Clinical phenotypes of cardiac sarcoidosis by latent class analysis

Background

Sarcoidosis is a systemic granulomatous disease with cardiac involvement reported in 20–27% of patients [1]. Cardiac sarcoidosis (CS) can lead to atrial or ventricular arrhythmias, various conduction system disorders, heart failure or sudden cardiac death, depending on the location of myocardial involvement [2]. Previous studies have investigated the possible types of CS based on the distribution of myocardial involvement on imaging as well as the role of genetic factors [3,4]. However, there are no studies describing the clinical heterogeneity of CS patients.

Purpose

In order to determine if clinical clusters exist in CS, we carried out a latent class analysis (LCA) to explore potential phenotypes in a large sample of CS patients from the National Inpatient Sample (NIS).

Methods

We identified 848 patients with a diagnosis of CS from the NIS in 2016–2018. A LCA was performed based on comorbidities. Utilizing the Bayesian information criterion and Akaike's information criterion we divided our study population into 3 cohorts. We subsequently applied the LCA model for our study population to fit each patient into one of the 3 cohorts. Finally, we compared the clinical outcomes among the 3 groups.

Results

Following LCA, patients in cohort 3 were strongly associated with a cardiometabolic syndrome profile with the highest prevalence of congestive heart failure (CHF, 95.1%), chronic kidney disease (CKD, 69.7%), diabetes mellitus (68.9%), hyperlipidemia (52.5%) and obesity (45.1%). Patients in cohort 2 had an intermediate prevalence of cardiometabolic syndrome with a universal diagnosis of hypertension (100%) but with the lowest number of CHF (32.5%) patients and none with CKD. Finally, patients in cohort 1 had the least comorbidities in comparison to the other groups but there was a higher prevalence of CHF (71.7%). There was no significant difference in mortality among the 3 groups, but acute respiratory failure was the highest in cohort 3. However, ventricular arrhythmias were more prevalent in cohort 1 patients (Table).

Conclusion

We identified 3 different types of CS based on their clinical phenotype. The clinical outcomes varied among the cohorts with ventricular arrhythmias being the most prevalent in patients with the least cardiometabolic comorbidities.

Funding Acknowledgement

Type of funding sources: None.

Globe sparing orbital exenteration

OBJECTIVE

Orbital exenteration has long been the oncologic standard for malignant craniofacial lesions that invade the periorbita/orbit from adjacent locations. Although oncologically sound, this radical surgical procedure is cosmetically disfiguring for all patients. Most of the reconstructive options available are complex, requiring further surgery and/or expense. We herein introduce an alternative surgical technique for radical orbital surgery that spares the globe, thereby allowing an early, aesthetic appearance at a nominal cost.

STUDY DESIGN AND SETTING

Twenty consecutive patients requiring an oncologic orbital exenteration and meeting the indications for the new procedure underwent surgery at a tertiary care medical center. Follow-up ranged from 1 to 6 years.

RESULTS

Only 1 patient recurred in the orbit due to an error in patient selection. There was no surgical morbidity resulting from the globe-sparing technique itself.

CONCLUSION

Globe-sparing orbital exenteration is a one-step, oncologically sound, aesthetically superior, low-cost alternative for those patients requiring radical orbital surgery and reconstruction.

Towards a microMRI atlas of mouse development

This study investigates the potential of microscopic Magnetic Resonance Imaging to obtain information for 3D digital atlases of mouse development using fixed samples. Fixed samples allow direct comparison with already published atlases and provide a testing ground for future in vivo efforts. 3D MR images of mouse embryos (dpc 6.5-16) illustrate that the necessary contrast and level of detail is available with this technique. Diffusion weighted imaging, diffusion tensor imaging, and multi-valued data sets are presented as examples of uniquely MR methods of obtaining anatomical information. MRI is performed non-invasively on the intact sample, leaving open the possibility of other manipulations (e.g. classical histology, immunohistochemistry, in situ hybridization, and in vitro growth for unfixed samples) after conducting the MRI experiment.