Dyssynchrony of the interventricular septum in sarcoid Patients revealed by Cardiac-MRI

<bold>Background:</bold> In 2021 ERS guidelines of sarcoidosis introduced cardiac CMR as mandatory step of screening of cardiac involvement. The aim of this study is to describe CMR features of a consecutive series of sarcoid patients enrolled to identify signs of cardiac involvement. <bold>Materials and methods:</bold> From January 2021 to July 2023 consecutive patients with a biopsy proven sarcoidosis were prospectively enrolled into the study (being the MDT in Respiratory disease a National Referral for Sarcoidosis). Inclusion criteria were: age above 18 years old; absence of any contraindication for MRI. Patients enrolled: first diagnosis or with onset of new symptoms (palpitation, chest pain, lung progression, new systemic symptoms). Exams performed: pulmonary function test, ECG, CT scan for lung parenchyma study, cardiac MRI and CT-PET. <bold>Results:</bold> One-hundred twenty consecutive patients were included (males: 58); the age range was 30-82 years-old The mean age was 55 years old. Respiratory symptoms included: chest pain (n=10), dry cough (n=21) and mild to moderate dyspnoea on exertion (n=23). The cardiac symptoms included palpitations (n= 23) and, rarely, angor (n=5). Cardiac-MRI showed a transmural LGE with non-coronary distribution was present in 11% of cases , and subepicardial LGE was observed in 12%. 53% (n=64) patients had dyssinchrony of the septum was observed, even in absence of associated septal LGE or history of right or left branch blockade; of these cases, 27 patients had cardiac symptoms and increased septal T1 mapping. <bold>Conclusions:</bold> cardiac MR findings may range from subtle to a severe involvement. Septal dyssinchrony potentially could represent an early involvement of the peripheral electric branches.