association. Circulation 2024:CIR.0000000000001240. [3] Vallelonga F, Airale L, Tonti G, Argulian E, Milan A, Narula J, Pedrizzetti G. Introduction to Hemodynamic Forces Analysis: Moving Into the New Frontier of Cardiac Deformation Analysis. JAHA 2021; 10 :e023417 [4] Judson MA, Costabel U, Drent M, Wells A, Maier L, Koth L, Shigemitsu H, et al. The WASOG Sarcoidosis Organ Assessment Instrument: An update of a previous clinical tool. Sarcoidosis Vasculitis and Diffuse Lung Diseases , 2014; 31; 19-2 Figure 1 Study flowchart depicting the selection and inclusion process. Abbreviations: CMR: cardiovascular magnetic resonance imaging; CS: cardiac sarcoidosis; HDF: hemodynamic forces. Figure 2Average longitudinal HDF in sarcoidosis patients with suspected-CS and healthy controls.Hemodynamic longitudinal force over the entire cardiac cycle comparison between sarcoidosis patients (blue) and healthy controls (red) using the average values of the entire cohorts. The vertical dotted line represents the end-systolic phase. *Systolic-diastolic transition and diastolic deceleration (in red rectangles) were both significantly altered in sarcoidosis patients compared to healthy controls. Abbreviations: HDF: hemodynamic forces; CS: cardiac sarcoidosis. Figure 3ROC curves of CMR-based HDF, LVEF and GLS for cardiac sarcoidosis diagnosis.The diagnostic performances standard CMR-assessed LVEF and GLS for evaluating CS was compared to 3 HDF parameters (LV systolic impulse, LV systolic peak, and LV longitudinal force). ROC curves were generated using a logistic regression model. The AUC of LVEF for CS diagnosis was 0.59 [95% CI: 0.24-0.95], while GLS had an AUC of 0.76 [95% CI: 0.24-0.94] and HDF an AUC of 0.88 [95% CI: 0.63-1.00]. Abbreviations: AUC: area under the curve. GLS: global longitudinal strain; HDF: hemodynamic forces; LV: left ventricle. LVEF: left ventricle ejection fraction; ROC: receiver operating characteristic. Acknowledgements: We thank the medical, paramedical and research staff of University Hospital of Lariboisiere (AP-HP, Paris, France). Aïcha Kante benefits from a grant from the Société Nationale Française de Medecine Interne (SNFMI) and the Filière des Maladies Auto-immunes et Auto-inflammatoires Rares (FAI2R). Disclosure of Interests: None declared . © The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.

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