1
|
Mactaggart S, Ahmed R. The role of ICDs in patients with sarcoidosis-A comprehensive review. Curr Probl Cardiol 2024; 49:102483. [PMID: 38401822 DOI: 10.1016/j.cpcardiol.2024.102483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 02/21/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Implantable cardioverter defibrillator (ICD) use in cardiac sarcoidosis (CS) to prevent sudden cardiac death (SCD) is a potentially life-saving intervention. However, the factors that determine outcome in this cohort remains largely unknown. This review analyses CS patients with an ICD and highlights determinants of poor outcome. OUTCOMES Analysis of studies which used the 2014 HRS Consensus, 2017 AHA/ACC/HRS Guideline and 2022 ESC Guidelines showed that those with class I recommendations have higher incidences of ventricular arrhythmia (VA) than those with class II recommendations. Additionally, even those with normal left ventricular ejection fraction (LVEF) and CS are at high risk of VA and SCD. SUMMARY Compounding research emphasises the importance of cardiac imaging in those with sarcoidosis, with evidence to suggest a possible need for revision of the guidelines. Other variables such as demographics and ventricular characteristics may prove useful in predicting those to benefit most from ICD insertion.
Collapse
Affiliation(s)
| | - Raheel Ahmed
- Royal Brompton Hospital, London, United Kingdom; National Heart and Lung Institute, Imperial College London, United Kingdom
| |
Collapse
|
2
|
Arps K, Doss J, Geiger K, Flores-Rosario K, DeVore AD, Karra R, Kim HW, Piccini JP, Pokorney SD, Sun AY. Incidence and Predictors of Relapse After Weaning Immune Suppressive Therapy in Cardiac Sarcoidosis. Am J Cardiol 2023; 204:249-256. [PMID: 37556894 DOI: 10.1016/j.amjcard.2023.07.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/13/2023] [Indexed: 08/11/2023]
Abstract
Cardiac sarcoidosis (CS) is a relapsing-remitting disease, and immune suppression (IS) is the mainstay of therapy. Predictors of relapse for patients with CS in remission are not well characterized. We assessed incidence of relapse in consecutive patients with CS treated with high-dose steroids and/or steroid-sparing agents (SSA) in our center from 2000 to 2020. Remission was defined as reaching maintenance therapy (no IS, SSA, and/or prednisone ≤5 mg/d) for ≥1 month. Relapse was defined as recurrence of CS syndrome requiring IS intensification: heart failure, ventricular arrhythmia, decrease in left ventricular ejection fraction, or increased disease burden on imaging. Among 68 patients, the mean age was 50.7±9.0 years; 25 (37%) were women, and 32 (47%) were Black. In total, 59 patients (87%) reached remission. Over a median follow-up of 39.5 months (interquartile range 17.6, 92.5), 28 (48%) relapsed. Greater percentage of late gadolinium enhancement (LGE) on pretreatment magnetic resonance imaging corresponded with increased likelihood of relapse (odds ratio 1.396 per 5% increase [95% confidence interval (CI) 1.04 to 1.88]; p = 0.028). LGE ≥11% predicted elevated risk of relapse (adjusted odds ratio 4.998 [1.34 to 18.64]; p = 0.017). Shorter time to relapse was observed with isolated CS (adjusted hazard ratio 4.084 [1.44,11.56]; p = 0.008) and LGE ≥11% (adjusted hazard ratio 3.007 [1.01, 8.98]; p = 0.049). Approximately 1 in 2 patients with CS in remission experienced relapse. Greater burden of LGE on cardiac magnetic resonance imaging and isolated CS are associated with greater risk of relapse. Future work is needed to refine risk stratification for relapse and to optimize surveillance strategies on the basis of the burden of disease.
Collapse
Affiliation(s)
- Kelly Arps
- Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
| | - Jayanth Doss
- Duke University Medical Center, Durham, North Carolina
| | - Kelly Geiger
- Duke University Medical Center, Durham, North Carolina
| | | | - Adam D DeVore
- Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Ravi Karra
- Duke University Medical Center, Durham, North Carolina
| | - Han W Kim
- Duke University Medical Center, Durham, North Carolina
| | - Jonathan P Piccini
- Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Sean D Pokorney
- Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Albert Y Sun
- Duke University Medical Center, Durham, North Carolina; Durham Veterans Affairs Medical Center, Durham, North Carolina
| |
Collapse
|
3
|
Magnocavallo M, Vetta G, Polselli M, Cauti FM, Parlavecchio A, Caminiti R, Crea P, Pannone L, Sorgente A, Chimenti C, Chierchia GB, Rossi P, Natale A, de Asmundis C, Bianchi S, Della Rocca DG. "Function follows form": Role of cardiac magnetic resonance for ventricular arrhythmia risk stratification in patients with cardiac sarcoidosis. J Cardiovasc Electrophysiol 2023; 34:1781-1784. [PMID: 37493490 DOI: 10.1111/jce.16020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/26/2023] [Accepted: 07/14/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Cardiac involvement is common and may become clinically relevant in approximately 5%-10% of patients with systemic sarcoidosis. Although reduced left ventricular ejection fraction is a recognized predictor of mortality, recent studies have suggested an increased risk of ventricular arrhythmia (VAs) and sudden cardiac death (SCD) in patients with cardiac sarcoidosis (CS) and evidence of late gadolinium enhancement-cardiac magnetic resonance (LGE-CMR), irrespective of the underlying left ventricular systolic function. We performed a meta-analysis to assess the correlation between VAs/SCD and presence of LGE-CMR in CS patients. METHODS We systematically searched Medline, Embase, and Cochrane electronic databases up to January 2, 2023, for studies enrolling patients with suspected or confirmed CS undergoing LGE-CMR. Clinical outcomes of interest included clinically relevant VAs, defined as sustained ventricular tachycardia, ventricular fibrillation, SCD, or aborted SCD during follow-up. The effect size was estimated using a random-effect model as risk ratio (RR) and relative 95% confidence interval (CI). RESULTS A total of 14 studies fulfilled the selection criteria and were included in the final analysis. Among 1273 patients, LGE was detected in 465 (36.5%; Group LGE+). Males accounted for 45.2% (95% CI: 40.5%-55.7%) of the total population and the average age was 56.8 (95% CI: 52.7%-60.9) years. A total of 104 (22.3%) of 465 LGE+ patients experienced a clinically relevant VA, compared to 6 (0.7%) of 808 LGE- ones. LGE+ was associated with a ninefold increased risk in life-threatening VAs (22.3% vs. 0.7%; RR = 9.52; 95% CI [5.18-17.49]; p < .0001) compared to patients without LGE (heterogeneity I2 = 0%). CONCLUSION In our meta-analysis, LGE+ in patients with CS was associated with a ninefold increased risk in life-threatening VAs compared to patients without LGE.
Collapse
Affiliation(s)
- Michele Magnocavallo
- Cardiology Division, Arrhythmology Unit, S. Giovanni Calibita Hospital, Isola Tiberina, Rome, Italy
- Mediterranean Consortium for Arrhythmia Research (MediCAR), Rome, Italy
| | - Giampaolo Vetta
- Mediterranean Consortium for Arrhythmia Research (MediCAR), Rome, Italy
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Marco Polselli
- Cardiology Division, Arrhythmology Unit, S. Giovanni Calibita Hospital, Isola Tiberina, Rome, Italy
| | - Filippo Maria Cauti
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Antonio Parlavecchio
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Rodolfo Caminiti
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Pasquale Crea
- Department of Clinical and Experimental Medicine, Cardiology Unit, University of Messina, Messina, Italy
| | - Luigi Pannone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Antonio Sorgente
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Cristina Chimenti
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Pietro Rossi
- Cardiology Division, Arrhythmology Unit, S. Giovanni Calibita Hospital, Isola Tiberina, Rome, Italy
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Stefano Bianchi
- Cardiology Division, Arrhythmology Unit, S. Giovanni Calibita Hospital, Isola Tiberina, Rome, Italy
| | - Domenico G Della Rocca
- Mediterranean Consortium for Arrhythmia Research (MediCAR), Rome, Italy
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| |
Collapse
|
4
|
Wang J, Zhang J, Hosadurg N, Iwanaga Y, Chen Y, Liu W, Wan K, Patel AR, Wicks EC, Gkoutos GV, Han Y, Chen Y. Prognostic Value of RV Abnormalities on CMR in Patients With Known or Suspected Cardiac Sarcoidosis. JACC Cardiovasc Imaging 2023; 16:361-372. [PMID: 36752447 DOI: 10.1016/j.jcmg.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/01/2022] [Accepted: 11/14/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Left ventricular abnormalities in cardiac sarcoidosis (CS) are associated with adverse cardiovascular events, whereas the prognostic value of right ventricular (RV) involvement found on cardiac magnetic resonance is unclear. OBJECTIVES This study aimed to systematically assess the prognostic value of right ventricular ejection fraction (RVEF) and RV late gadolinium enhancement (LGE) in known or suspected CS. METHODS This study was prospectively registered in PROSPERO (CRD42022302579). PubMed, Embase, and Web of Science were searched to identify studies that evaluated the association between RVEF or RV LGE on clinical outcomes in CS. A composite endpoint of all-cause death, cardiovascular events, or sudden cardiac death (SCD) was used. A meta-analysis was performed to determine the pooled risk ratio (RR) for these adverse events. The calculated sensitivity, specificity, and area under the curve with 95% CIs were weighted and summarized. RESULTS Eight studies including a total of 899 patients with a mean follow-up duration of 3.2 ± 0.7 years were included. The pooled RR of RV systolic dysfunction was 3.1 (95% CI: 1.7-5.5; P < 0.01) for composite events and 3.0 (95% CI: 1.3-7.0; P < 0.01) for SCD events. In addition, CS patients with RV LGE had a significant risk for composite events (RR: 4.8 [95% CI: 2.4-9.6]; P < 0.01) and a higher risk for SCD (RR: 9.5 [95% CI: 4.4-20.5]; P < 0.01) than patients without RV LGE. Furthermore, the pooled area under the curve, sensitivity, and specificity of RV LGE for identifying patients with CS who were at highest SCD risk were 0.8 (95% CI: 0.8-0.9), 69% (95% CI: 50%-84%), and 90% (95% CI: 70%-97%), respectively. CONCLUSIONS In patients with known or suspected CS, RVEF and RV LGE were both associated with adverse events. Furthermore, RV LGE shows good discrimination in identifying CS patients at high risk of SCD.
Collapse
Affiliation(s)
- Jie Wang
- Cardiology Division, Department of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China; College of Medical and Dental Sciences, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Jinquan Zhang
- West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - Nisha Hosadurg
- Division of Cardiovascular Medicine, The University of Virginia Health System, Charlottesville, Virginia, USA
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yuxin Chen
- West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - Wei Liu
- West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - Ke Wan
- Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Amit R Patel
- Division of Cardiovascular Medicine, The University of Virginia Health System, Charlottesville, Virginia, USA
| | - Eleanor C Wicks
- Oxford University Hospitals, John Radcliffe Hospital, Headley Way, Headington, Oxford, United Kingdom
| | - Georgios V Gkoutos
- College of Medical and Dental Sciences, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, England; Health Data Research UK, Midlands Site, United Kingdom
| | - Yuchi Han
- Cardiovascular Division, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Yucheng Chen
- Cardiology Division, Department of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Center of Rare Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| |
Collapse
|
5
|
Prognostic Value of Late Gadolinium Enhancement Detected on Cardiac Magnetic Resonance in Cardiac Sarcoidosis. JACC Cardiovasc Imaging 2023; 16:345-357. [PMID: 36752432 DOI: 10.1016/j.jcmg.2022.10.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/07/2022] [Accepted: 10/13/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Sarcoidosis is a complex multisystem inflammatory disorder, with approximately 5% of patients having overt cardiac involvement. Patients with cardiac sarcoidosis are at an increased risk of both ventricular arrhythmias and sudden cardiac death. Previous studies have shown that the presence of late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) is associated with an increased risk of mortality and ventricular arrhythmias and may be useful in predicting prognosis. OBJECTIVES This systematic review and meta-analysis assessed the value of LGE on CMR imaging in predicting prognosis for patients with known or suspected cardiac sarcoidosis. METHODS The authors searched the Embase and MEDLINE databases from inception to March 2022 for studies reporting individuals with known or suspected cardiac sarcoidosis referred for CMR with LGE. Outcomes were defined as all-cause mortality, ventricular arrhythmia, or a composite outcome of either death or ventricular arrhythmias. The primary analysis evaluated these outcomes according to the presence of LGE. A secondary analysis evaluated outcomes specifically according to the presence of biventricular LGE. RESULTS Thirteen studies were included (1,318 participants) in the analysis, with an average participant age of 52.0 years and LGE prevalence of 13% to 70% over a follow-up of 3.1 years. Patients with LGE on CMR vs those without had higher odds of ventricular arrhythmias (odds ratio [OR]: 20.3; 95% CI: 8.1-51.0), all-cause mortality (OR: 3.45; 95% CI: 1.6-7.3), and the composite of both (OR: 9.2; 95% CI: 5.1-16.7). Right ventricular LGE is invariably accompanied by left ventricular LGE. Biventricular LGE is also associated with markedly increased odds of ventricular arrhythmias (OR: 43.6; 95% CI: 16.2-117.2). CONCLUSIONS Patients with known or suspected cardiac sarcoidosis with LGE on CMR have significantly increased odds of both ventricular arrhythmias and all-cause mortality. The presence of biventricular LGE may confer additional prognostic information regarding arrhythmogenic risk.
Collapse
|
6
|
Aitken M, Davidson M, Chan MV, Urzua Fresno C, Vasquez LI, Huo YR, McAllister BJ, Broncano J, Thavendiranathan P, McInnes MDF, Iwanochko MR, Balter M, Moayedi Y, Farrell A, Hanneman K. Prognostic Value of Cardiac MRI and FDG PET in Cardiac Sarcoidosis: A Systematic Review and Meta-Analysis. Radiology 2023; 307:e222483. [PMID: 36809215 DOI: 10.1148/radiol.222483] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Background There is no consensus regarding the relative prognostic value of cardiac MRI and fluorodeoxyglucose (FDG) PET in cardiac sarcoidosis. Purpose To perform a systematic review and meta-analysis of the prognostic value of cardiac MRI and FDG PET for major adverse cardiac events (MACE) in cardiac sarcoidosis. Materials and Methods In this systematic review, MEDLINE, Ovid Epub, CENTRAL, Embase, Emcare, and Scopus were searched from inception until January 2022. Studies that evaluated the prognostic value of cardiac MRI or FDG PET in adults with cardiac sarcoidosis were included. The primary outcome of MACE was assessed as a composite including death, ventricular arrhythmia, and heart failure hospitalization. Summary metrics were obtained using random-effects meta-analysis. Meta-regression was used to assess covariates. Risk of bias was assessed using the Quality in Prognostic Studies, or QUIPS, tool. Results Thirty-seven studies were included (3489 patients with mean follow-up of 3.1 years ± 1.5 [SD]); 29 studies evaluated MRI (2931 patients) and 17 evaluated FDG PET (1243 patients). Five studies directly compared MRI and PET in the same patients (276 patients). Left ventricular late gadolinium enhancement (LGE) at MRI and FDG uptake at PET were both predictive of MACE (odds ratio [OR], 8.0 [95% CI: 4.3, 15.0] [P < .001] and 2.1 [95% CI: 1.4, 3.2] [P < .001], respectively). At meta-regression, results varied by modality (P = .006). LGE (OR, 10.4 [95% CI: 3.5, 30.5]; P < .001) was also predictive of MACE when restricted to studies with direct comparison, whereas FDG uptake (OR, 1.9 [95% CI: 0.82, 4.4]; P = .13) was not. Right ventricular LGE and FDG uptake were also associated with MACE (OR, 13.1 [95% CI: 5.2, 33] [P < .001] and 4.1 [95% CI: 1.9, 8.9] [P < .001], respectively). Thirty-two studies were at risk for bias. Conclusion Left and right ventricular late gadolinium enhancement at cardiac MRI and fluorodeoxyglucose uptake at PET were predictive of major adverse cardiac events in cardiac sarcoidosis. Limitations include few studies with direct comparison and risk of bias. Systematic review registration no. CRD42021214776 (PROSPERO) © RSNA, 2023 Supplemental material is available for this article.
Collapse
Affiliation(s)
- Matthew Aitken
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Malcolm Davidson
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Michael V Chan
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Camila Urzua Fresno
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Leon I Vasquez
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Ya R Huo
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Brylie J McAllister
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Jordi Broncano
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Paaladinesh Thavendiranathan
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Matthew D F McInnes
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Mark R Iwanochko
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Meyer Balter
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Yasbanoo Moayedi
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Ashley Farrell
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Kate Hanneman
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| |
Collapse
|
7
|
Nordenswan HK, Pöyhönen P, Lehtonen J, Ekström K, Uusitalo V, Niemelä M, Vihinen T, Kaikkonen K, Haataja P, Kerola T, Rissanen TT, Alatalo A, Pietilä-Effati P, Kupari M. Incidence of Sudden Cardiac Death and Life-Threatening Arrhythmias in Clinically Manifest Cardiac Sarcoidosis With and Without Current Indications for an Implantable Cardioverter Defibrillator. Circulation 2022; 146:964-975. [PMID: 36000392 PMCID: PMC9508990 DOI: 10.1161/circulationaha.121.058120] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 07/18/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Cardiac sarcoidosis (CS) predisposes to sudden cardiac death (SCD). Guidelines for implantable cardioverter defibrillators (ICDs) in CS have been issued by the Heart Rhythm Society in 2014 and the American College of Cardiology/American Heart Association/Heart Rhythm Society consortium in 2017. How well they discriminate high from low risk remains unknown. METHODS We analyzed the data of 398 patients with CS detected in Finland from 1988 through 2017. All had clinical cardiac manifestations. Histological diagnosis was myocardial in 193 patients (definite CS) and extracardiac in 205 (probable CS). Patients with and without Class I or IIa ICD indications at presentation were identified, and subsequent occurrences of SCD (fatal or aborted) and sustained ventricular tachycardia were recorded, as were ICD indications emerging first on follow-up. RESULTS Over a median of 4.8 years, 41 patients (10.3%) had fatal (n=8) or aborted (n=33) SCD, and 98 (24.6%) experienced SCD or sustained ventricular tachycardia as the first event. By the Heart Rhythm Society guideline, Class I or IIa ICD indications were present in 339 patients (85%) and absent in 59 (15%), of whom 264 (78%) and 30 (51%), respectively, received an ICD. Cumulative 5-year incidence of SCD was 10.7% (95% CI, 7.4%-15.4%) in patients with ICD indications versus 4.8% (95% CI, 1.2%-19.1%) in those without (χ2=1.834, P=0.176). The corresponding rates of SCD were 13.8% (95% CI, 9.1%-21.0%) versus 6.3% (95% CI, 0.7%-54.0%; χ2=0.814, P=0.367) in definite CS and 7.6% (95% CI, 3.8%-15.1%) versus 3.3% (95% CI, 0.5%-22.9%; χ2=0.680, P=0.410) in probable CS. In multivariable regression analysis, SCD was predicted by definite histological diagnosis (P=0.033) but not by Class I or IIa ICD indications (P=0.210). In patients without ICD indications at presentation, 5-year incidence of SCD, sustained ventricular tachycardia, and emerging Class I or IIa indications was 53% (95% CI, 40%-71%). By the American College of Cardiology/American Heart Association/Heart Rhythm Society guideline, all patients with complete data (n=245) had Class I or IIa indications for ICD implantation. CONCLUSIONS Current ICD guidelines fail to distinguish a truly low-risk group of patients with clinically manifest CS, the 5-year risk of SCD approaching 5% despite absent ICD indications. Further research is needed on prognostic factors, including the role of diagnostic histology. Meanwhile, all patients with CS presenting with clinical cardiac manifestations should be considered for an ICD implantation.
Collapse
MESH Headings
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/epidemiology
- Arrhythmias, Cardiac/therapy
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Defibrillators, Implantable/adverse effects
- Humans
- Incidence
- Myocarditis/complications
- Risk Factors
- Sarcoidosis/complications
- Sarcoidosis/diagnosis
- Sarcoidosis/epidemiology
- Tachycardia, Ventricular/diagnosis
- Tachycardia, Ventricular/epidemiology
- Tachycardia, Ventricular/therapy
Collapse
Affiliation(s)
- Hanna-Kaisa Nordenswan
- Heart and Lung Center (H.-K.N., P.P., J.L., K.E., M.N., M.K.), Helsinki University Hospital and University of Helsinki, Finland
| | - Pauli Pöyhönen
- Heart and Lung Center (H.-K.N., P.P., J.L., K.E., M.N., M.K.), Helsinki University Hospital and University of Helsinki, Finland
- Radiology (P.P., V.U.), Helsinki University Hospital and University of Helsinki, Finland
| | - Jukka Lehtonen
- Heart and Lung Center (H.-K.N., P.P., J.L., K.E., M.N., M.K.), Helsinki University Hospital and University of Helsinki, Finland
| | - Kaj Ekström
- Heart and Lung Center (H.-K.N., P.P., J.L., K.E., M.N., M.K.), Helsinki University Hospital and University of Helsinki, Finland
| | - Valtteri Uusitalo
- Radiology (P.P., V.U.), Helsinki University Hospital and University of Helsinki, Finland
- Clinical Physiology and Nuclear Medicine (V.U.), Helsinki University Hospital and University of Helsinki, Finland
| | - Meri Niemelä
- Heart and Lung Center (H.-K.N., P.P., J.L., K.E., M.N., M.K.), Helsinki University Hospital and University of Helsinki, Finland
| | | | - Kari Kaikkonen
- Medical Research Center Oulu, University and University Hospital of Oulu, Finland (K.K.)
| | - Petri Haataja
- Heart Hospital, Tampere University Hospital, Finland (P.H.)
| | - Tuomas Kerola
- Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland (T.K.)
| | | | - Aleksi Alatalo
- South Ostrobothnia Central Hospital, Seinäjoki, Finland (A.A.)
| | | | - Markku Kupari
- Heart and Lung Center (H.-K.N., P.P., J.L., K.E., M.N., M.K.), Helsinki University Hospital and University of Helsinki, Finland
| |
Collapse
|
8
|
Tanizawa K, Handa T, Nagai S, Yokomatsu T, Ueda S, Ikezoe K, Ogino S, Hirai T, Izumi T. Basal interventricular septum thinning and long-term left ventricular function in patients with sarcoidosis. Respir Investig 2022; 60:385-392. [PMID: 35283057 DOI: 10.1016/j.resinv.2022.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/30/2022] [Accepted: 02/03/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Basal interventricular septum (IVS) thinning on transthoracic echocardiography (TTE) is highly specific to cardiac sarcoidosis. Although basal IVS thinning is listed as one of the five major diagnostic criteria for cardiac sarcoidosis, its association with long-term cardiac function has not been investigated. This study aimed to evaluate the epidemiology and clinical relevance of basal IVS thinning in a clinic-based cohort of patients with sarcoidosis. METHODS This retrospective observational study was conducted at a general sarcoidosis clinic. The incidence of basal IVS thinning and associations with variables at baseline and a delayed onset of left ventricular (LV) dysfunction (LV ejection fraction [LVEF] < 50%) were analyzed. RESULTS Of the 1009 patients, 23 (2.3%) had basal IVS thinning. Basal IVS thinning was associated with cardiac pacemaker (PM) implantation at baseline (adjusted odds ratio = 20.5; 95% confidence interval [CI] = 7.9-53.2; P < 0.01). Of the 768 patients with an LVEF of ≥50% at baseline who underwent one or more longitudinal TTEs after baseline, 36 (4.7%) developed LV dysfunction over a median observation period of 88.9 months. Basal IVS thinning and PM implantation at baseline were the independent predictors of a delayed onset of LV dysfunction (basal IVS thinning, adjusted hazard ratio [HR] = 3.7; 95% CI = 1.5-9.6; PM implantation, adjusted HR = 15.7; 95% CI = 7.4-33.3). CONCLUSIONS Basal IVS thinning in patients with sarcoidosis can predict a delayed onset of LV dysfunction even when the LV function is preserved at the time of detection.
Collapse
Affiliation(s)
- Kiminobu Tanizawa
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomohiro Handa
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Sonoko Nagai
- Kyoto Central Clinic, Clinical Research Center, Kyoto, Japan
| | - Takafumi Yokomatsu
- Department of Cardiovascular Medicine, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Seigen Ueda
- Kyoto Central Clinic, Clinical Research Center, Kyoto, Japan
| | - Kohei Ikezoe
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shumpei Ogino
- Kyoto Central Clinic, Clinical Research Center, Kyoto, Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takateru Izumi
- Kyoto Central Clinic, Clinical Research Center, Kyoto, Japan
| |
Collapse
|
9
|
How to risk stratify cardiac sarcoidosis patients with normal or near normal ventricular function? Heart Rhythm 2021; 19:361-362. [PMID: 34923160 DOI: 10.1016/j.hrthm.2021.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 11/22/2022]
|
10
|
Muccioli S, Albani S, Mabritto B, Musumeci G. Conduction disorders as the first hallmark of isolated cardiac sarcoidosis in a highly active individual: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab416. [PMID: 34755032 PMCID: PMC8573167 DOI: 10.1093/ehjcr/ytab416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/03/2021] [Accepted: 10/11/2021] [Indexed: 11/14/2022]
Abstract
Background Cardiac sarcoidosis (CS) is an inflammatory disease with various clinical presentations depending on the extension of cardiac involvement. The disease is often clinically silent, therefore diagnosis is challenging. Case summary We discuss the case of a middle-aged highly active individual presenting with an occasional finding of low heart rate during self-monitoring. The electrocardiogram shows a Mobitz 2 heart block; thanks to multimodality imaging CS was diagnosed and corticosteroid therapy improved cardiac conduction. Discussion To our knowledge, this is one of the first documented cases of occasional, early findings of CS in a middle-aged highly active individual who presented with cardiac conduction involvement. Despite the very early diagnosis, multimodality imaging suggested an advanced disease with no oedema detection at the cardiac magnetic resonance. Nevertheless, prompt corticosteroid therapy was able to improve clinical conduction. Although non-sustained ventricular arrhythmias were detected, electrophysiological study allowed to discharge the patient safely without implantable cardioverter-defibrillator implantation. Light-to-moderate physical activity was allowed at mid-term follow-up. A multidisciplinary evaluation should be considered to resume a high-intensity training.
Collapse
Affiliation(s)
- Silvia Muccioli
- Division of Cardiology, Azienda Ospedaliera Ordine Mauriziano di Torino, Largo Filippo Turati, 62, 10128, Turin, Italy
| | - Stefano Albani
- Division of Cardiology, Azienda Ospedaliera Ordine Mauriziano di Torino, Largo Filippo Turati, 62, 10128, Turin, Italy
| | - Barbara Mabritto
- Division of Cardiology, Azienda Ospedaliera Ordine Mauriziano di Torino, Largo Filippo Turati, 62, 10128, Turin, Italy
| | - Giuseppe Musumeci
- Division of Cardiology, Azienda Ospedaliera Ordine Mauriziano di Torino, Largo Filippo Turati, 62, 10128, Turin, Italy
| |
Collapse
|
11
|
Franke KB, Marshall H, Kennewell P, Pham HD, Tully PJ, Rattanakosit T, Mahadevan G, Mahajan R. Risk and predictors of sudden death in cardiac sarcoidosis: A systematic review and meta-analysis. Int J Cardiol 2020; 328:130-140. [PMID: 33242509 DOI: 10.1016/j.ijcard.2020.11.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/18/2020] [Accepted: 11/17/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND To evaluate the risk for ventricular arrhythmia (VA) and sudden cardiac death (SCD) in patients with cardiac sarcoidosis (CS) and determine the prognostic factors. METHODS AND RESULTS PUBMED, EMBASE and SCOPUS were searched up to 14th April 2020. Studies reporting the incidence of SCD, appropriate ICD therapy in CS patients, or relevant prognostic information in patients having undergone MRI, PET, or programmed electrical stimulation (PES) were included. Nineteen studies consisting of 1247 patients, reported the risk of ICD therapies or SCD over a follow-up period of 1.7-7 years. 22.7% (n = 9; 22.7, 95%CI [16.10-29.36]) of patients in primary and 58.4% (n = 9; 58.42, 95% CI [38.61-78.22]) in secondary prevention cohorts experienced appropriate device therapy or SCD events. 18% (n = 2; 18, 95%CI [14-23]) of patients received ≥5 appropriate therapies. 9 out of 664 patients with confirmed cardiac sarcoidosis but without implanted ICDs died suddenly. 17.9% of patients (n = 4; 17.9, 95%CI [10.80-25.03]) experienced inappropriate device therapy. Positive LGE-MRI and PES were associated with an 8.6-fold (n = 6; RR = 8.60, 95%CI [3.80-19.48]) and 9-fold (n = 5; RR = 9.07, 95%CI [4.65-17.68]) increased risk of VA respectively. Positive LGE-MRI and PET with associated with a 6.8-fold (n = 12; RR = 6.82, 95%CI [4.57-10.18]) and 3.4-fold (n = 7; RR = 3.41, 95%CI [2.03-5.74]) respectively for increased risk of major adverse cardiac events. CONCLUSIONS The risk of appropriate ICD therapy or sudden cardiac death is high in patients with CS. The presence of LGE-MRI and positive electrophysiology study identify patients at increased risk of ventricular arrhythmias. [CRD42019124220].
Collapse
Affiliation(s)
- Kyle B Franke
- The University of Adelaide, Adelaide, Australia; South Australian Health and Medical Research Institute, Adelaide, Australia
| | | | | | | | | | - Thirakan Rattanakosit
- The University of Adelaide, Adelaide, Australia; South Australian Health and Medical Research Institute, Adelaide, Australia
| | | | - Rajiv Mahajan
- The University of Adelaide, Adelaide, Australia; South Australian Health and Medical Research Institute, Adelaide, Australia; Lyell McEwin Hospital, Adelaide, Australia.
| |
Collapse
|
12
|
Association between sarcoidosis and cardiovascular comorbidity: A systematic review and meta-analysis. Heart Lung 2020; 49:512-517. [DOI: 10.1016/j.hrtlng.2020.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/09/2020] [Accepted: 03/12/2020] [Indexed: 11/17/2022]
|
13
|
Juneau D, Nery PB, Pena E, Inácio JR, Beanlands RSB, deKemp RA, Alhajari ZM, Spence S, Medor MC, Dwivedi G, Birnie D. Reproducibility of cardiac magnetic resonance imaging in patients referred for the assessment of cardiac sarcoidosis; implications for clinical practice. Int J Cardiovasc Imaging 2020; 36:2199-2207. [PMID: 32613384 DOI: 10.1007/s10554-020-01923-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 06/17/2020] [Indexed: 11/25/2022]
Abstract
Cardiac sarcoidosis (CS) is an increasingly recognized condition, but cardiac magnetic resonance (CMR) image interpretation in these patients may be challenging as findings are often non-specific. The main objective of this study was to investigate the inter-reader agreement for the overall interpretation of CMR for the diagnosis of CS in an experienced reference center and investigate factors that may lead to discrepancies between readers. Consecutive patients undergoing CMR imaging to investigate for CS were included. CMR images were independently reviewed by two readers, blinded to all clinical, imaging and demographic information. The readers classified each scan as "consistent with cardiac sarcoidosis", "not consistent with cardiac sarcoidosis" or "indeterminate". Inter-reader agreement was assessed using κ-statistics. When there was disagreement on the overall interpretation, a third reader reviewed the images. Also, two readers independently commented on the presence of edema, presence of LGE (both ventricles) and quantified the extent of left ventricular LGE. 87 patients (43 women, mean age 54.3 ± 12.2 years) were included in the study. There was agreement regarding the overall interpretation in 72 of 87 (83%) CMR scans. The κ value was 0.64, indicating moderate agreement. There was similar moderate agreement in the interpretation of LGE parameters. In an experienced referral center, we found moderate agreement between readers in the interpretation of CMR in patients with suspected CS. Physicians should be aware of this inter-observer variability in interpretation of CMR studies in patients with suspected CS.
Collapse
Affiliation(s)
- Daniel Juneau
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
- Department of Radiology and Nuclear Medicine, Centre Hospitalier de L'Université de Montréal, Montréal, QC, Canada
| | - Pablo B Nery
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Elena Pena
- Department of Radiology, University of Ottawa and Medical Imaging Department, The Ottawa Hospital, Ottawa, ON, Canada
| | - João R Inácio
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
- Department of Radiology, University of Ottawa and Medical Imaging Department, The Ottawa Hospital, Ottawa, ON, Canada
| | - Rob S B Beanlands
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Robert A deKemp
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Zainab M Alhajari
- Department of Radiology, University of Ottawa and Medical Imaging Department, The Ottawa Hospital, Ottawa, ON, Canada
| | - Stewart Spence
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Maria C Medor
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
| | - Girish Dwivedi
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada
- Harry Perkins Institute of Medical Research and Fiona Stanley Hospital, The University of Western Australia, Perth, Australia
| | - David Birnie
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada.
| |
Collapse
|
14
|
Crouser ED, Maier LA, Wilson KC, Bonham CA, Morgenthau AS, Patterson KC, Abston E, Bernstein RC, Blankstein R, Chen ES, Culver DA, Drake W, Drent M, Gerke AK, Ghobrial M, Govender P, Hamzeh N, James WE, Judson MA, Kellermeyer L, Knight S, Koth LL, Poletti V, Raman SV, Tukey MH, Westney GE. Diagnosis and Detection of Sarcoidosis. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2020; 201:e26-e51. [PMID: 32293205 PMCID: PMC7159433 DOI: 10.1164/rccm.202002-0251st] [Citation(s) in RCA: 443] [Impact Index Per Article: 110.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: The diagnosis of sarcoidosis is not standardized but is based on three major criteria: a compatible clinical presentation, finding nonnecrotizing granulomatous inflammation in one or more tissue samples, and the exclusion of alternative causes of granulomatous disease. There are no universally accepted measures to determine if each diagnostic criterion has been satisfied; therefore, the diagnosis of sarcoidosis is never fully secure. Methods: Systematic reviews and, when appropriate, meta-analyses were performed to summarize the best available evidence. The evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation approach and then discussed by a multidisciplinary panel. Recommendations for or against various diagnostic tests were formulated and graded after the expert panel weighed desirable and undesirable consequences, certainty of estimates, feasibility, and acceptability. Results: The clinical presentation, histopathology, and exclusion of alternative diagnoses were summarized. On the basis of the available evidence, the expert committee made 1 strong recommendation for baseline serum calcium testing, 13 conditional recommendations, and 1 best practice statement. All evidence was very low quality. Conclusions: The panel used systematic reviews of the evidence to inform clinical recommendations in favor of or against various diagnostic tests in patients with suspected or known sarcoidosis. The evidence and recommendations should be revisited as new evidence becomes available.
Collapse
|
15
|
Abstract
Approximately 5% of patients with sarcoidosis will have clinically manifest cardiac involvement presenting with one or more of ventricular arrhythmias, conduction abnormalities, and heart failure. It is estimated that another 20 to 25% of pulmonary/systemic sarcoidosis patients have asymptomatic cardiac involvement (clinically silent disease). Cardiac presentations can be the first (and/or an unrecognized) manifestation of sarcoidosis in a variety of circumstances. Immunosuppression therapy (usually with corticosteroids) has been suggested for the treatment of clinically manifest cardiac sarcoidosis (CS) despite minimal data supporting it. Positron emission tomography imaging is often used to detect active disease and guide immunosuppression. Patients with clinically manifest disease often need device therapy, typically with implantable cardioverter defibrillators (ICDs). The extent of left ventricular dysfunction seems to be the most important predictor of prognosis among patients with clinically manifest CS. In the current era of earlier diagnosis, modern heart failure treatment, and use of ICD therapy, the prognosis from CS is much improved. In a recent Finnish nationwide study, 10-year cardiac survival was 92.5% in 102 patients.
Collapse
Affiliation(s)
- David H Birnie
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| |
Collapse
|
16
|
Smedema JP, Ainslie G, Crijns HJGM. Review: Contrast-enhanced magnetic resonance in the diagnosis and management of cardiac sarcoidosis. Prog Cardiovasc Dis 2020; 63:271-307. [PMID: 32330463 DOI: 10.1016/j.pcad.2020.03.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 03/22/2020] [Indexed: 01/14/2023]
Abstract
Sarcoidosis is a relatively rare inflammatory condition which potentially carries high morbidity and substantial mortality. Due to the fact that it does not subject patients to ionizing radiation, has high temporal, spatial and contrast resolutions, cardiovascular magnetic resonance imaging (CMR) has become an important diagnostic and prognostic modality in the evaluation for cardiac involvement in this condition. This review provides relevant clinical and pathophysiological background on cardiac sarcoidosis, whilst detailing the role of CMR imaging in the diagnosis, and management of this condition.
Collapse
Affiliation(s)
| | - Gillian Ainslie
- Respiratory Clinic, Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa.
| | - Harry J G M Crijns
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands.
| |
Collapse
|
17
|
Prognostic value of cardiovascular magnetic resonance in patients with biopsy-proven systemic sarcoidosis. Eur Radiol 2020; 30:3702-3710. [PMID: 32166494 DOI: 10.1007/s00330-020-06765-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/13/2020] [Accepted: 02/19/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES As prognosis in sarcoidosis is determined by cardiac involvement, the objective was to study the added value of cardiovascular magnetic resonance (CMR) in risk stratification. METHODS In 114 patients (48 ± 12 years/52% male) with biopsy-proven sarcoidosis, we studied the value of clinical and CMR-derived parameters to predict future events, using sustained ventricular tachycardia, ventricular fibrillation, aborted cardiac death, implantable cardioverter-defibrillator (ICD) placement with appropriate shocks, hospitalization for heart failure, and death as composite endpoint. Median follow-up after CMR was 3.1 years (1.1-5.7 years). RESULTS The ejection fraction (EF) was 58.2 ± 9.1% and 54.7 ± 10.8% for left ventricle (LV) and right ventricle (RV), respectively. LV late gadolinium enhancement (LGE) was present in 40 patients (35%) involving 5.1% of the LV mass (IQR, 3.0-12.0%), with concomitant RV involvement in 12 patients (11%). T2-weighting imaging and/or T2 mapping showed active disease in 14 patients. The composite endpoint was reached in 34 patients, with 7 deaths in the LGE-positive group (17.5%), versus two deaths in the LGE-negative group (2.7%) (p = 0.015). At univariate analysis, RVEF (p = 0.009), pulmonary arterial pressure (p = 0.002), and presence of LGE (p < 0.001) and LGE (% of LV) (p < 0.001) were significant. At multivariate analysis, only presence of LGE and LGE (% of LV) was significant (both p = 0.03). At Kaplan-Meier, presence of LGE and an LGE of 3% predicted event-free survival and patient survival. We found no difference in active versus inactive disease with regard to patient survival. CONCLUSION Myocardial enhancement at LGE-CMR adds independent prognostic value in risk stratification sarcoidosis patients. In contrast, clinical as well as functional cardiac parameters lack discriminative power. KEY POINTS • Sarcoidosis often affects the heart. • Comprehensive CMR, including T2 imaging and LGE enhancement CMR, allows to depict both active and inactive myocardial damage. • Patient prognosis in sarcoidosis is determined by the presence and severity of myocardial involvement at LGE CMR.
Collapse
|
18
|
Birnie DH, Tzemos N, Nery PB. Comparing and Contrasting Guidelines for the Management of Cardiac Sarcoidosis. ANNALS OF NUCLEAR CARDIOLOGY 2020; 6:61-66. [PMID: 37123482 PMCID: PMC10133928 DOI: 10.17996/anc.20-00123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/20/2020] [Accepted: 07/28/2020] [Indexed: 05/02/2023]
Abstract
Introduction: The Japanese Circulation Society (JCS) recently published new guidelines for the diagnosis and treatment of Cardiac Sarcoidosis (CS). There are two other guideline documents, the World Association of Sarcoidosis and Other Granulomatous Disorders Sarcoidosis Organ (WASOG) Assessment Instrument created in 1999 and updated in 2014. Also, in 2014, the Heart Rhythm Society (HRS) published their international guideline document. As co-chair of the HRS document I have been invited to compare and contrast the management aspects of the HRS guidelines with the new JCS document. Comments: (i) The HRS document recommended a stepwise approach to VT management and the JCS document is somewhat similar; but with some key differences. (ii) The HRS statement suggested that an ICD for CS patients with an indication for a pacemaker "can be useful". The JCS document take a similar position although with some additional criteria related to National Health Institute Coverage guidelines. (iii) Both HRS and the JCS documents agree that ICDs are recommended in patients with general guideline indications for primary prevention (i.e. LVEF less than 35%). However which additional patients should be considered for ICDs is controversial. The 2016 JCS document is broadly similar, with the major exception that it is recommended that all patients with LVEF 35-50% should have an EP study. Conclusion: The Japanese have been leaders in many aspects of CS including in guideline development. It is clear that the future of CS management is bright, with increasing international collaborations and also multiple efforts underway to obtain higher quality data to inform future guidelines.
Collapse
Affiliation(s)
- David H. Birnie
- Division of Cardiology, University of Ottawa Heart Institute, Canada
- Reprint requests and correspondence: David H. Birnie, MD, MB, ChB, Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4 W7, Canada / E-mail:
| | - Niko Tzemos
- Division of Cardiology, London Health Sciences, University of Western Ontario, Canada
| | - Pablo B. Nery
- Division of Cardiology, University of Ottawa Heart Institute, Canada
| |
Collapse
|
19
|
Mavrogeni SI, Markousis-Mavrogenis G, Aggeli C, Tousoulis D, Kitas GD, Kolovou G, Iliodromitis EK, Sfikakis PP. Arrhythmogenic Inflammatory Cardiomyopathy in Autoimmune Rheumatic Diseases: A Challenge for Cardio-Rheumatology. Diagnostics (Basel) 2019; 9:diagnostics9040217. [PMID: 31835542 PMCID: PMC6963646 DOI: 10.3390/diagnostics9040217] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 12/04/2019] [Accepted: 12/07/2019] [Indexed: 12/12/2022] Open
Abstract
Ventricular arrhythmia (VA) in autoimmune rheumatic diseases (ARD) is an expression of autoimmune inflammatory cardiomyopathy (AIC), caused by structural, electrical, or inflammatory heart disease, and has a serious impact on a patient’s outcome. Myocardial scar of ischemic or nonischemic origin through a re-entry mechanism facilitates the development of VA. Additionally, autoimmune myocardial inflammation, either isolated or as a part of the generalized inflammatory process, also facilitates the development of VA through arrhythmogenic autoantibodies and inflammatory channelopathies. The clinical presentation of AIC varies from oligo-asymptomatic presentation to severe VA and sudden cardiac death (SCD). Both positron emission tomography (PET) and cardiovascular magnetic resonance (CMR) can diagnose AIC early and be useful tools for the assessment of therapies during follow-ups. The AIC treatment should be focused on the following: (1) early initiation of cardiac medication, including ACE-inhibitors, b-blockers, and aldosterone antagonists; (2) early initiation of antirheumatic medication, depending on the underlying disease; and (3) potentially implantable cardioverter–defibrillator (ICD) and/or ablation therapy in patients who are at high risk for SCD.
Collapse
Affiliation(s)
- Sophie I. Mavrogeni
- Onassis Cardiac surgery Center, 17674 Athens, Greece; (G.M.-M.); (G.K.)
- Correspondence:
| | | | - Constantina Aggeli
- First Cardiac Clinic, Hippokration University Hospital, 17674 Athens, Greece; (C.A.); (D.T.)
| | - Dimitris Tousoulis
- First Cardiac Clinic, Hippokration University Hospital, 17674 Athens, Greece; (C.A.); (D.T.)
| | - George D. Kitas
- Arthritis Research UK Epidemiology Unit, Manchester University, Manchester M13 9PT, UK;
| | - Genovefa Kolovou
- Onassis Cardiac surgery Center, 17674 Athens, Greece; (G.M.-M.); (G.K.)
| | | | - Petros P. Sfikakis
- First Department of Propeudeutic and Internal medicine, Laikon Hospital, Athens University Medical School, 17674 Athens, Greece;
| |
Collapse
|
20
|
Birnie D, Ha A, Kron J. Which Patients With Cardiac Sarcoidosis Should Receive Implantable Cardioverter-Defibrillators: Some Answers but Many Questions Remain. Circ Arrhythm Electrophysiol 2019; 11:e006685. [PMID: 30354325 DOI: 10.1161/circep.118.006685] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- David Birnie
- Division of Cardiology, University of Ottawa Heart Institute, ON, Canada (D.B.)
| | - Andrew Ha
- Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada (A.H.)
| | - Jordana Kron
- Division of Cardiology, Virginia Commonwealth University, Richmond (J.K.)
| |
Collapse
|
21
|
Kazmirczak F, Chen KHA, Adabag S, von Wald L, Roukoz H, Benditt DG, Okasha O, Farzaneh-Far A, Markowitz J, Nijjar PS, Velangi PS, Bhargava M, Perlman D, Duval S, Akçakaya M, Shenoy C. Assessment of the 2017 AHA/ACC/HRS Guideline Recommendations for Implantable Cardioverter-Defibrillator Implantation in Cardiac Sarcoidosis. Circ Arrhythm Electrophysiol 2019; 12:e007488. [PMID: 31431050 DOI: 10.1161/circep.119.007488] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Implantable cardioverter-defibrillators are used to prevent sudden cardiac death in patients with cardiac sarcoidosis. The most recent recommendations for implantable cardioverter-defibrillator implantation in these patients are in the 2017 American Heart Association/American College of Cardiology/Heart Rhythm Society Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death. These recommendations, based on observational studies or expert opinion, have not been assessed. We aimed to assess them. METHODS We performed a large retrospective cohort study of patients with biopsy-proven sarcoidosis and known or suspected cardiac sarcoidosis that underwent cardiovascular magnetic resonance imaging. Patients were followed for a composite end point of significant ventricular arrhythmia or sudden cardiac death. The discriminatory performance of the Guideline recommendations was tested using time-dependent receiver operating characteristic analyses. The optimal cutoff for the extent of late gadolinium enhancement predictive of the composite end point was determined using the Youden index. RESULTS In 290 patients, the class I and IIa recommendations identified all patients who experienced the composite end point during a median follow-up of 3.0 years. Patients meeting class I recommendations had a significantly higher incidence of the composite end point than those meeting class IIa recommendations. Left ventricular ejection fraction (LVEF) >35% with >5.7% late gadolinium enhancement on cardiovascular magnetic resonance imaging was as sensitive as and significantly more specific than LVEF >35% with any late gadolinium enhancement. Patients meeting 2 class IIa recommendations, LVEF >35% with the need for a permanent pacemaker and LVEF >35% with late gadolinium enhancement >5.7%, had high annualized event rates. Excluding 2 class IIa recommendations, LVEF >35% with syncope and LVEF >35% with inducible ventricular arrhythmia, resulted in improved discrimination for the composite end point. CONCLUSIONS We assessed the Guideline recommendations for implantable cardioverter-defibrillator implantation in patients with known or suspected cardiac sarcoidosis and identified topics for future research.
Collapse
Affiliation(s)
- Felipe Kazmirczak
- Cardiovascular Division, Department of Medicine (F.K., K.-H.A.C., S.A., L.v.W., H.R., D.G.B., O.O., J.M., P.S.N., P.S.V., S.D., C.S.), University of Minnesota Medical School, Minneapolis
| | - Ko-Hsuan Amy Chen
- Cardiovascular Division, Department of Medicine (F.K., K.-H.A.C., S.A., L.v.W., H.R., D.G.B., O.O., J.M., P.S.N., P.S.V., S.D., C.S.), University of Minnesota Medical School, Minneapolis
| | - Selcuk Adabag
- Cardiovascular Division, Department of Medicine (F.K., K.-H.A.C., S.A., L.v.W., H.R., D.G.B., O.O., J.M., P.S.N., P.S.V., S.D., C.S.), University of Minnesota Medical School, Minneapolis.,Division of Cardiology, Department of Medicine, Veterans Affairs Health Care System, Minneapolis, MN (S.A.)
| | - Lisa von Wald
- Cardiovascular Division, Department of Medicine (F.K., K.-H.A.C., S.A., L.v.W., H.R., D.G.B., O.O., J.M., P.S.N., P.S.V., S.D., C.S.), University of Minnesota Medical School, Minneapolis
| | - Henri Roukoz
- Cardiovascular Division, Department of Medicine (F.K., K.-H.A.C., S.A., L.v.W., H.R., D.G.B., O.O., J.M., P.S.N., P.S.V., S.D., C.S.), University of Minnesota Medical School, Minneapolis
| | - David G Benditt
- Cardiovascular Division, Department of Medicine (F.K., K.-H.A.C., S.A., L.v.W., H.R., D.G.B., O.O., J.M., P.S.N., P.S.V., S.D., C.S.), University of Minnesota Medical School, Minneapolis
| | - Osama Okasha
- Cardiovascular Division, Department of Medicine (F.K., K.-H.A.C., S.A., L.v.W., H.R., D.G.B., O.O., J.M., P.S.N., P.S.V., S.D., C.S.), University of Minnesota Medical School, Minneapolis
| | - Afshin Farzaneh-Far
- Section of Cardiology, Department of Medicine, University of Illinois at Chicago (A.F.-F.)
| | - Jeremy Markowitz
- Cardiovascular Division, Department of Medicine (F.K., K.-H.A.C., S.A., L.v.W., H.R., D.G.B., O.O., J.M., P.S.N., P.S.V., S.D., C.S.), University of Minnesota Medical School, Minneapolis
| | - Prabhjot S Nijjar
- Cardiovascular Division, Department of Medicine (F.K., K.-H.A.C., S.A., L.v.W., H.R., D.G.B., O.O., J.M., P.S.N., P.S.V., S.D., C.S.), University of Minnesota Medical School, Minneapolis
| | - Pratik S Velangi
- Cardiovascular Division, Department of Medicine (F.K., K.-H.A.C., S.A., L.v.W., H.R., D.G.B., O.O., J.M., P.S.N., P.S.V., S.D., C.S.), University of Minnesota Medical School, Minneapolis
| | - Maneesh Bhargava
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine (M.B., D.P.), University of Minnesota Medical School, Minneapolis
| | - David Perlman
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine (M.B., D.P.), University of Minnesota Medical School, Minneapolis
| | - Sue Duval
- Cardiovascular Division, Department of Medicine (F.K., K.-H.A.C., S.A., L.v.W., H.R., D.G.B., O.O., J.M., P.S.N., P.S.V., S.D., C.S.), University of Minnesota Medical School, Minneapolis
| | - Mehmet Akçakaya
- Department of Electrical and Computer Engineering, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis (M.A.)
| | - Chetan Shenoy
- Cardiovascular Division, Department of Medicine (F.K., K.-H.A.C., S.A., L.v.W., H.R., D.G.B., O.O., J.M., P.S.N., P.S.V., S.D., C.S.), University of Minnesota Medical School, Minneapolis
| |
Collapse
|
22
|
Smedema JP, van Geuns RJ, Ector J, Heidbuchel H, Ainslie G, Crijns HJGM. Right ventricular involvement and the extent of left ventricular enhancement with magnetic resonance predict adverse outcome in pulmonary sarcoidosis. ESC Heart Fail 2017; 5:157-171. [PMID: 28967698 PMCID: PMC5793959 DOI: 10.1002/ehf2.12201] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 07/14/2017] [Indexed: 01/20/2023] Open
Abstract
AIMS Cardiac involvement is the main determinant of poor outcomes in sarcoidosis. Right ventricular (RV) dysfunction and left ventricular (LV) late gadolinium enhancement (LGE) have been reported to be predictive of adverse outcome in non-ischaemic cardiomyopathies. The aim of our study was to determine whether delayed RV LGE with cardiovascular magnetic resonance would be predictive of adverse events in addition to LV LGE during the long-term follow-up of pulmonary sarcoidosis patients. METHODS AND RESULTS Eighty-four consecutive biopsy-proven pulmonary sarcoidosis patients were followed for a median of 56 months [38-74] after baseline delayed contrast-enhanced cardiac magnetic resonance. The composite primary endpoint consisted of admission for congestive heart failure, sustained ventricular tachycardia, appropriate implantable cardioverter defibrillator therapy, pacemaker implantation for high degree atrio-ventricular block, or cardiac death. The composite secondary endpoint included all-cause mortality in addition to the primary endpoint. RV and LV LGE were demonstrated in respectively 12 and 27 patients. Five of 10 events included in the primary endpoint occurred in the group with RV LGE. RV LGE, LV, or biventricular LGE yielded Cox hazard ratios of 8.71 [95% confidence interval (CI) 1.90-23.81], 9.22 (95% CI 1.96-43.45), and 12.09 (95% CI 3.43-42.68) for the composite primary endpoint. In a multivariate model, the predictive value of biventricular LGE for the composite primary and secondary endpoints was strongest. Kaplan-Meier event-free survival curves were most significant for RV LGE and biventricular LGE (log rank with P < 0.001). CONCLUSIONS Biventricular LGE at presentation is the strongest, independent predictor of adverse outcome during long-term follow-up. Asymptomatic myocardial scar <8% of LV mass carried a favourable long-term outcome.
Collapse
Affiliation(s)
- Jan-Peter Smedema
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Joris Ector
- Department of Cardiology, University Hospitals Gasthuisberg, Leuven, Belgium
| | - Hein Heidbuchel
- Virga Jesse Hospital, University of Hasselt Heart Centre, Hasselt, Belgium
| | - Gillian Ainslie
- Respiratory Clinic, Department of Medicine, Groote Schuur Hospital, Cape Town, Republic of South Africa
| | - Harry J G M Crijns
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| |
Collapse
|
23
|
|
24
|
Ammirati E, Moroni F, Sormani P, Peritore A, Milazzo A, Quattrocchi G, Cipriani M, Oliva F, Giannattasio C, Frigerio M, Roghi A, Camici PG, Pedrotti P. Quantitative changes in late gadolinium enhancement at cardiac magnetic resonance in the early phase of acute myocarditis. Int J Cardiol 2016; 231:216-221. [PMID: 27913009 DOI: 10.1016/j.ijcard.2016.11.282] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/01/2016] [Accepted: 11/15/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND The presence of late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR) has diagnostic and prognostic value in patients with acute myocarditis (AM). Aim of our study was to quantify the changes in LGE extension (LGE%) early after AM and evaluate its relations with biventricular function and morphology. METHODS We investigated 76 consecutive patients with AM (acute onset of chest pain/heart failure/ventricular arrhythmias not explained by other causes, and raised troponin) that met CMR criteria based on myocardial oedema at T2-weighted images and LGE on post-contrast images at median time of 6days from onset of symptoms. We quantified LGE% at baseline and after 148days in 49 patients. RESULTS Median left ventricular (LV)-ejection fraction (EF) was 64% (interquartile range [Q1-Q3]: 56-67%), and LGE% 9.4% (Q1-Q3: 7.5-13.2%). LGE% was correlated with LV end-systolic volume index (LV-ESVi; r=+0.34; p=0.003). LGE% was inversely correlated with LV-EF (r=-0.31; p=0.009) and time to CMR scan (r=-0.25; p=0.028). In the 49 patients with a second CMR scan, despite no significant variations in LV-EF, a significant decrease of LGE% was observed (p<0.0001) with a relative reduction of 42% compared with baseline. Patients showing increased LV-ESVi at follow up had a lower decrease of LGE% (p=0.038). CONCLUSIONS In the acute phase of AM the LGE extension is a dynamic process that reflects impairment of LV function and is time dependent. LGE% appears one of the CMR parameters with the largest relative variations in the first months after AM.
Collapse
Affiliation(s)
- Enrico Ammirati
- "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy.
| | - Francesco Moroni
- Cardiothoracic Department, San Raffaele Hospital and Vita Salute University, Milano, Italy
| | - Paola Sormani
- "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy; Health Science Department, Bicocca University, Milano, Italy
| | | | - Angela Milazzo
- "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy
| | | | - Manlio Cipriani
- "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy
| | - Fabrizio Oliva
- "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy
| | - Cristina Giannattasio
- "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy; Health Science Department, Bicocca University, Milano, Italy
| | - Maria Frigerio
- "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy
| | - Alberto Roghi
- "De Gasperis" Cardio Center, Niguarda Hospital, Milan, Italy
| | - Paolo G Camici
- Cardiothoracic Department, San Raffaele Hospital and Vita Salute University, Milano, Italy.
| | | |
Collapse
|