| Sumario: | Background: Patients with cardiac sarcoidosis (CS) are at increased risk of life‐threatening ventricular arrhythmias (VA). Current approaches to risk stratification have limited predictive value. Objectives: To assess the utility of spatial dispersion analysis of late gadolinium enhancement cardiac magnetic resonance (LGE‐CMR), as a quantitative measure of myocardial tissue heterogeneity, in risk stratifying patients with CS for VA and death. Methods: Sixty two patients with CS underwent LGE‐CMR. LGE images were segmented and dispersion maps of the left and right ventricles were generated as follows. Based on signal intensity (SI), each pixel was categorized as abnormal (SI ≥3SD above the mean), intermediate (SI 1–3 SD above the mean) or normal (SI <1SD above the mean); and each pixel was then assigned a value of 0 to 8 based on the number of adjacent pixels of a different category. Average dispersion score was calculated for each patient. The primary endpoint was VA during follow up. The composite of VA or death was assessed as a secondary endpoint. Results: During 4.7 ± 3.5 years of follow up, six patients had VA, and five without documented VA died. Average dispersion score was significantly higher in patients with VA versus those without (0.87 ± 0.08 vs. 0.71 ± 0.16; p =.002) and in patients with events versus those without (0.83 ± 0.08 vs. 0.70 ± 0.16; p =.003). Patients at higher tertiles of dispersion score had a higher incidence of VA (p =.03) and the composite of VA or death (p =.01). Conclusions: Increased substrate heterogeneity, quantified by spatial dispersion analysis of LGE‐CMR, may be helpful in risk‐stratifying patients with CS for adverse events, including life‐threatening arrhythmias.
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