1. Serviço de Cardiologia Hospital de Santa Maria Centro Hospitalar Lisboa Norte Subclinical focal fibrosis and abnormal strain in patients with sarcoidosis without clinical evidence of cardiac disease Gustavo Lima Silva, MD, Ana G. Almeida, MD, PhD, Cláudio David, MD, Ana Rita Francisco, MD, Andreia Magalhães, MD, Rui Plácido, MD, Miguel Menezes, MD,Tatiana Guimarães, MD, Ana Cristina Mendes, MD, A. Nunes Diogo, MD Cardiology Department University Hospital Santa Maria/CHLN Faculty of Medicine of Lisbon University

2. Cardiac involvement in sarcoidosis (SC) occurs in 20-25% of patients and is associated with poor outcome and reduced survival; The diagnosis of cardiac SC using conventional methods (including echocardiography) is challenging in asymptomatic patients. Background

3. To determine the role of cardiac magnetic resonance (CMR) in the diagnosis of subclinical cardiac SC in patients with pulmonary SC. Aim

4. Prospective observational study Inclusion criteria: Consecutive patients with pulmonary SC referred for CMR by a specialized SC clinic, with pulmonary SC and absence of cardiovascular disease based on clinical data, normal ECG and normal conventional echocardiography A control group of 17 healthy individuals was included for myocardial deformation assessment Exclusion criteria: 1.Non sinus rhythm; 2.More than mild valvular disease; 3.Ischemic heart disease; 4.General contraindication to CMR and/or gadolinium administration. Methods

5. CMR - 3.0 Tesla, Phillips Achieva a)CineCMR SSFP for LV and RV volumes and EF b)T2-weighted imaging for myocardial edema c)Late gadolinium enhancement d)Tagging obtained in 4-chamber and 2-chamber planes longitudinal strain evaluation CMR analysis - cmr42 Statistical analysis - SPSS 20.0 Methods

6. RESULTS CMR data in the population of SC patients Focal LGE was found in the midwall and/or subepicardium of the basal septum and inferolateral myocardial segments. N31 Age (years), mean±SD50±14 Females, N (%)15 (48) LV EDV (ml/m2); mean±SD72±11 EF (%); mean±SD59±6 T2W increased intensity, N (%)0 (0) Presence of LGE, N (%)9 (29)

7. SA image of LGE at the infero-lateral wall of a patient with sarcoidosis 2-chamber image of midwall LGE at the inferior wall and apical segment of a patient with sarcoidosis

8. RESULTS In 18 SC patients (9 patients focal LGE+, 9 LGE-) longitudinal strain values were abnormal, with a mean value of -13.5% ±1.2 CMR longitudinal strain in the population of SC patients Mean longitudinal strain %p SC patients with LGE+ -11.6±1.1 0.003* All SC patients -13,5±1.2 0.006** Controls-18.0±1.1 * Patients with LGE vs all patients ** All patients vs controls

9. Serviço de Cardiologia Hospital de Santa Maria Centro Hospitalar Lisboa Norte In patients with sarcoidosis, CMR showed subclinical cardiac involvement in a substantial proportion of patients. We found focal LGE and abnormal longitudinal strain in patients probably due to both focal and widespread myocardial disease The impact of these findings on the outcome is presently being assessed by our group. Conclusion Cardiology Department University Hospital Santa Maria/CHLN Faculty of Medicine of Lisbon University