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Final Program


Program-At-A-Glance

Rapid Fire Session

Session: Rapid Fire Session 5: CMR - Analysis (including machine learning) (Monitor 5)

Hemodynamic forces: a novel non-contrast CMR parameter to detect early cardiac involvement in Sarcoidosis patients

Saturday, February 7, 2026
10:15 AM - 10:22 AM  
Location: Galapagos / Aruba / Ilhabela (2nd Lower Level)
Background: Cardiac sarcoidosis (CS) is an underdiagnosed condition characterised by the formation of non-caseating granuloma in the myocardium, potentially leading to arrhythmia, heart failure and sudden cardiac death. Cardiovascular magnetic resonance imaging (CMR) based hemodynamic forces (HDF) are novel non-contrast parameters used to assess early cardiac dysfunction. We investigated left ventricle (LV) HDF in sarcoidosis with suspected cardiac involvement compared to healthy controls (HC), and between patients with confirmed and refuted CS diagnosis.

Methods: In a single-centre study, all consecutive patients with biopsy-proven sarcoidosis underwent a 1.5T CMR exam. Using a dedicated core laboratory analysis, HDF were obtained from cine images using an advanced post-processing software (Medis Suite). CS was defined according to the WASOG (World Association for Sarcoidosis and Other Granulomatous diseases) 2014 criteria.

Results: Of 45 patients with suspicion of cardiac involvement, 27 (60 %) had confirmed CS: 6 (13%) showed positive findings on positron emission tomography, 3 (7%) had defects on scintigraphy and 23 (51 %) displayed late gadolinium enhancement (LGE). HDF were significantly altered in the sarcoidosis cohort compared to HC (Figure 1). Although LV strain measurements and ejection fraction (median [IQR]) were not statistically different between CS (56 [53–60]%) and non-CS patients (60 [55–64]%) (p=0.2), HDF parameters including LV longitudinal force (p=0.041), LV impulse (p=0.018), and LV systolic peak (p=0.035) were significantly altered in patients with CS. The diagnostic performances standard CMR-assessed LVEF and GLS for evaluating CS was compared to 3 combined 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] (Figure 2).

Conclusion: Compared to HC, patients with suspected CS showed altered LV HDF due to altered LV geometry and mechanics. LV HDF parameters outperformed traditional volumetric and functional parameters in predicting CS in sarcoidosis patients.

Table 1. Hemodynamic forces comparison between healthy controls and all sarcoidosis patients.

 

LV hemodynamic forces parameters

 

Overall,

N=90

 

Healthy controls,

N=45

Sarcoidosis patients

N=45

p-value

LV longitudinal force

18.0 (14.0, 21.0)

18.0 (16.0, 22.0)

17.0 (12.0, 20.0)

0.084

LV transversal force

2.8 (2.1, 3.2)

2.7 (2.2, 3.2)

2.9 (2.1, 3.3)

0.70

Transverse / Longitudinal ratio

15.6 (12.2, 17.5)

15.1 (11.4, 16.8)

16.3 (14.4, 18.8)

0.033

Angle (°)

77.0 (76.0, 79.0)

77.0 (76.0, 79.0)

77.0 (73.0, 78.0)

0.031

LV systolic longitudinal force

24.0 (19.0, 30.0)

25.0 (21.0, 30.0)

24.0 (17.0, 28.0)

0.12

LV systolic transversal force

3.3 (2.3, 4.0)

3.1 (2.3, 3.9)

3.5 (2.3, 4.0)

0.50

LV systolic ratio

13.0 (10.2, 16.0)

11.5 (9.2, 15.0)

14.3 (10.9, 17.3)

0.018

LV systolic peak

41.0 (34.0, 53.0)

45.0 (37.0, 53.0)

41.0 (27.0, 52.0)

0.13

LV impulse

27.0 (21.0, 32.0)

28.0 (23.0, 33.0)

25.0 (18.0, 32.0)

0.065

LV diastolic longitudinal force

10.3 (7.6, 13.0)

11.3 (8.3, 14.0)

9.9 (6.7, 12.1)

0.079

LV diastolic transversal force

2.1 (1.5, 2.8)

2.1 (1.5, 2.8)

2.2 (1.59, 2.7)

>0.9

LV diastolic ratio

20.0 (15.0, 25.0)

20.0 (15.0, 23.0)

20.0 (15.0, 28.0)

0.40

LV systolic-diastolic transition

13.0 (9.0, 17.0)

15.0 (11.0, 18.0)

12.0 (8.0, 15.0)

0.012

LV diastolic deceleration

9.9 (7.1, 13.4)

12.0 (7.7, 13.7)

9.3 (6.2, 11.2)

0.013

LV atrial thrust

3.9 (2.6, 5.3)

3.4 (2.7, 4.9)

4.6 (2.6, 5.9)

0.30


  
Table 2. Hemodynamic forces comparison between sarcoidosis patients with and without cardiac involvement.

 

LV hemodynamic forces parameters

 

Overall population

with sarcoidosis

N=45

 

Sarcoidosis patients

with refuted-CS*

N=18

Sarcoidosis patients

with confirmed-CS*

N=27

p-value

LV longitudinal force

17.0 (12.0, 20.0)

19.0 (17.0, 22.0)

14.0 (12.0, 19.0)

0.041

LV transversal force

2.9 (2.1, 3.3)

3.0 (2.4, 3.3)

2.6 (2.0, 3.1)

0.13

Transverse / Longitudinal ratio

16.3 (14.4, 18.8)

16.0 (14.2, 17.5)

16.4 (14.6, 19.7)

0.70

Angle (°)

77.0 (73.0, 78.0)

77.0 (74.0, 78.0)

77.0 (74.0, 79.0)

0.70

LV systolic longitudinal force

24.0 (17.0, 28.0)

27.0 (20.0, 32.0)

19.0 (16.0, 26.0)

0.091

LV systolic transversal force

3.5 (2.3, 4.0)

3.7 (2.8, 4.6)

3.3 (2.2, 3.8)

0.30

LV systolic ratio

14.3 (10.9, 17.3)

14.1 (10.4, 16.9)

14.7 (11.3, 17.5)

0.40

LV impulse

25.0 (18.0, 32.0)

30.0 (23.0, 34.0)

21.0 (17.0, 28.0)

0.018

LV systolic peak

41.0 (27.0, 52.0)

50.0 (36.0, 57.0)

36.0 (25.0, 46.0)

0.035

LV diastolic longitudinal force

9.9 (6.7, 12.1)

9.9 (7.1, 11.9)

9.9 (6.9, 11.8)

>0.9

LV diastolic transversal force

2.2 (1.6, 2.7)

2.3 (1.7, 2.8)

2.1 (1.6, 2.5)

0.30

LV diastolic ratio

20.0 (15.0, 28.0)

20.0 (17.0, 34.0)

20.0 (15.0, 26.0)

0.30

LV systolic-diastolic transition

11.6 (8.4, 15.2)

11.7 (8.9, 15.0)

11.6 (8.2, 15.3)

0.80

LV diastolic deceleration

9.3 (6.2, 11.2)

9.1 (6.3, 11.5)

9.3 (6.4, 11.2)

0.80

LV atrial thrust

4.6 (2.6, 5.9)

4.4 (2.5, 5.2)

4.6 (3.3, 6.0)

0.70


 
Figure 1. Average longitudinal HDF in sarcoidosis patients with suspected-CS and healthy controls.
Figure 2. ROC curves of CMR-based HDF, LVEF and GLS for cardiac sarcoidosis diagnosis.
Central illustration: Hemodynamic forces: a novel CMR parameter to detect early cardiac involvement in sarcoidosis patients.