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
|
Trivieri MG, Robson PM, Vergani V, LaRocca G, Romero-Daza AM, Abgral R, Devesa A, Azoulay LD, Karakatsanis NA, Parikh A, Panagiota C, Palmisano A, DePalo L, Chang HL, Rothstein JH, Fayad RA, Miller MA, Fuster V, Narula J, Dweck MR, Morgenthau A, Jacobi A, Padilla M, Kovacic JC, Fayad ZA. Hybrid Magnetic Resonance Positron Emission Tomography Is Associated With Cardiac-Related Outcomes in Cardiac Sarcoidosis. JACC Cardiovasc Imaging 2024; 17:411-424. [PMID: 38300202 DOI: 10.1016/j.jcmg.2023.11.010] [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: 03/01/2023] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Imaging with late gadolinium enhancement (LGE) magnetic resonance (MR) and 18F-fluorodeoxyglucose (18F-FDG) PET allows complementary assessment of myocardial injury and disease activity and has shown promise for improved characterization of active cardiac sarcoidosis (CS) based on the combined positive imaging outcome, MR(+)PET(+). OBJECTIVES This study aims to evaluate qualitative and quantitative assessments of hybrid MR/PET imaging in CS and to evaluate its association with cardiac-related outcomes. METHODS A total of 148 patients with suspected CS underwent hybrid MR/PET imaging. Patients were classified based on the presence/absence of LGE (MR+/MR-), presence/absence of 18F-FDG (PET+/PET-), and pattern of 18F-FDG uptake (focal/diffuse) into the following categories: MR(+)PET(+)FOCAL, MR(+)PET(+)DIFFUSE, MR(+)PET(-), MR(-)PET(+)FOCAL, MR(-)PET(+)DIFFUSE, MR(-)PET(-). Further analysis classified MR positivity based on %LGE exceeding 5.7% as MR(+/-)5.7%. Quantitative values of standard uptake value, target-to-background ratio, target-to-normal-myocardium ratio (TNMRmax), and T2 were measured. The primary clinical endpoint was met by the occurrence of cardiac arrest, ventricular tachycardia, or secondary prevention implantable cardioverter-defibrillator (ICD) before the end of the study. The secondary endpoint was met by any of the primary endpoint criteria plus heart failure or heart block. MR/PET imaging results were compared between those meeting or not meeting the clinical endpoints. RESULTS Patients designated MR(+)5.7%PET(+)FOCAL had increased odds of meeting the primary clinical endpoint compared to those with all other imaging classifications (unadjusted OR: 9.2 [95% CI: 3.0-28.7]; P = 0.0001), which was higher than the odds based on MR or PET alone. TNMRmax achieved an area under the receiver-operating characteristic curve of 0.90 for separating MR(+)PET(+)FOCAL from non-MR(+)PET(+)FOCAL, and 0.77 for separating those reaching the clinical endpoint from those not reaching the clinical endpoint. CONCLUSIONS Hybrid MR/PET image-based classification of CS was statistically associated with clinical outcomes in CS. TNMRmax had modest sensitivity and specificity for quantifying the imaging-based classification MR(+)PET(+)FOCAL and was associated with outcomes. Use of combined MR and PET image-based classification may have use in prognostication and treatment management in CS.
Collapse
Affiliation(s)
- Maria Giovanna Trivieri
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Philip M Robson
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vittoria Vergani
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Gina LaRocca
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Ronan Abgral
- Department of Nuclear Medicine, University Hospital of Brest, European University of Brittany, Brest, France
| | - Ana Devesa
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Levi-Dan Azoulay
- Sorbonne Université, INSERM, CNRS, Laboratoire d'Imagerie Biomédicale (LIB), Paris, France
| | - Nicolas A Karakatsanis
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Division of Radiopharmaceutical Sciences, Department of Radiology, Weill Cornell Medical College, New York, New York, USA
| | - Aditya Parikh
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Christia Panagiota
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anna Palmisano
- Experimental Imaging Center, Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Louis DePalo
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Helena L Chang
- International Center for Health Outcomes and Innovation Research, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joseph H Rothstein
- International Center for Health Outcomes and Innovation Research, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rima A Fayad
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marc A Miller
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Valentin Fuster
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jagat Narula
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, Scotland, UK
| | - Adam Morgenthau
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Adam Jacobi
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Maria Padilla
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jason C Kovacic
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Victor Chang Cardiac Research Institute and St Vincent's Clinical School, University of NSW, Darlinghurst, New South Wales, Australia
| | - Zahi A Fayad
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
3
|
Waller AH, Kim Y. Diagnosis and Outcomes Using Magnetic Resonance Positron Emission Tomography in Known or Suspected Cardiac Sarcoidosis. JACC Cardiovasc Imaging 2024; 17:425-427. [PMID: 38363263 DOI: 10.1016/j.jcmg.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 01/02/2024] [Indexed: 02/17/2024]
Affiliation(s)
- Alfonso H Waller
- Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Department of Radiology, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Division of Cardiovascular Medicine, Department of Medicine, Newark Beth Israel Medical Center, Newark, New Jersey, USA.
| | - Yekaterina Kim
- Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Division of Cardiovascular Medicine, Department of Medicine, Newark Beth Israel Medical Center, Newark, New Jersey, USA
| |
Collapse
|
4
|
Adhaduk M, Paudel B, Khalid MU, Ashwath M, Mansour S, Liu K. Comparison of cardiac magnetic resonance imaging and fluorodeoxyglucose positron emission tomography in the assessment of cardiac sarcoidosis: Meta-analysis and systematic review. J Nucl Cardiol 2023; 30:1574-1587. [PMID: 36443587 DOI: 10.1007/s12350-022-03129-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 10/03/2022] [Indexed: 11/30/2022]
Abstract
AIM Fluorine-18 fluorodeoxyglucose-positron emission tomography (FDG-PET) and cardiac magnetic resonance (CMR) are frequently used advanced cardiac imaging to diagnose cardiac sarcoidosis (CS). We conducted a meta-analysis and systematic review to compare diagnostic parameters of FDG-PET and CMR in the diagnosis of cardiac sarcoidosis (CS). METHODS We searched PubMed, EMBASE, and Scopus databases from their inception to 9/30/2021 with search terms "cardiac sarcoidosis" AND "cardiac magnetic resonance imaging" AND "positronemission tomography". We extracted patient characteristics, results of the FDG-PET and CMR, and adverse outcomes from the included studies. Adverse outcomes served as a reference standard for the evaluation of FDG-PET and CMR. RESULTS We included 4 studies in the meta-analysis which provided adverse outcomes and all patients underwent FDG-PET and CMR. There were 237 patients, 60.3% male, and ages ranged from 50-53 years. There were 45 events in 237 patients from four studies included in the meta-analyses. The pooled sensitivity (95% confidence interval-CI) and specificity (CI) of CMR in predicting an adverse event were 0.94 (0.79-0.98) and 0.49 (0.40-0.59), respectively. The pooled sensitivity (CI) and specificity (CI) of FDG-PET in predicting an adverse event were 0.51 (0.26-0.75) and 0.60 (0.35-0.81), respectively. CONCLUSION CMR was more sensitive but less specific than FDG-PET in predicting adverse events; however, the study population and definition of a positive test need to be considered while interpreting the results.
Collapse
Affiliation(s)
- Mehul Adhaduk
- Division of General Internal Medicine, University of Iowa Department of Internal Medicine, Iowa City, USA.
| | - Bishow Paudel
- Division of General Internal Medicine, University of Iowa Department of Internal Medicine, Iowa City, USA
| | - Muhammad Umar Khalid
- Division of General Internal Medicine, University of Iowa Department of Internal Medicine, Iowa City, USA
| | - Mahi Ashwath
- Division of Cardiovascular Medicine, University of Iowa Department of Internal Medicine, Iowa City, USA
| | - Shareef Mansour
- Division of Cardiovascular Medicine, University of Iowa Department of Internal Medicine, Iowa City, USA
| | - Kan Liu
- Division of Cardiovascular Medicine, University of Iowa Department of Internal Medicine, Iowa City, USA
| |
Collapse
|
5
|
Al-Sadawi M, Henriques M, Tao M, Gier C, Kim P, Aslam F, Almasry I, Singh A, Fan R, Rashba E. Prognostic value of late-gadolinium enhancement on cardiac magnetic resonance in patients with cardiac sarcoidosis. Pacing Clin Electrophysiol 2023. [PMID: 37216284 DOI: 10.1111/pace.14722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/28/2023] [Accepted: 05/02/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Late-gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) is a predictor of adverse events in patients with cardiac sarcoidosis (CS), but available studies had small sample sizes and did not consider all relevant endpoints. OBJECTIVE To evaluate the association between LGE on CMR in patients with CS and mortality, ventricular arrhythmias (VA) and sudden cardiac death (SCD), and heart failure (HF) hospitalization. METHODS A literature search was conducted for studies reporting the association between LGE in CS and the study endpoints. The endpoints were mortality, VA and SCD, and HF hospitalization. The search included the following databases: Ovid MEDLINE, EMBASE, Web of Science, and Google Scholar. The search was not restricted to time or publication status. The minimum follow-up duration was 1 year. RESULTS A total of 17 studies and 1915 CS patients (595 with LGE vs. 1320 without LGE) were included; mean follow-up was 3.3 years (ranging between 17 and 84 months). LGE was associated with increased all-cause mortality (OR 6.05, 95% CI 3.16-11.58; p < .01), cardiovascular mortality (OR 5.83, 95% CI 2.89-11.77; p < .01), and VA and SCD (OR 16.48, 95% CI 8.29-32.73; p < .01). Biventricular LGE was associated with increased VA and SCD (OR 6.11, 95% CI 1.14-32.68; p = .035). LGE was associated with an increased HF hospitalization (OR 17.47, 95% CI 5.54-55.03; p < .01). Heterogeneity was low: df = 7 (p = .43), I2 = 0%. CONCLUSIONS LGE in CS patients is associated with increased mortality, VA and SCD, and HF hospitalization. Biventricular LGE is associated with an increased risk of VA and SCD.
Collapse
Affiliation(s)
- Mohammed Al-Sadawi
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Matthew Henriques
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Michael Tao
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Chad Gier
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Paul Kim
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Faisal Aslam
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Ibrahim Almasry
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Abhijeet Singh
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Roger Fan
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Eric Rashba
- Division of Cardiology, Department of Medicine, Stony Brook University Hospital, Stony Brook, New York, USA
| |
Collapse
|
6
|
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
|
7
|
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: 3] [Impact Index Per Article: 3.0] [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
|
8
|
Imaging of metabolic and overload disorders in tissues and organs. Jpn J Radiol 2023; 41:571-595. [PMID: 36680702 DOI: 10.1007/s11604-022-01379-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/24/2022] [Indexed: 01/22/2023]
Abstract
Metabolic and overload disorders are a heterogeneous group of relatively uncommon but important diseases. While imaging plays a key role in the early detection and accurate diagnosis in specific organs with a pivotal role in several metabolic pathways, most of these diseases affect different tissues as part of a systemic syndromes. Moreover, since the symptoms are often vague and phenotypes similar, imaging alterations can present as incidental findings, which must be recognized and interpreted in the light of further biochemical and histological investigations. Among imaging modalities, MRI allows, thanks to its multiparametric properties, to obtain numerous information on tissue composition, but many metabolic and accumulation alterations require a multimodal evaluation, possibly using advanced imaging techniques and sequences, not only for the detection but also for accurate characterization and quantification. The purpose of this review is to describe the different alterations resulting from metabolic and overload pathologies in organs and tissues throughout the body, with particular reference to imaging findings.
Collapse
|
9
|
Heo GS, Diekmann J, Thackeray JT, Liu Y. Nuclear Methods for Immune Cell Imaging: Bridging Molecular Imaging and Individualized Medicine. Circ Cardiovasc Imaging 2023; 16:e014067. [PMID: 36649445 PMCID: PMC9858352 DOI: 10.1161/circimaging.122.014067] [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] [Indexed: 01/19/2023]
Abstract
Inflammation is a key mechanistic contributor to the progression of cardiovascular disease, from atherosclerosis through ischemic injury and overt heart failure. Recent evidence has identified specific roles of immune cell subpopulations in cardiac pathogenesis that diverges between individual patients. Nuclear imaging approaches facilitate noninvasive and serial quantification of inflammation severity, offering the opportunity to predict eventual outcome, stratify patient risk, and guide novel targeted molecular therapies against specific leukocyte subpopulations. Here, we will discuss the established and emerging nuclear imaging methods to label and track exogenous and endogenous immune cells, with a particular focus on clinical situations in which targeted molecular inflammation imaging would be advantageous. The expanding options for imaging inflammation provide the foundation to bridge between molecular imaging and individual therapy.
Collapse
Affiliation(s)
- Gyu Seong Heo
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO (G.S.H., Y. L.)
| | - Johanna Diekmann
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany (J.D., J.T.T.)
| | - James T Thackeray
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany (J.D., J.T.T.)
| | - Yongjian Liu
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO (G.S.H., Y. L.)
| |
Collapse
|
10
|
Slivnick JA, Wali E, Patel AR. Imaging in Cardiac Sarcoidosis: Complementary Role of Cardiac Magnetic Resonance and Cardiac Positron Emission Tomography. CURRENT CARDIOVASCULAR IMAGING REPORTS 2022. [DOI: 10.1007/s12410-022-09571-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
11
|
Bazoukis G, Liatakis I, Vassiliou VS, Tse G, Gounopoulos P, Saplaouras A, Letsas KP, Vlachos K, Papadatos SS, Konstantinidou E, Lakoumentas I, Sideris A, Efremidis M. The role of late gadolinium enhancement in predicting arrhythmic events in cardiac sarcoidosis patients - a mini-review. Acta Cardiol 2022; 77:768-773. [PMID: 35086421 DOI: 10.1080/00015385.2022.2029231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Sarcoidosis is a multisystem inflammatory disorder with an unknown origin. Symptomatic cardiac involvement is rare and occurs in about 5% of patients with sarcoidosis. Fatal ventricular arrhythmias are the most severe clinical presentation of the disease. Cardiac magnetic resonance (CMR) is a useful non-invasive tool for the risk stratification of ventricular arrhythmias and sudden cardiac death (SCD) in patients with cardiac sarcoidosis (CS). More specifically, late gadolinium enhancement (LGE), a CMR tool for scar detection, has been found to be significantly associated with arrhythmic events in CS patients. This review aims to present the existing evidence regarding the association of LGE with adverse events and especially with fatal ventricular arrhythmias.
Collapse
Affiliation(s)
- George Bazoukis
- Department of Cardiology, Larnaca General Hospital, Larnaca, Cyprus.,University of Nicosia Medical School, Nicosia, Cyprus
| | - Ioannis Liatakis
- Second Department of Cardiology, General Hospital of Athens "Evangelismos", Athens, Greece
| | | | - Gary Tse
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease Tianjin Institute of Cardiology Second Hospital of Tianjin Medical University Tianjin, PR China.,Kent and Medway Medical School, Canterbury, UK
| | - Pantelis Gounopoulos
- Second Department of Cardiology, General Hospital of Athens "Evangelismos", Athens, Greece
| | - Athanasios Saplaouras
- Second Department of Cardiology, General Hospital of Athens "Evangelismos", Athens, Greece
| | | | | | - Stamatis S Papadatos
- Department of Anatomy, Histology and Embryology, Medical School, University of Ioannina, Ioannina, Greece
| | - Eleni Konstantinidou
- Second Department of Cardiology, General Hospital of Athens "Evangelismos", Athens, Greece
| | - Ioannis Lakoumentas
- Second Department of Cardiology, General Hospital of Athens "Evangelismos", Athens, Greece
| | - Antonios Sideris
- Second Department of Cardiology, General Hospital of Athens "Evangelismos", Athens, Greece
| | | |
Collapse
|
12
|
Abstract
PURPOSE OF REVIEW Cardiac sarcoidosis (CS) is a potentially fatal condition when unrecognized or not treated adequately. The purpose of this review is to provide new strategies to increase clinical recognition of CS and to present an updated overview of the immunosuppressive treatments using most recent data published in the last 18 months. RECENT FINDINGS CS is an increasingly recognized pathology, and its diagnostic is made 20 times more often in the last two decades. Recent studies have shown that imaging alone usually lacks specificity to distinguish CS from other inflammatory cardiomyopathies. However, imaging can be used to increase significantly diagnostic yield of extracardiac and cardiac biopsy. Recent reviews have also demonstrated that nearly 25% of patients will be refractory to standard treatment with prednisone and that combined treatment with a corticosteroid-sparing agent is often necessary for a period that remains undetermined. SUMMARY CS is a complex pathology that should always require a biopsy attempt to have a histological proven diagnosis before starting immunosuppressive therapy consisting of corticosteroids with or without a corticosteroid-sparing agent.
Collapse
Affiliation(s)
- Sylvain Lemay
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Quebec City, Quebec, Canada
| | | | | |
Collapse
|
13
|
Wand AL, Chrispin J, Saad E, Mukherjee M, Hays AG, Gilotra NA. Current State and Future Directions of Multimodality Imaging in Cardiac Sarcoidosis. Front Cardiovasc Med 2022; 8:785279. [PMID: 35155601 PMCID: PMC8828956 DOI: 10.3389/fcvm.2021.785279] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/31/2021] [Indexed: 12/19/2022] Open
Abstract
Cardiac sarcoidosis (CS) is an increasingly recognized cause of heart failure and arrhythmia. Historically challenging to identify, particularly in the absence of extracardiac sarcoidosis, diagnosis of CS has improved with advancements in cardiac imaging. Recognition as well as management may require interpretation of multiple imaging modalities. Echocardiography may serve as an initial screening study for cardiac involvement in patients with systemic sarcoidosis. Cardiac magnetic resonance imaging (CMR) provides information on diagnosis as well as risk stratification, particularly for ventricular arrhythmia in the setting of late gadolinium enhancement. More recently, 18F-fluorodeoxyglucose position emission tomography (FDG-PET) has assumed a valuable role in the diagnosis and longitudinal management of patients with CS, allowing for the assessment of response to treatment. Hybrid FDG-PET/CT may also be used in the evaluation of extracardiac inflammation, permitting the identification of biopsy sites for diagnostic confirmation. Herein we examine the approach to diagnosis and management of CS using multimodality imaging via a case-based review.
Collapse
Affiliation(s)
- Alison L Wand
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jonathan Chrispin
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Elie Saad
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Monica Mukherjee
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Allison G Hays
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Nisha A Gilotra
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| |
Collapse
|
14
|
Adhaduk M, Paudel B, Liu K, Ashwath M, Giudici M. The role of electrophysiology study in risk stratification of cardiac sarcoidosis patients: Meta-analyses and systemic review. Int J Cardiol 2021; 349:55-61. [PMID: 34864075 DOI: 10.1016/j.ijcard.2021.11.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/17/2021] [Accepted: 11/24/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND The utility of an electrophysiologic study (EPS) in the risk stratification of cardiac sarcoidosis (CS) patients is not clear. We conducted a systemic review and meta-analysis to evaluate the utility of EPS in the risk stratification of CS patients. METHODS We searched PubMed, Embase, and Scopus databases from their inception to 12/4/2020 with search terms "Cardiac sarcoidosis" And "Electrophysiological studies OR ablation". The first and second authors reviewed all the studies. We extracted the data of positive and negative EPS, and outcomes defined as ventricular arrhythmias, implantable cardioverter defibrillator therapy, death, left ventricular assist device placement, or heart transplantation. Risk of bias assessment was done by the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Subgroup analysis of patients with left ventricular ejection fraction (LVEF) >35%, and probable CS, no prior ventricular tachycardia (VT) and LVEF >35% were performed. RESULTS We found 544 articles after removing duplicates. A total of 52 full articles were reviewed, and eight studies were included in the meta-analysis. The pooled sensitivity and specificity (95% confidence interval) of EPS in predicting clinical outcomes were 0.70 (0.51-0.85) and 0.93 (0.85-0.97), respectively. Subgroup analysis of patients with LVEF >35% resulted in pooled sensitivity of 0.63 (0.29-0.88) and pooled specificity of 0.97 (0.92-0.99), and subgroup analysis of patients with probable CS, no prior VT, and LVEF >35% resulted in pooled sensitivity of 0.71 (0.33-0.93) and pooled specificity of 0.96 (0.88-0.99) in predicting adverse clinical outcomes. CONCLUSIONS EPS is an effective risk stratification tool in patients with CS across all subgroups with high sensitivity and specificity.
Collapse
Affiliation(s)
| | | | - Kan Liu
- The University of Iowa, United States of America
| | - Mahi Ashwath
- The University of Iowa, United States of America
| | | |
Collapse
|
15
|
Ahmed AI, Abebe AT, Han Y, Alnabelsi T, Agrawal T, Kassi M, Aljizeeri A, Taylor A, Tleyjeh IM, Al-Mallah MH. The prognostic role of cardiac positron emission tomography imaging in patients with sarcoidosis: A systematic review. J Nucl Cardiol 2021; 28:1545-1552. [PMID: 34228337 DOI: 10.1007/s12350-021-02681-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/27/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Sarcoidosis is a multi-systemic inflammatory disease of unknown etiology. Cardiac sarcoidosis (CS) has been reported in as much as 25% of patients with systemic involvement. 18Fluorodeoxyglucose (FDG) positron emission tomography (PET) has a high diagnostic sensitivity/specificity in the diagnosis of CS. The aim of this review is to summarize evidence on the prognostic role of FDG PET. METHODS Studies were identified by searching MEDLINE from inception to October 2020. Medical subject headings (MeSH) terms for sarcoidosis; cardiac and FDG PET imaging were used. Studies of any design assessing the prognostic role of FDG PET in patients with either suspected or confirmed cardiac sarcoidosis imaging done at baseline were included. Abnormal PET was defined as abnormal metabolism (presence of focal or focal-on-diffuse uptake of FDG) OR abnormal metabolism and a perfusion defect. Studies reporting any outcome measure were included. Pooled risk ratio for the composite outcome of MACE was done. RESULTS A total of 6 studies were selected for final inclusion (515 patients, 53.4% women, 19.8% racial minorities.) Studies were institution based, retrospective in design and enrolled consecutive patients. All were observational in nature and published in English. All studies used a qualitative assessment of PET scans (abnormal FDG uptake with or without abnormal perfusion). Two studies assessed quantitative metrics (summed stress score in segments with abnormal FDG uptake, standardized uptake value and cardiac metabolic activity.) All studies reported major adverse cardiovascular events (MACE) as a composite outcome. After a mean follow up ranging from 1.4 to 4.1 years, there were a total of 105 MACE. All studies included death (either all-cause death or sudden cardiac death) and ventricular arrhythmia (ventricular tachycardia or ventricular fibrillation) as a component of MACE. Four of the six studies adjusted for several characteristics in their analysis. All four studies used left ventricular ejection fraction (LVEF). However, other adjustment variables were not consistent across studies. Five studies found a positive prognostic association with the primary outcome, two of which assessing right ventricular uptake. CONCLUSION Although available evidence indicates FDG PET can be used in the risk stratification of patients with CS, our findings show further studies are needed to quantify the effect in this patient group.
Collapse
Affiliation(s)
- Ahmed Ibrahim Ahmed
- Houston Methodist Debakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA
| | - Abel Tsehay Abebe
- Department of Radiology, Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA, 19146, USA
| | - Yushui Han
- Houston Methodist Debakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA
| | - Talal Alnabelsi
- Houston Methodist Debakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA
| | - Tanushree Agrawal
- Houston Methodist Debakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA
| | - Mahwash Kassi
- Houston Methodist Debakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA
| | - Ahmed Aljizeeri
- King Abdulaziz Cardiac Center, Ministry of National Guard, Health Affairs, Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Amy Taylor
- Houston Methodist Debakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA
| | | | - Mouaz H Al-Mallah
- Houston Methodist Debakey Heart & Vascular Center, 6550 Fannin Street, Smith Tower - Suite 1801, Houston, TX, 77030, USA.
| |
Collapse
|
16
|
Kebed KY, Carter SV, Flatley E, Ward RP, Moss JD, Appelbaum DE, Singh A, Lang RM, Tung R, Patel AR. Prevalence of newly diagnosed sarcoidosis in patients with ventricular arrhythmias: a cardiac magnetic resonance and 18F-FDG cardiac PET study. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2021; 37:1361-1369. [PMID: 33225427 DOI: 10.1007/s10554-019-01745-z.measurement] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/26/2020] [Indexed: 05/22/2023]
Abstract
Cardiac sarcoidosis (CS) is known to be associated with ventricular tachycardia (VT); however, most investigations to date have focused on patients with known extra-cardiac sarcoidosis. The presence of CS is typically evaluated using 18F-fluorodeoxyglucose (18F-FDG) uptake on cardiac positron emission tomography (PET) or late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR). In this study, we sought to determine the prevalence of primary CS and the relationship between myocardial 18F-FDG uptake and LGE in patients with VT without known sarcoidosis. We retrospectively identified 67 patients without known sarcoidosis or active ischemic heart disease (i.e. significant ischemic disease that had not been previously revascularized) referred for both CMR and PET for evaluation of VT. Standard cine- and LGE- CMR and cardiac PET protocols were used. Myocardial LGE was defined as signal intensity > 5 SDs above the mean signal intensity of normal myocardium. Cardiac PET images were considered positive if there was focal myocardial 18F-FDG uptake having greater activity than the left ventricular blood pool. 45 patients (67%) had LGE, while only 4 (6%) had myocardial FDG uptake. Nine percent of patients with LGE had FDG-uptake while none without LGE did, and 10% of the cohort had indeterminate FDG uptake presumably from poor dietary preparation. Of those with both FDG uptake and LGE, 3/4 ultimately received a clinical diagnosis of CS. 4.5% of patients without previously known sarcoidosis or active ischemic heart disease presenting with VT have newly diagnosed CS. Detection of CS can be increased using a CMR first approach followed by cardiac PET for patients with non-ischemic LGE.
Collapse
Affiliation(s)
| | - Spencer V Carter
- Department of Internal Medicine, University of Chicago, Chicago, USA
| | - Erin Flatley
- Department of Medicine, Division of Cardiology, University of California San Francisco, San Francisco, USA
| | - R Parker Ward
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, 5758 S. Maryland Avenue, MC 9067, Chicago, IL, 60637, USA
| | - Joshua D Moss
- Department of Medicine, Division of Cardiology, University of California San Francisco, San Francisco, USA
| | | | - Amita Singh
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, 5758 S. Maryland Avenue, MC 9067, Chicago, IL, 60637, USA
| | - Roberto M Lang
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, 5758 S. Maryland Avenue, MC 9067, Chicago, IL, 60637, USA
| | - Roderick Tung
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, 5758 S. Maryland Avenue, MC 9067, Chicago, IL, 60637, USA
| | - Amit R Patel
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, 5758 S. Maryland Avenue, MC 9067, Chicago, IL, 60637, USA.
| |
Collapse
|
17
|
Affiliation(s)
- Vasileios Kouranos
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Rakesh Sharma
- National Heart and Lung Institute, Imperial College London, London, UK .,Cardiology Department, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| |
Collapse
|
18
|
Challenges in Cardiac and Pulmonary Sarcoidosis: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 76:1878-1901. [PMID: 33059834 DOI: 10.1016/j.jacc.2020.08.042] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 12/17/2022]
Abstract
Sarcoidosis is a complex disease with heterogeneous clinical presentations that can affect virtually any organ. Although the lung is typically the most common organ involved, combined pulmonary and cardiac sarcoidosis (CS) account for most of the morbidity and mortality associated with this disease. Pulmonary sarcoidosis can be asymptomatic or result in impairment in quality of life and end-stage, severe, and/or life-threatening disease. The latter outcome is seen almost exclusively in those with fibrotic pulmonary sarcoidosis, which accounts for 10% to 20% of pulmonary sarcoidosis patients. CS is problematic to diagnose and may cause significant morbidity and death from heart failure or ventricular arrhythmias. The diagnosis of CS usually requires surrogate cardiac imaging biomarkers, as endomyocardial biopsy has relatively low yield, even with directed electrophysiological mapping. Treatment of CS is often multifactorial, involving a combination of antigranulomatous therapy and pharmacotherapy for cardiac arrhythmias and/or heart failure in addition to device placement and cardiac transplantation.
Collapse
|
19
|
Tuominen H, Haarala A, Tikkakoski A, Kähönen M, Nikus K, Sipilä K. FDG-PET in possible cardiac sarcoidosis: Right ventricular uptake and high total cardiac metabolic activity predict cardiovascular events. J Nucl Cardiol 2021; 28:199-205. [PMID: 30815833 PMCID: PMC7920884 DOI: 10.1007/s12350-019-01659-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 02/01/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cardiac involvement accounts for the majority of morbidity and mortality in sarcoidosis. Pathological myocardial fluorodeoxyglucose (FDG)-uptake in positron emission tomography (PET) has been associated with cardiovascular events and quantitative metabolic parameters have been shown to add prognostic value. Our aim was to study whether the pattern of pathological cardiac FDG-uptake and quantitative parameters are able to predict cardiovascular events in patients with suspected cardiac sarcoidosis (CS). METHODS 137 FDG-PET examinations performed in Tampere University Hospital were retrospectively analyzed visually and quantitatively. Location of pathological uptake was noted and pathological metabolic volume, average standardized uptake value (SUV), and total cardiac metabolic activity (tCMA) were calculated. Patients were followed for ventricular tachycardia, decrease in left ventricular ejection fraction, and death. RESULTS Eleven patients had one or more cardiovascular events during the follow-up. Five patients out of 12 with uptake in both ventricles had an event during follow-up. Eight patients had high tCMA (> 900 MBq) and three of them had a cardiovascular event. Right ventricular uptake and tCMA were significantly associated with cardiovascular events during follow-up (P-value .001 and .018, respectively). CONCLUSIONS High tCMA and right ventricular uptake were significant risk markers for cardiac events among patient with suspected CS.
Collapse
Affiliation(s)
- Heikki Tuominen
- Department of Clinical Physiology and Nuclear Medicine, Tampere University Hospital, 33520, Tampere, Finland.
| | - Atte Haarala
- Department of Clinical Physiology and Nuclear Medicine, Tampere University Hospital, 33520, Tampere, Finland
| | - Antti Tikkakoski
- Department of Clinical Physiology and Nuclear Medicine, Tampere University Hospital, 33520, Tampere, Finland
| | - Mika Kähönen
- Department of Clinical Physiology and Nuclear Medicine, Tampere University Hospital, 33520, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Kjell Nikus
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Cardiology, Heart Center, Tampere University Hospital, Tampere, Finland
| | - Kalle Sipilä
- Department of Clinical Physiology and Nuclear Medicine, Tampere University Hospital, 33520, Tampere, Finland
| |
Collapse
|
20
|
Crouser ED, Julian MW, Bicer S, Ghai V, Kim TK, Maier LA, Gillespie M, Hamzeh NY, Wang K. Circulating exosomal microRNA expression patterns distinguish cardiac sarcoidosis from myocardial ischemia. PLoS One 2021; 16:e0246083. [PMID: 33497386 PMCID: PMC7837479 DOI: 10.1371/journal.pone.0246083] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 01/13/2021] [Indexed: 12/21/2022] Open
Abstract
Objective Cardiac sarcoidosis is difficult to diagnose, often requiring expensive and inconvenient advanced imaging techniques. Circulating exosomes contain genetic material, such as microRNA (miRNA), that are derived from diseased tissues and may serve as potential disease-specific biomarkers. We thus sought to determine whether circulating exosome-derived miRNA expression patterns would distinguish cardiac sarcoidosis (CS) from acute myocardial infarction (AMI). Methods Plasma and serum samples conforming to CS, AMI or disease-free controls were procured from the Biologic Specimen and Data Repository Information Coordinating Center repository and National Jewish Health. Next generation sequencing (NGS) was performed on exosome-derived total RNA (n = 10 for each group), and miRNA expression levels were compared after normalization using housekeeping miRNA. Quality assurance measures excluded poor quality RNA samples. Differentially expressed (DE) miRNA patterns, based upon >2-fold change (p < 0.01), were established in CS compared to controls, and in CS compared to AMI. Relative expression of several DE-miRNA were validated by qRT-PCR. Results Despite the advanced age of the stored samples (~5–30 years), the quality of the exosome-derived miRNA was intact in ~88% of samples. Comparing plasma exosomal miRNA in CS versus controls, NGS yielded 18 DE transcripts (12 up-regulated, 6 down-regulated), including miRNA previously implicated in mechanisms of myocardial injury (miR-92, miR-21) and immune responses (miR-618, miR-27a). NGS further yielded 52 DE miRNA in serum exosomes from CS versus AMI: 5 up-regulated in CS; 47 up-regulated in AMI, including transcripts previously detected in AMI patients (miR-1-1, miR-133a, miR-208b, miR-423, miR-499). Five miRNAs with increased DE in CS included two isoforms of miR-624 and miR-144, previously reported as markers of cardiomyopathy. Conclusions MiRNA patterns of exosomes derived from CS and AMI patients are distinct, suggesting that circulating exosomal miRNA patterns could serve as disease biomarkers. Further studies are required to establish their specificity relative to other cardiac disorders.
Collapse
Affiliation(s)
- Elliott D. Crouser
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, The Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
- * E-mail:
| | - Mark W. Julian
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, The Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
| | - Sabahattin Bicer
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, The Dorothy M. Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States of America
| | - Vikas Ghai
- Institute for Systems Biology, Seattle, Washington, United States of America
| | - Taek-Kyun Kim
- Institute for Systems Biology, Seattle, Washington, United States of America
| | - Lisa A. Maier
- Department of Medicine, Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, Colorado, United States of America
| | - May Gillespie
- Department of Medicine, Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, Colorado, United States of America
| | - Nabeel Y. Hamzeh
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States of America
| | - Kai Wang
- Institute for Systems Biology, Seattle, Washington, United States of America
| |
Collapse
|
21
|
Ishidoya Y, Ranjan R. Novel Approaches to Risk Assessment for Ventricular Tachycardia Induction and Therapy. CURRENT CARDIOVASCULAR RISK REPORTS 2021. [DOI: 10.1007/s12170-020-00666-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
22
|
Schindler TH, Derenoncourt P, Leucker TM. Cardiac sarcoidosis and prediction of sudden death: An ongoing clinical dilemma? Int J Cardiol 2020; 329:177-178. [PMID: 33358833 DOI: 10.1016/j.ijcard.2020.12.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Thomas H Schindler
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, Cardiovascular Medicine, Washington University School of Medicine, St. Louis, MO, USA; Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA; Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA.
| | - Paul Derenoncourt
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, Cardiovascular Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Thorsten M Leucker
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
| |
Collapse
|
23
|
Prevalence of newly diagnosed sarcoidosis in patients with ventricular arrhythmias: a cardiac magnetic resonance and 18F-FDG cardiac PET study. Int J Cardiovasc Imaging 2020; 37:1361-1369. [PMID: 33225427 DOI: 10.1007/s10554-020-02090-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/26/2020] [Indexed: 10/22/2022]
Abstract
Cardiac sarcoidosis (CS) is known to be associated with ventricular tachycardia (VT); however, most investigations to date have focused on patients with known extra-cardiac sarcoidosis. The presence of CS is typically evaluated using 18F-fluorodeoxyglucose (18F-FDG) uptake on cardiac positron emission tomography (PET) or late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR). In this study, we sought to determine the prevalence of primary CS and the relationship between myocardial 18F-FDG uptake and LGE in patients with VT without known sarcoidosis. We retrospectively identified 67 patients without known sarcoidosis or active ischemic heart disease (i.e. significant ischemic disease that had not been previously revascularized) referred for both CMR and PET for evaluation of VT. Standard cine- and LGE- CMR and cardiac PET protocols were used. Myocardial LGE was defined as signal intensity > 5 SDs above the mean signal intensity of normal myocardium. Cardiac PET images were considered positive if there was focal myocardial 18F-FDG uptake having greater activity than the left ventricular blood pool. 45 patients (67%) had LGE, while only 4 (6%) had myocardial FDG uptake. Nine percent of patients with LGE had FDG-uptake while none without LGE did, and 10% of the cohort had indeterminate FDG uptake presumably from poor dietary preparation. Of those with both FDG uptake and LGE, 3/4 ultimately received a clinical diagnosis of CS. 4.5% of patients without previously known sarcoidosis or active ischemic heart disease presenting with VT have newly diagnosed CS. Detection of CS can be increased using a CMR first approach followed by cardiac PET for patients with non-ischemic LGE.
Collapse
|
24
|
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
|
25
|
Gowani Z, Habibi M, Okada DR, Smith J, Derakhshan A, Zimmerman SL, Misra S, Gilotra NA, Berger RD, Calkins H, Tandri H, Chrispin J. Utility of Cardiac Magnetic Resonance Imaging Versus Cardiac Positron Emission Tomography for Risk Stratification for Ventricular Arrhythmias in Patients With Cardiac Sarcoidosis. Am J Cardiol 2020; 134:123-129. [PMID: 32950203 DOI: 10.1016/j.amjcard.2020.08.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 08/03/2020] [Accepted: 08/03/2020] [Indexed: 12/20/2022]
Abstract
Abnormalities on cardiac magnetic resonance imaging (CMR) and positron emission tomography (PET) predict ventricular arrhythmias (VA) in patients with cardiac sarcoidosis (CS). Little is known whether concurrent abnormalities on CMR and PET increases the risk of developing VA. Our aim was to compare the additive utility of CMR and PET in predicting VA in patients with CS. We included all patients treated at our institution from 2000 to 2018 who (1) had probable or definite CS and (2) had undergone both CMR and PET. The primary endpoint was VA at follow up, which was defined as sustained ventricular tachycardia, sudden cardiac death, or any appropriate device tachytherapy. Fifty patients were included, 88% of whom had a left ventricular ejection fraction >35%. During a mean follow-up 4.1 years, 7/50 (14%) patients had VA. The negative predictive value of LGE for VA was 100% and the negative predictive value of FDG for VA was 79%. Among groups, VA occurred in 4/21 (19%) subjects in the LGE+/FDG+ group, 3/14 (21%) in the LGE+/FDG- group, and 0/15 (0%) in the FDG+/LGE- group. There were no LGE-/FDG- patients. In conclusion, CMR may be the preferred initial clinical risk stratification tool in patients with CS. FDG uptake without LGE on initial imaging may not add additional prognostic information regarding VA risk.
Collapse
MESH Headings
- Adult
- Aged
- Cardiomyopathies/complications
- Cardiomyopathies/diagnostic imaging
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Defibrillators, Implantable
- Electric Countershock
- Female
- Fluorodeoxyglucose F18
- Humans
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Positron-Emission Tomography
- Predictive Value of Tests
- Radiopharmaceuticals
- Risk Assessment
- Sarcoidosis/complications
- Sarcoidosis/diagnostic imaging
- Tachycardia, Ventricular/epidemiology
- Tachycardia, Ventricular/etiology
- Tachycardia, Ventricular/therapy
- Ventricular Fibrillation/epidemiology
- Ventricular Fibrillation/etiology
- Ventricular Fibrillation/therapy
Collapse
Affiliation(s)
- Zain Gowani
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Mohammadali Habibi
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - David R Okada
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - John Smith
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Arsalan Derakhshan
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | | | - Satish Misra
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Nisha A Gilotra
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Ronald D Berger
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Harikrishna Tandri
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Jonathan Chrispin
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland.
| |
Collapse
|
26
|
Ha FJ, Agarwal S, Tweed K, Palmer SC, Adams HS, Thillai M, Williams L. Imaging in Suspected Cardiac Sarcoidosis: A Diagnostic Challenge. Curr Cardiol Rev 2020; 16:90-97. [PMID: 31345153 PMCID: PMC7460708 DOI: 10.2174/1573403x15666190725121246] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/05/2019] [Accepted: 07/11/2019] [Indexed: 12/18/2022] Open
Abstract
Cardiac Sarcoidosis (CS) represents a unique diagnostic dilemma. Guidelines have been recently revised to reflect the established role of sophisticated imaging techniques. Trans-thoracic Echocardiography (TTE) is widely adopted for initial screening of CS. Contemporary TTE techniques could enhance detection of subclinical Left Ventricular (LV) dysfunction, particularly LV global longitudinal strain assessment which predicts event-free survival (meta-analysis of 5 studies, hazard ratio 1.28, 95% confidence interval 1.18-1.37, p < 0.0001). However, despite the wide availability of TTE, it has limited sensitivity and specificity for CS diagnosis. Cardiac Magnetic resonance Imaging (CMR) is a crucial diagnostic modality for suspected CS. Presence of late gadolinium enhancement signifies myocardial scar and enables risk stratification. Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) coupled with myocardial perfusion imaging can identify active CS and guide immunosuppressant therapy. Gallium scintigraphy may be considered although FDG-PET is often preferred. While CMR and FDG-PET provide complementary information in CS evaluation, current guidelines do not recommend which imaging modalities are essential in suspected CS and if so, which modality should be performed first. The utility of hybrid imaging combining both advanced imaging modalities in a single scan is currently being explored, although not yet widely available. In view of recent, significant advances in cardiac imaging techniques, this review aims to discuss changes in guidelines for CS diagnosis, the role of various cardiac imaging modalities and the future direction in CS.
Collapse
Affiliation(s)
- Francis J Ha
- St Vincent's Hospital Melbourne, Victoria, Australia
| | - Sharad Agarwal
- Royal Papworth Hospital, NHS Foundation Trust, Cambridge, CB2 0AY, United Kingdom
| | - Katharine Tweed
- Royal Papworth Hospital, NHS Foundation Trust, Cambridge, CB2 0AY, United Kingdom
| | - Sonny C Palmer
- St Vincent's Hospital Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Victoria, Australia
| | - Heath S Adams
- St Vincent's Hospital Melbourne, Victoria, Australia
| | - Muhunthan Thillai
- Royal Papworth Hospital, NHS Foundation Trust, Cambridge, CB2 0AY, United Kingdom.,Department of Medicine University of Cambridge, Cambridge, CB2 0AY, United Kingdom
| | - Lynne Williams
- Royal Papworth Hospital, NHS Foundation Trust, Cambridge, CB2 0AY, United Kingdom
| |
Collapse
|
27
|
Kraaijvanger R, Janssen Bonás M, Vorselaars ADM, Veltkamp M. Biomarkers in the Diagnosis and Prognosis of Sarcoidosis: Current Use and Future Prospects. Front Immunol 2020; 11:1443. [PMID: 32760396 PMCID: PMC7372102 DOI: 10.3389/fimmu.2020.01443] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/03/2020] [Indexed: 12/15/2022] Open
Abstract
Sarcoidosis is a heterogeneous disease in terms of presentation, duration, and severity. Due to this heterogeneity, it is difficult to align treatment decisions. Biomarkers have proved to be useful for the diagnosis and prognosis of many diseases, and over the years, many biomarkers have been proposed to facilitate diagnosis, prognosis, and treatment decisions. Unfortunately, the ideal biomarker for sarcoidosis has not yet been discovered. The most commonly used biomarkers are serum and bronchoalveolar lavage biomarkers, but these lack the necessary specificity and sensitivity. In sarcoidosis, therefore, a combination of these biomarkers is often used to establish a proper diagnosis or detect possible progression. Other potential biomarkers include imaging tools and cell signaling pathways. Fluor-18-deoxyglucose positron emission tomography and high-resolution computed tomography have been proven to be more sensitive for the diagnosis and prognosis of both pulmonary and cardiac sarcoidosis than the serum biomarkers ACE and sIL-2R. There is an upcoming role for exploration of signaling pathways in sarcoidosis pathogenesis. The JAK/STAT and mTOR pathways in particular have been investigated because of their role in granuloma formation. The activation of these signaling pathways also proved to be a specific biomarker for the prognosis of sarcoidosis. Furthermore, both imaging and cell signaling biomarkers also enable patients who might benefit from a particular type of treatment to be distinguished from those who will not. In conclusion, the diagnostic and prognostic path of sarcoidosis involves many different types of existing and new biomarker. Research addressing biomarkers and disease pathology is ongoing in order to find the ideal sensitive and specific biomarker for this disease.
Collapse
Affiliation(s)
- Raisa Kraaijvanger
- Department of Pulmonology, ILD Center of Excellence, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Montse Janssen Bonás
- Department of Pulmonology, ILD Center of Excellence, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Adriane D. M. Vorselaars
- Department of Pulmonology, ILD Center of Excellence, St. Antonius Hospital, Nieuwegein, Netherlands
| | - Marcel Veltkamp
- Department of Pulmonology, ILD Center of Excellence, St. Antonius Hospital, Nieuwegein, Netherlands
- Department of Pulmonology, University Medical Center, Utrecht, Netherlands
| |
Collapse
|
28
|
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: 437] [Impact Index Per Article: 109.3] [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
|
29
|
Abstract
See Article Okasha et al
Collapse
Affiliation(s)
- Amit R Patel
- 1 Department of Medicine University of Chicago Chicago IL
| | - Nina Rashedi
- 1 Department of Medicine University of Chicago Chicago IL
| |
Collapse
|
30
|
Hybrid cardiac PET/MR: the value of multiparametric assessment in cardiac sarcoidosis. Clin Transl Imaging 2019. [DOI: 10.1007/s40336-019-00345-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
31
|
Rosenthal DG, Parwani P, Murray TO, Petek BJ, Benn BS, De Marco T, Gerstenfeld EP, Janmohamed M, Klein L, Lee BK, Moss JD, Scheinman MM, Hsia HH, Selby V, Koth LL, Pampaloni MH, Zikherman J, Vedantham V. Long-Term Corticosteroid-Sparing Immunosuppression for Cardiac Sarcoidosis. J Am Heart Assoc 2019; 8:e010952. [PMID: 31538835 PMCID: PMC6818011 DOI: 10.1161/jaha.118.010952] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Long‐term corticosteroid therapy is the standard of care for treatment of cardiac sarcoidosis (CS). The efficacy of long‐term corticosteroid‐sparing immunosuppression in CS is unknown. The goal of this study was to assess the efficacy of methotrexate with or without adalimumab for long‐term disease suppression in CS, and to assess recurrence and adverse event rates after immunosuppression discontinuation. Methods and Results Retrospective chart review identified treatment‐naive CS patients at a single academic medical center who received corticosteroid‐sparing maintenance therapy. Demographics, cardiac uptake of 18‐fluorodeoxyglucose, and adverse cardiac events were compared before and during treatment and between those with persistent or interrupted immunosuppression. Twenty‐eight CS patients were followed for a mean 4.1 (SD 1.5) years. Twenty‐five patients received 4 to 8 weeks of high‐dose prednisone (>30 mg/day), followed by taper and maintenance therapy with methotrexate±low‐dose prednisone (low‐dose prednisone, <10 mg/day). Adalimumab was added in 19 patients with persistently active CS or in those with intolerance to methotrexate. Methotrexate±low‐dose prednisone resulted in initial reduction (88%) or elimination (60%) of 18‐fluorodeoxyglucose uptake, and patients receiving adalimumab‐containing regimens experienced improved (84%) or resolved (63%) 18‐fluorodeoxyglucose uptake. Radiologic relapse occurred in 8 of 9 patients after immunosuppression cessation, 4 patients on methotrexate‐containing regimens, and in no patients on adalimumab‐containing regimens. Conclusions Corticosteroid‐sparing regimens containing methotrexate with or without adalimumab is an effective maintenance therapy in patients after an initial response is confirmed. Disease recurrence in patients on and off immunosuppression support need for ongoing radiologic surveillance regardless of immunosuppression regimen.
Collapse
Affiliation(s)
- David G Rosenthal
- Division of Cardiology Department of Medicine University of California, San Francisco San Francisco CA
| | - Purvi Parwani
- Division of Cardiology Department of Medicine University of California, San Francisco San Francisco CA
| | - Tyler O Murray
- Division of Cardiology Department of Medicine University of California, San Francisco San Francisco CA
| | - Bradley J Petek
- Department of Medicine Massachusetts General Hospital Boston MA
| | - Bryan S Benn
- Division of Pulmonary and Critical Care Department of Medicine University of California, San Francisco San Francisco CA
| | - Teresa De Marco
- Division of Cardiology Department of Medicine University of California, San Francisco San Francisco CA
| | - Edward P Gerstenfeld
- Division of Cardiology Department of Medicine University of California, San Francisco San Francisco CA
| | - Munir Janmohamed
- Division of Cardiology Department of Medicine University of California, San Francisco San Francisco CA
| | - Liviu Klein
- Division of Cardiology Department of Medicine University of California, San Francisco San Francisco CA
| | - Byron K Lee
- Division of Cardiology Department of Medicine University of California, San Francisco San Francisco CA
| | - Joshua D Moss
- Division of Cardiology Department of Medicine University of California, San Francisco San Francisco CA
| | - Melvin M Scheinman
- Division of Cardiology Department of Medicine University of California, San Francisco San Francisco CA
| | - Henry H Hsia
- Division of Cardiology Department of Medicine University of California, San Francisco San Francisco CA
| | - Van Selby
- Division of Cardiology Department of Medicine University of California, San Francisco San Francisco CA
| | - Laura L Koth
- Division of Pulmonary and Critical Care Department of Medicine University of California, San Francisco San Francisco CA
| | - Miguel H Pampaloni
- Division of Nuclear Medicine Department of Radiology University of California, San Francisco San Francisco CA
| | - Julie Zikherman
- Division of Rheumatology Department of Medicine University of California, San Francisco San Francisco CA
| | - Vasanth Vedantham
- Division of Cardiology Department of Medicine University of California, San Francisco San Francisco CA
| |
Collapse
|
32
|
Ramirez R, Trivieri M, Fayad ZA, Ahmadi A, Narula J, Argulian E. Advanced Imaging in Cardiac Sarcoidosis. J Nucl Med 2019; 60:892-898. [PMID: 31171594 DOI: 10.2967/jnumed.119.228130] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 06/03/2019] [Indexed: 12/14/2022] Open
Abstract
Sarcoidosis is a chronic disease of unknown etiology characterized by the presence of noncaseating granulomas. Cardiac involvement in sarcoidosis may lead to adverse outcomes such as advanced heart block, arrhythmias, cardiomyopathy, or death. Cardiac sarcoidosis can occur in patients with established sarcoidosis, or it can be the sole manifestation of the disease. Traditional diagnostic techniques, including echocardiography, have poor sensitivity for diagnosing cardiac sarcoidosis. The accumulating evidence supports the essential role of advanced cardiac imaging modalities such as MRI and PET in diagnosis, risk stratification, and management of patients with cardiac sarcoidosis. The current review highlights important theoretic and practical aspects of using cardiac imaging tools in the evaluation of patients with suspected or established cardiac sarcoidosis.
Collapse
Affiliation(s)
- Roberto Ramirez
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Maria Trivieri
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Zahi A Fayad
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Amir Ahmadi
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jagat Narula
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Edgar Argulian
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| |
Collapse
|
33
|
Bravo PE, Singh A, Di Carli MF, Blankstein R. Advanced cardiovascular imaging for the evaluation of cardiac sarcoidosis. J Nucl Cardiol 2019; 26:188-199. [PMID: 30390241 PMCID: PMC6374180 DOI: 10.1007/s12350-018-01488-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/04/2018] [Indexed: 12/17/2022]
Abstract
Cardiac sarcoidosis (CS) remains an intriguing infiltrating disorder and one of the most important forms of inflammatory cardiomyopathy. Identification of patients with CS is of extreme importance because they are at higher risk of sudden death, and heart-failure progression. And while it remains a diagnostic conundrum, a great amount of experience has been accumulated over the last decade with the advent of fluorine-18 fluorodeoxyglucose positron emission tomography and cardiac magnetic resonance with late gadolinium enhancement imaging. They have both proven to be advanced imaging techniques that provide important, and often complementary, diagnostic and prognostic information for the management of CS. However, they have also shown to have limitations, and, thus, there is a continued need for developing more specific imaging probes for identifying cardiac inflammation. The aim of the present manuscript is to provide the reader with a better understanding of the histopathology of the disease, how this potentially relates to noninvasive imaging detection, and the best strategies available for the diagnosis and management of patients with CS.
Collapse
Affiliation(s)
- Paco E Bravo
- Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Divisions of Nuclear Medicine and Cardiology, Departments of Radiology and Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Amitoj Singh
- Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Marcelo F Di Carli
- Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Ron Blankstein
- Cardiovascular Imaging Program, Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
34
|
Sgard B, Brillet PY, Bouvry D, Djelbani S, Nunes H, Meune C, Valeyre D, Soussan M. Evaluation of FDG PET combined with cardiac MRI for the diagnosis and therapeutic monitoring of cardiac sarcoidosis. Clin Radiol 2018; 74:81.e9-81.e18. [PMID: 30482560 DOI: 10.1016/j.crad.2018.09.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 09/26/2018] [Indexed: 02/07/2023]
Abstract
AIM To compare combined 2-[18F]-fluoro-2-deoxy-d-glucose (FDG)-positron-emission tomography (PET) and cardiac magnetic resonance imaging (CMR) for the diagnosis and therapy monitoring of cardiac sarcoidosis (CS). MATERIALS AND METHODS Eighty patients with sarcoidosis and a suspicion of CS who underwent PET and CMR were included retrospectively. PET was undertaken after a low-carbohydrate-high-fat diet in all patients using a combined 16-section PET/computed tomography (CT) camera. PET was considered positive (PET+) in cases of focal or multifocal FDG uptake. CMR was considered positive (CMR+) in cases of subepicardial late gadolinium enhancement (LGE). A subgroup of 50 patients (50/80) was monitored during therapy and classified as responders or non-responders. RESULTS Eighty-two percent of patients with PET+ (9/11) also had CMR+ imaging, with good spatial agreement (kappa=0,79; 95% confidence interval [CI]: 0.65-0.94). Twenty-seven percent (22/80) had residual physiological FDG uptake, with a standardised uptake value (SUV) not significantly different compared to the SUV from pathological uptake (6.4 versus 6 respectively, p=0,92). The clinical response was more frequent in patients with baseline PET+ compared to baseline PET- (80% versus 45%, p=0.07). PET findings improved in all cases under treatment (7/7), whereas LGE improved in only 33% of patients (3/9). CONCLUSION Due to high risk of false-positive or undetermined findings, PET might be performed as a second-line study in cases of LGE, to assess inflammatory load. In addition, PET seems suitable to predict and assess response under therapy.
Collapse
Affiliation(s)
- B Sgard
- Department of Nuclear Medicine, Hôpital Avicenne, Paris 13 University, Bobigny, France
| | - P-Y Brillet
- Department of Radiology, Hôpital Avicenne, Paris 13 University, Bobigny, France
| | - D Bouvry
- Department of Pneumology, Hôpital Avicenne, Paris 13 University, Bobigny, France
| | - S Djelbani
- Department of Nuclear Medicine, Hôpital Avicenne, Paris 13 University, Bobigny, France
| | - H Nunes
- Department of Pneumology, Hôpital Avicenne, Paris 13 University, Bobigny, France
| | - C Meune
- Department of Cardiology, Hôpital Avicenne, Paris 13 University, Bobigny, France
| | - D Valeyre
- Department of Pneumology, Hôpital Avicenne, Paris 13 University, Bobigny, France
| | - M Soussan
- Department of Nuclear Medicine, Hôpital Avicenne, Paris 13 University, Bobigny, France.
| |
Collapse
|
35
|
Mehdipoor G, Bokhari S, R. Prince M. Imaging for Diagnosis and Monitoring of Cardiac Sarcoidosis. INTERNATIONAL JOURNAL OF CARDIOVASCULAR PRACTICE 2018. [DOI: 10.21859/ijcp-03204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|