Abstract 13286: Reduced Left Ventricular Ejection Fraction and Higher Angiotensin-Converting Enzyme Levels as Key Determinants of Histopathologic Diagnosis by Endomyocardial Biopsy in Patients With Cardiac Sarcoidosis

BackgroundThe presence of cardiac involvement has been recognized as a determinant of worse clinical outcomes in patients with systemic sarcoidosis. However, it is often difficult to diagnose cardiac sarcoidosis (CS) histologically because of the sampling error in endomyocardial biopsy (EMB), and the determinants of positive EMB are also unclear. Lower left ventricular ejection fraction (LVEF) is a common parameter of the extent of myocardial damage and higher angiotensin- converting enzyme (ACE) levels would indicate the spread of disease activity in CS patients. We therefore sought to examine whether LVEF and ACE levels are related to positive findings of EMB in patients with CS.MethodsA total of 101 consecutive CS patients who underwent both echocardiography and EMB in two academic hospitals between August 1986 and March 2019 were examined. We determined positive EMB if non-caseating epithelioid granulomas were confirmed in the myocardial tissue. We assessed the relationship between LVEF, ACE levels and the detection of positive EMB.ResultsMean age was 59 ± 11 years and 79 (78%) were female. Positive EMB was found in 41 (41%) patients. Patients were divided into two groups according to positive (n=41) and negative (n=60) EMB. Patients with positive EMB were younger and had lower LVEF and higher ACE levels than those with negative EMB. Multivariable analysis revealed that LVEF and ACE were independent determinants of positive EMB, while any other parameters except for age were not significant determinants (Table). Moreover, patients with lower LVEF (