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Saric P, Bois JP, Giudicessi JR, Rosenbaum AN, Kusmirek JE, Lin G, Chareonthaitawee P. Imaging of Cardiac Sarcoidosis: An Update and Future Aspects. Semin Nucl Med 2024; 54:701-716. [PMID: 38480041 DOI: 10.1053/j.semnuclmed.2024.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 08/20/2024]
Abstract
Cardiac sarcoidosis (CS), an increasingly recognized disease of unknown etiology, is associated with significant morbidity and mortality. Given the limited diagnostic yield of traditional endomyocardial biopsy (EMB), there is increasing reliance on multimodality cardiovascular imaging in the diagnosis and management of CS, with EMB being largely supplanted by the use of 18F-fluorodeoxyglucose (FDG-PET) and cardiac magnetic resonance imaging (CMR). This article aims to provide a comprehensive review of imaging modalities currently utilized in the screening, diagnosis, and monitoring of CS, while highlighting the latest developments in each area.
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Affiliation(s)
- Petar Saric
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - John P Bois
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | | | | | - Grace Lin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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2
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Kouranos V, Sharma R, Wells A, Singh-Curry V. Cardiac sarcoidosis and neurosarcoidosis - multidisciplinary approach for diagnosis. Curr Opin Pulm Med 2024; 30:540-550. [PMID: 38958578 DOI: 10.1097/mcp.0000000000001097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
PURPOSE OF REVIEW The current review aims to highlight the role of multidisciplinary approach in the diagnosis of patients with cardiac and neurosarcoidosis. Multidisciplinary approach integrates the available clinical information, imaging and histopathological results aiming to reach a definite or at least provisional diagnosis and allow appropriate management. Multidisciplinary approach is the reference standard for diagnosis of interstitial lung disease and should be strongly considered in complex clinical conditions such as cardiac sarcoidosis (CS) and neurosarcoidosis. RECENT FINDINGS Histopathological confirmation of noncaseating granulomatous inflammation provides a definite diagnosis of sarcoidosis involving any organ. However, a provisional high confidence or even definite clinical diagnosis can be reached using multidisciplinary evaluation of all available evidence. The diagnosis of cardiac sarcoidosis and neurosarcoidosis requires the integration of different expertise based on the current diagnostic criteria sets. Identifying typical or at least compatible patterns on advanced imaging modalities (CMR and Fluro-Deoxy-Glucose Positron Emission Tomography (FDG-PET)) seems key for the diagnosis of CS, while a confident diagnosis of extra-cardiac disease supports an at least provisional diagnosis. Similarly, in neurosarcoidosis integrating compatible MRI appearances and cerebrospinal fluid results in patients with systemic sarcoidosis allows an at least provisional diagnosis. Exclusion of alternative differential diagnoses is crucial and requires high clinical suspicion, imaging review expertise and appropriate tests performance. SUMMARY There have been considerable advances in the diagnostic approach of patients with cardiac and neurosarcoidosis. Multidisciplinary approach for both diagnosis and management is required to reach a confident clinical diagnosis and should be applied when possible.
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Affiliation(s)
- Vasileios Kouranos
- Interstitial Lung Disease unit, Royal Brompton Hospital
- National Heart and Lung Institute, Imperial College London
| | - Rakesh Sharma
- National Heart and Lung Institute, Imperial College London
- Cardiology Department, Royal Brompton Hospital
| | - Athol Wells
- Interstitial Lung Disease unit, Royal Brompton Hospital
- National Heart and Lung Institute, Imperial College London
| | - Victoria Singh-Curry
- Interstitial Lung Disease unit, Royal Brompton Hospital
- Department of Neurology, Chelsea and Westminster Hospital NHS Foundation Trust
- Department of Neurology, Imperial College NHS Trust, London UK
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3
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Boczar KE, Park Y, Wiefels C. Can FDG-PET Imaging Identify Cardiac Sarcoidosis Disease Phenotypes? Curr Cardiol Rep 2024; 26:851-857. [PMID: 38990493 DOI: 10.1007/s11886-024-02086-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2024] [Indexed: 07/12/2024]
Abstract
PURPOSE OF REVIEW Despite the scarcity of data, most guidelines have advocated for the treatment of cardiac sarcoidosis with corticosteroids. However, there is heterogeneity in disease presentation and response to treatment, which can make treatment challenging. The ability to identify disease phenotypes to allow for tailored therapy is therefore highly desirable. This review will seek to outline the disease phenotypes of cardiac sarcoidosis and the role that FDG-PET imaging can play in identifying these phenotypes to optimize disease diagnosis and treatment management. RECENT FINDINGS FDG PET can identify cardiac sarcoidosis and is being increasingly used to monitor therapeutic response to immunosuppressive therapy, to follow treatment response after discontinuation of corticosteroid therapy, and to evaluate for disease relapse. Modern quantitative techniques using FDG PET imaging may allow for even better phenotypic disease characterization and the ability to track the response to immunosuppression more accurately. FDG PET currently plays an important role in cardiac sarcoidosis diagnosis. However, it also affords us the opportunity to offer insights into cardiac sarcoidosis disease phenotypes to better understand the underlying disease process and in the future may allows us to tailor therapies accordingly.
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Affiliation(s)
- Kevin Emery Boczar
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada.
- School of Epidemiology and Public Health, Department of Medicine, University of Ottawa, Ottawa, Canada.
| | - Yooyhun Park
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Christiane Wiefels
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
- Division of Nuclear Medicine, Department of Medicine, University of Ottawa, Ottawa, Canada
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4
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Stjepanovic M, Markovic F, Milivojevic I, Popevic S, Dimic-Janjic S, Popadic V, Zdravkovic D, Popovic M, Klasnja A, Radojevic A, Radovanovic D, Zdravkovic M. Contemporary Diagnostics of Cardiac Sarcoidosis: The Importance of Multimodality Imaging. Diagnostics (Basel) 2024; 14:1865. [PMID: 39272650 PMCID: PMC11394254 DOI: 10.3390/diagnostics14171865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 08/20/2024] [Accepted: 08/23/2024] [Indexed: 09/15/2024] Open
Abstract
Sarcoidosis is an inflammatory condition that can affect multiple organ systems and is characterized by the formation of non-caseating granulomas in various organs, including the heart. Due to suboptimal diagnostic rates, the true prevalence and incidence of cardiac sarcoidosis (CS) remain to be determined. In patients with suspected CS, an initial examination should include 12-lead ECG or ambulatory ECG monitoring, and echocardiography with the estimation of LV, RV function, and strain rate. In patients with confirmed extracardiac sarcoidosis and with high clinical suspicion for CS, sophisticated imaging modalities, including cardiac MRI and PET, are indicated. Typical inflammation patterns and myocardial scarring should pose a high suspicion for CS. In patients without diagnosed extracardiac sarcoidosis and high clinical suspicion, although with low diagnostic probability, an endomyocardial biopsy should be considered to establish the diagnosis of definite isolated cardiac sarcoidosis. Timely diagnosis enables the initiation of therapy and close monitoring of adverse cardiac events that can be life-threatening, including sudden cardiac death, ventricular tachycardia, high-degree AV block, and heart failure. Implementing biomarkers in correlation to cardiac imaging can determine the disease's severity and progression but can also be helpful in following the treatment response. The formation of larger global registries can be helpful in the identification of independent predictors of adverse clinical events and the development of specific diagnostic algorithms to reduce the overall risk of this serious condition.
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Affiliation(s)
- Mihailo Stjepanovic
- Clinic of Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Filip Markovic
- Clinic of Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Ivan Milivojevic
- Clinic of Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Spasoje Popevic
- Clinic of Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Sanja Dimic-Janjic
- Clinic of Pulmonology, University Clinical Center of Serbia, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Viseslav Popadic
- Department of Cardiology, University Clinical Hospital Center Bezanijska Kosa, 11000 Belgrade, Serbia
| | | | - Maja Popovic
- Department of Radiology, University Clinical Hospital Center Bezanijska Kosa, 11000 Belgrade, Serbia
| | - Andrea Klasnja
- Department of Cardiology, University Clinical Hospital Center Bezanijska Kosa, 11000 Belgrade, Serbia
| | - Aleksandra Radojevic
- Department of Cardiology, University Clinical Hospital Center Bezanijska Kosa, 11000 Belgrade, Serbia
| | - Dusan Radovanovic
- Department of Cardiology, University Clinical Hospital Center Bezanijska Kosa, 11000 Belgrade, Serbia
| | - Marija Zdravkovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Department of Cardiology, University Clinical Hospital Center Bezanijska Kosa, 11000 Belgrade, Serbia
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5
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Marchetti D, Buzzi F, Di Febo R, Modugno S, Schillaci M, Paolisso P, Doldi M, Melotti E, Ratti A, Provera A, Guarnieri G, Terzi R, Gallazzi M, Conte E, Andreini D. Role of Cardiac Magnetic Resonance in Inflammatory and Infiltrative Cardiomyopathies: A Narrative Review. J Clin Med 2024; 13:4733. [PMID: 39200875 PMCID: PMC11355574 DOI: 10.3390/jcm13164733] [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: 05/24/2024] [Revised: 07/21/2024] [Accepted: 07/27/2024] [Indexed: 09/02/2024] Open
Abstract
Cardiac magnetic resonance (CMR) has acquired a pivotal role in modern cardiology. It represents the gold standard for biventricular volume and systolic function assessment. Moreover, CMR allows for non-invasive myocardial tissue evaluation, highlighting tissue edema, fibrosis, fibro-fatty infiltration and iron overload. This manuscript aims to review the impact of CMR in the main inflammatory and infiltrative cardiomyopathies, providing details on specific imaging patterns and insights regarding the most relevant trials in the setting.
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Affiliation(s)
- Davide Marchetti
- Division of University Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant’Ambrogio, 20157 Milan, Italy; (D.M.)
| | - Federica Buzzi
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Riccardo Di Febo
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Sara Modugno
- Division of University Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant’Ambrogio, 20157 Milan, Italy; (D.M.)
| | - Matteo Schillaci
- Division of University Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant’Ambrogio, 20157 Milan, Italy; (D.M.)
| | - Pasquale Paolisso
- Division of University Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant’Ambrogio, 20157 Milan, Italy; (D.M.)
| | - Marco Doldi
- Division of University Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant’Ambrogio, 20157 Milan, Italy; (D.M.)
| | - Eleonora Melotti
- Division of University Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant’Ambrogio, 20157 Milan, Italy; (D.M.)
| | - Angelo Ratti
- Division of University Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant’Ambrogio, 20157 Milan, Italy; (D.M.)
| | - Andrea Provera
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Gianluca Guarnieri
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Riccardo Terzi
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Michele Gallazzi
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Edoardo Conte
- Division of University Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant’Ambrogio, 20157 Milan, Italy; (D.M.)
| | - Daniele Andreini
- Division of University Cardiology and Cardiac Imaging, IRCCS Ospedale Galeazzi Sant’Ambrogio, 20157 Milan, Italy; (D.M.)
- Department of Biomedical and Clinical Sciences, University of Milan, 20122 Milan, Italy
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6
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Sharma R, Kouranos V, Cooper LT, Metra M, Ristic A, Heidecker B, Baksi J, Wicks E, Merino JL, Klingel K, Imazio M, de Chillou C, Tschöpe C, Kuchynka P, Petersen SE, McDonagh T, Lüscher T, Filippatos G. Management of cardiac sarcoidosis. Eur Heart J 2024; 45:2697-2726. [PMID: 38923509 DOI: 10.1093/eurheartj/ehae356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 05/01/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024] Open
Abstract
Cardiac sarcoidosis (CS) is a form of inflammatory cardiomyopathy associated with significant clinical complications such as high-degree atrioventricular block, ventricular tachycardia, and heart failure as well as sudden cardiac death. It is therefore important to provide an expert consensus statement summarizing the role of different available diagnostic tools and emphasizing the importance of a multidisciplinary approach. By integrating clinical information and the results of diagnostic tests, an accurate, validated, and timely diagnosis can be made, while alternative diagnoses can be reasonably excluded. This clinical expert consensus statement reviews the evidence on the management of different CS manifestations and provides advice to practicing clinicians in the field on the role of immunosuppression and the treatment of cardiac complications based on limited published data and the experience of international CS experts. The monitoring and risk stratification of patients with CS is also covered, while controversies and future research needs are explored.
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Affiliation(s)
- Rakesh Sharma
- Department of Cardiology, Royal Brompton Hospital, part of Guy's and St Thomas's NHS Foundation Trust, London SW3 6NP, UK
- National Heart and Lung Institute, Imperial College London, UK
- King's College London, UK
| | - Vasileios Kouranos
- National Heart and Lung Institute, Imperial College London, UK
- Interstitial Lung Disease Unit, Royal Brompton Hospital, part of Guys and St. Thomas's Hospital, London, UK
| | - Leslie T Cooper
- Department of Cardiovascular Medicine, Mayo Clinic in Florida, 4500 San Pablo, Jacksonville, USA
| | - Marco Metra
- Cardiology Unit, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Arsen Ristic
- Department of Cardiology, University of Belgrade, Pasterova 2, Floor 9, 11000 Belgrade, Serbia
| | - Bettina Heidecker
- Department for Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin; Charité Universitätsmedizin Berlin, Berlin Institute of Health (BIH) at Charité, Berlin, Germany
| | - John Baksi
- National Heart and Lung Institute, Imperial College London, UK
- Cardiac MRI Unit, Royal Brompton Hospital, part of Guy's and St Thomas's NHS Foundation Trust, London, UK
| | - Eleanor Wicks
- Department of Cardiology, Oxford University Hospitals NHS Trust, Oxford, UK
- University College London, London, UK
| | - Jose L Merino
- La Paz University Hospital-IdiPaz, Universidad Autonoma, Madrid, Spain
| | | | - Massimo Imazio
- Department of Medicine, University of Udine, Udine, Italy
- Department of Cardiology, University Hospital Santa Maria della Misericordia, Udine, Italy
| | - Christian de Chillou
- Department of Cardiology, CHRU-Nancy, Université de Lorraine, Nancy, France
- Department of Cardiology, IADI, INSERM U1254, Université de Lorraine, Nancy, France
| | - Carsten Tschöpe
- Department of Cardiology, Deutsches Herzzentrum der Charité (DHZC), Angiology and Intensive Medicine (Campus Virchow) and German Centre for Cardiovascular Research (DZHK)- partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH) at Charité - Center for Regenerative Therapies, Universitätsmedizin Berlin, Berlin, Germany
| | - Petr Kuchynka
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Steffen E Petersen
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University London, Charterhouse Square, London, EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, EC1A 7BE, London, UK
| | | | - Thomas Lüscher
- Royal Brompton Hospital, part of Guys and St Thomas's NHS Foundation Trust, Professor of Cardiology at Imperial College and Kings College, London, UK
| | - Gerasimos Filippatos
- Department of Cardiology, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
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7
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Sekii R, Kato S, Horita N, Utsunomiya D. Prognostic role of late gadolinium-enhanced MRI in confirmed and suspected cardiac sarcoidosis: meta-analysis. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:1797-1807. [PMID: 39012402 DOI: 10.1007/s10554-024-03191-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 07/03/2024] [Indexed: 07/17/2024]
Abstract
The prognostic implications of late gadolinium-enhanced (LGE) magnetic resonance imaging (MRI) in the context of cardiac sarcoidosis (CS) have attracted considerable attention. Nevertheless, a subset of studies has undistinguished confirmed and suspected CS cases, thereby engendering interpretative ambiguities. In this meta-analysis, we evaluated the differences in cardiac MRI findings and their prognostic utility between confirmed and suspected CS. A literature search was conducted using PubMed, Web of Science, and Cochrane libraries to compare the findings of cardiac MRI and its prognostic value in CS and suspected CS. A meta-analysis was performed to compare the prevalence of LGE MRI, odds ratios, and hazard ratios for predicting cardiac events in both groups. A total of 21 studies encompassing 24 different populations were included in the meta-analysis (CS: 393 cases, suspected CS: 2151 cases). CS had a higher frequency of LGE of the left ventricle (87.2% vs. 36.4%, p < 0.0001) and right ventricle (62.1% vs. 23.8%, p = 0.04) than suspected CS. In patients with suspected CS, the presence of left ventricular LGE was associated with higher all-cause mortality [odds ratio: 5.70 (95%CI: 2.51-12.93), p < 0.0001, I2 = 8%, p for heterogeneity = 0.37] and ventricular arrhythmia [odds ratio: 15.51 (95%CI: 5.65-42.55), p < 0.0001, I2 = 0, p for heterogeneity = 0.94]. In contrast, in CS, not the presence but extent of left ventricular LGE was a significant predictor of outcome (hazard ratio = 1.83 per 10% increase of %LGE (95%CI: 1.43-2.34, p < 0.001, I2 = 15, p for heterogeneity = 0.31). The presence of left ventricular LGE was a strong prognostic factor in suspected sarcoidosis. However, the extremely high prevalence of left ventricular LGE in confirmed CS suggests that the quantitative assessment of LGE is useful for prognostic estimation.
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Affiliation(s)
- Ryusuke Sekii
- Department of Cardiology, Yokohama Hodogaya Central Hospital, Kanagawa, Japan
| | - Shingo Kato
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan.
| | - Nobuyuki Horita
- Chemotherapy Center, Yokohama City University Hospital, Kanagawa, Japan
| | - Daisuke Utsunomiya
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
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8
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Harper LJ, Farver CF, Yadav R, Culver DA. A framework for exclusion of alternative diagnoses in sarcoidosis. J Autoimmun 2024:103288. [PMID: 39084998 DOI: 10.1016/j.jaut.2024.103288] [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: 04/29/2024] [Revised: 07/02/2024] [Accepted: 07/13/2024] [Indexed: 08/02/2024]
Abstract
Sarcoidosis is a multisystem granulomatous syndrome that arises from a persistent immune response to a triggering antigen(s). There is no "gold standard" test or algorithm for the diagnosis of sarcoidosis, making the diagnosis one of exclusion. The presentation of the disease varies substantially between individuals, in both the number of organs involved, and the manifestations seen in individual organs. These qualities dictate that health care providers diagnosing sarcoidosis must consider a wide range of possible alternative diagnoses, from across a range of presentations and medical specialties (infectious, inflammatory, cardiac, neurologic). Current guideline-based diagnosis of sarcoidosis recommends fulfillment of three criteria: 1) compatible clinical presentation and/or imaging 2) demonstration of granulomatous inflammation by biopsy (when possible) and, 3) exclusion of alternative causes, but do not provide guidance on standardized strategies for exclusion of alternative diagnoses. In this review, we provide a summary of the most common differential diagnoses for sarcoidosis involvement of lung, eye, skin, central nervous system, heart, liver, and kidney. We then propose a framework for testing to exclude alternative diagnoses based on pretest probability of sarcoidosis, defined as high (typical findings with sarcoidosis involvement confirmed in another organ), moderate (typical findings in a single organ), or low (atypical/findings suggesting of an alternative diagnosis). This work highlights the need for informed and careful exclusion of alternative diagnoses in sarcoidosis.
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Affiliation(s)
- Logan J Harper
- Department of Pulmonary and Critical Care Medicine, Integrated Hospital Care Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Carol F Farver
- Department of Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - Ruchi Yadav
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Daniel A Culver
- Department of Pulmonary and Critical Care Medicine, Integrated Hospital Care Institute, Cleveland Clinic, Cleveland, OH, USA
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9
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Owusu R, Alakhras H, Strubchevska K, Walsh DG. Isolated Cardiac Sarcoidosis Presenting as High-Degree Atrioventricular Block. Cureus 2024; 16:e62685. [PMID: 39036248 PMCID: PMC11258927 DOI: 10.7759/cureus.62685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2024] [Indexed: 07/23/2024] Open
Abstract
Isolated cardiac sarcoidosis is a rare phenomenon of systemic sarcoidosis, with presentation ranging from asymptomatic to sudden cardiac death. Controversy exists on diagnostic and therapeutic options, creating an ongoing challenge for clinicians in providing patient care. A 79-year-old male presented status post looposcopy and interval ureteral stent replacement with sinus bradycardia and high-degree atrioventricular block. A comprehensive examination was performed that conclusively ruled out common etiologies of atrioventricular block, including coronary artery disease, electrolyte abnormalities, and medications. This prompted an investigation using advanced cardiac imaging modalities that demonstrated cardiac sarcoidosis. Computed tomography of the chest was negative for lymphadenopathy or infiltrates indicative of pulmonary involvement. The lack of extracardiac manifestations, in combination with imaging findings, led to a probable diagnosis of isolated cardiac sarcoidosis. The patient underwent biventricular implantable cardioverter defibrillator placement and was started on oral corticosteroids.
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Affiliation(s)
- Ryian Owusu
- Internal Medicine, Oakland University William Beaumont School of Medicine, Rochester, USA
| | - Hazem Alakhras
- Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, USA
| | - Kateryna Strubchevska
- Internal Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, USA
| | - Daniel G Walsh
- Cardiovascular Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, USA
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10
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Kouranos V, Wells AU. Monitoring of Sarcoidosis. Clin Chest Med 2024; 45:45-57. [PMID: 38245370 DOI: 10.1016/j.ccm.2023.08.002] [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] [Indexed: 01/22/2024]
Abstract
This article focuses on the monitoring of pulmonary sarcoidosis. The monitoring of sarcoidosis is, in part, focused on serial change in major organ involvement but also includes diagnostic re-evaluation and review of change in quality of life. Recent criteria for progression of fibrotic interstitial lung disease are adapted to pulmonary sarcoidosis. The frequency and nature of monitoring are discussed, integrating baseline risk stratification and strategic treatment goals. Individual variables used to identify changes in pulmonary disease severity are discussed with a focus on their flaws and the need for a multidimensional approach. Other key monitoring issues are covered briefly.
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Affiliation(s)
- Vasileios Kouranos
- Interstitial Lung Disease/Sarcoidosis Unit, Royal Brompton Hospital, Sydney street, London, SW3 6NP; National Heart and Lung Institute, Imperial College London, Guy Scadding Building, Cale Street, London, SW3 6LY.
| | - Athol Umfrey Wells
- Interstitial Lung Disease/Sarcoidosis Unit, Royal Brompton Hospital, Sydney street, London, SW3 6NP; National Heart and Lung Institute, Imperial College London, Guy Scadding Building, Cale Street, London, SW3 6LY
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11
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Ribeiro Neto ML, Jellis CL, Cremer PC, Harper LJ, Taimeh Z, Culver DA. Cardiac Sarcoidosis. Clin Chest Med 2024; 45:105-118. [PMID: 38245360 DOI: 10.1016/j.ccm.2023.08.006] [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] [Indexed: 01/22/2024]
Abstract
Cardiac involvement is a major cause of morbidity and mortality in patients with sarcoidosis. It is important to distinguish between clinical manifest diseases from clinically silent diseases. Advanced cardiac imaging studies are crucial in the diagnostic pathway. In suspected isolated cardiac sarcoidosis, it's key to rule out alternative diagnoses. Therapeutic options can be divided into immunosuppressive agents, guideline-directed medical therapy, antiarrhythmic medications, device/ablation therapy, and heart transplantation.
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Affiliation(s)
- Manuel L Ribeiro Neto
- Department of Pulmonary Medicine, Cleveland Clinic, 9500 Euclid Avenue / A90, Cleveland, OH 44195, USA.
| | - Christine L Jellis
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Paul C Cremer
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Logan J Harper
- Department of Pulmonary Medicine, Cleveland Clinic, 9500 Euclid Avenue / A90, Cleveland, OH 44195, USA
| | - Ziad Taimeh
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Daniel A Culver
- Department of Pulmonary Medicine, Cleveland Clinic, 9500 Euclid Avenue / A90, Cleveland, OH 44195, USA
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12
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Tan JL, Supple GE, Nazarian S. Sarcoid heart disease and imaging. Heart Rhythm O2 2024; 5:50-59. [PMID: 38312203 PMCID: PMC10837178 DOI: 10.1016/j.hroo.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024] Open
Abstract
Cardiac sarcoidosis (CS) can mimic any cardiomyopathy due to its ability to manifest with a variety of clinical presentations. The exact prevalence of CS remains unknown but has been reported ranging from 2.3% to as high as 29.9% among patients presenting with new onset cardiomyopathy and/or atrioventricular block. Early and accurate diagnosis of CS is often challenging due to the nature of disease progression and lack of diagnostic reference standard. The current diagnostic criteria for CS are lacking in sensitivity and specificity. Here, we review the contemporary role of advanced imaging modalities such as cardiac magnetic resonance imaging and positron emission tomography/computed tomography imaging in diagnosing and prognosticating patients with CS.
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Affiliation(s)
- Jian Liang Tan
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gregory E Supple
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Saman Nazarian
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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13
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Ozer G, Ozcan HN, Gocmen R, Orhan D, Oguz B, Haliloglu M. Imaging Features of Pediatric Sarcoidosis. Radiographics 2024; 44:e230098. [PMID: 38096112 DOI: 10.1148/rg.230098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Sarcoidosis is a granulomatous inflammatory disease of uncertain cause. It occurs most commonly in young and middle-aged adults and less frequently in children; therefore, few data on pediatric sarcoidosis exist in the literature. The diagnosis and management of sarcoidosis remain challenging because of diverse and often nonspecific clinical and imaging findings. In addition, the clinical picture varies widely by age. Prepubertal and adolescent patients often present with adult-like pulmonary disease; however, early-onset sarcoidosis is typically characterized by the triad of arthritis, uveitis, and skin rash. Sarcoidosis is mostly a diagnosis of exclusion made by demonstrating noncaseating granulomas at histopathologic examination in patients with compatible clinical and radiologic findings. Although sarcoidosis often affects the lungs and thoracic lymph nodes, it can involve almost any organ in the body. The most common radiologic manifestation is pulmonary involvement, characterized by mediastinal and bilateral symmetric hilar lymphadenopathies with perilymphatic micronodules. Abdominal involvement is also common in children and often manifests as hepatomegaly, splenomegaly, and abdominal lymph node enlargement. Although neurosarcoidosis and cardiac sarcoidosis are rare, imaging is essential to the diagnosis of central nervous system and cardiac involvement because of the risky biopsy procedure and its low diagnostic yield due to focal involvement. Being familiar with the spectrum of imaging findings of sarcoidosis may aid in appropriate diagnosis and management. ©RSNA, 2023 Test Your Knowledge questions are available in the supplemental material.
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Affiliation(s)
- Gozde Ozer
- From the Departments of Radiology (G.O., H.N.O., R.G., B.O., M.H.) and Pathology (D.O.), Hacettepe University School of Medicine, Hacettepe M, Gevher Nesibe C, 06230 Altındag/Ankara, Turkey
| | - H Nursun Ozcan
- From the Departments of Radiology (G.O., H.N.O., R.G., B.O., M.H.) and Pathology (D.O.), Hacettepe University School of Medicine, Hacettepe M, Gevher Nesibe C, 06230 Altındag/Ankara, Turkey
| | - Rahsan Gocmen
- From the Departments of Radiology (G.O., H.N.O., R.G., B.O., M.H.) and Pathology (D.O.), Hacettepe University School of Medicine, Hacettepe M, Gevher Nesibe C, 06230 Altındag/Ankara, Turkey
| | - Diclehan Orhan
- From the Departments of Radiology (G.O., H.N.O., R.G., B.O., M.H.) and Pathology (D.O.), Hacettepe University School of Medicine, Hacettepe M, Gevher Nesibe C, 06230 Altındag/Ankara, Turkey
| | - Berna Oguz
- From the Departments of Radiology (G.O., H.N.O., R.G., B.O., M.H.) and Pathology (D.O.), Hacettepe University School of Medicine, Hacettepe M, Gevher Nesibe C, 06230 Altındag/Ankara, Turkey
| | - Mithat Haliloglu
- From the Departments of Radiology (G.O., H.N.O., R.G., B.O., M.H.) and Pathology (D.O.), Hacettepe University School of Medicine, Hacettepe M, Gevher Nesibe C, 06230 Altındag/Ankara, Turkey
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14
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Uccello G, Bonacchi G, Rossi VA, Montrasio G, Beltrami M. Myocarditis and Chronic Inflammatory Cardiomyopathy, from Acute Inflammation to Chronic Inflammatory Damage: An Update on Pathophysiology and Diagnosis. J Clin Med 2023; 13:150. [PMID: 38202158 PMCID: PMC10780032 DOI: 10.3390/jcm13010150] [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: 12/03/2023] [Revised: 12/18/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
Acute myocarditis covers a wide spectrum of clinical presentations, from uncomplicated myocarditis to severe forms complicated by hemodynamic instability and ventricular arrhythmias; however, all these forms are characterized by acute myocardial inflammation. The term "chronic inflammatory cardiomyopathy" describes a persistent/chronic inflammatory condition with a clinical phenotype of dilated and/or hypokinetic cardiomyopathy associated with symptoms of heart failure and increased risk for arrhythmias. A continuum can be identified between these two conditions. The importance of early diagnosis has grown markedly in the contemporary era with various diagnostic tools available. While cardiac magnetic resonance (CMR) is valid for diagnosis and follow-up, endomyocardial biopsy (EMB) should be considered as a first-line diagnostic modality in all unexplained acute cardiomyopathies complicated by hemodynamic instability and ventricular arrhythmias, considering the local expertise. Genetic counseling should be recommended in those cases where a genotype-phenotype association is suspected, as this has significant implications for patients' and their family members' prognoses. Recognition of the pathophysiological pathway and clinical "red flags" and an early diagnosis may help us understand mechanisms of progression, tailor long-term preventive and therapeutic strategies for this complex disease, and ultimately improve clinical outcomes.
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Affiliation(s)
- Giuseppe Uccello
- Division of Cardiology, Alessandro Manzoni Hospital—ASST Lecco, 23900 Lecco, Italy;
| | - Giacomo Bonacchi
- Division of Cardiology, Tor Vergata University Hospital, 00133 Rome, Italy;
| | | | - Giulia Montrasio
- Inherited Cardiovascular Diseases Unit, Barts Heart Centre, St. Bartholomew’s Hospital, London EC1A 7BS, UK;
| | - Matteo Beltrami
- Cardiomyopathy Unit, Careggi University Hospital, 50134 Florence, Italy
- Arrhythmia and Electrophysiology Unit, Careggi University Hospital, 50134 Florence, Italy
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15
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Pham T, Abraham J, Sheikh FH. Great mimicker: definite isolated cardiac sarcoidosis masquerading as hypertrophic cardiomyopathy. BMJ Case Rep 2023; 16:e256579. [PMID: 38087480 PMCID: PMC10728929 DOI: 10.1136/bcr-2023-256579] [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] [Indexed: 12/18/2023] Open
Abstract
A healthy man in his 50s was hospitalised after presenting with chest pain and dyspnoea. An echocardiogram revealed asymmetrical septal hypertrophy, leading to a diagnosis of hypertrophic cardiomyopathy. Due to progressive conduction abnormalities during his hospitalisation, further evaluation was performed. Cardiac MRI revealed dense late gadolinium enhancement of the septum in the area of hypertrophy. Additionally, fluorodeoxyglucose-positron emission tomography demonstrated increased uptake within the same region, suggestive of active inflammation. Subsequent endomyocardial biopsy showed non-caseating granulomatous inflammation, consistent with cardiac sarcoidosis. Treatment with prednisone and methotrexate was initiated, and an implantable cardioverter-defibrillator was placed following thorough risk stratification. This case highlights the importance of multimodality imaging and the pursuit of a tissue diagnosis in the evaluation of cardiomyopathy.
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Affiliation(s)
- Tuan Pham
- Department of Medicine, Adventist Health Portland, Portland, Oregon, USA
| | - Jacob Abraham
- Heart and Vascular Institute, Providence Health and Services Oregon and Southwest Washington, Portland, Oregon, USA
| | - Farooq H Sheikh
- MedStart Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, District of Columbia, USA
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16
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Kouranos V, Khattar RS, Okafor J, Ahmed R, Azzu A, Baksi JA, Wechalekar K, Cowie MR, Wells AU, Lüscher TF, Sharma R. Predictors of outcome in a contemporary cardiac sarcoidosis population: Role of brain natriuretic peptide, left ventricular function and myocardial inflammation. Eur J Heart Fail 2023; 25:2287-2298. [PMID: 37877328 DOI: 10.1002/ejhf.3057] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 10/26/2023] Open
Abstract
AIMS Cardiac sarcoidosis (CS) is a potentially fatal condition that varies in its clinical presentation. Here, we describe baseline characteristics at presentation along with prognosis and predictors of outcome in a sizable and deeply phenotyped contemporary cohort of CS patients. METHODS AND RESULTS Consecutive CS patients seen at one institution were retrospectively enrolled after undergoing laboratory testing, electrocardiogram, echocardiography, cardiac magnetic resonance (CMR) imaging and 18 F-flourodeoxyglucose positron emission tomography (FDG-PET) at baseline. The composite endpoint consisted of all-cause mortality, aborted sudden cardiac death, major ventricular arrhythmic events, heart failure hospitalization and heart transplantation. A total of 319 CS patients were studied (67% male, 55.4 ± 12 years). During a median follow-up of 2.2 years (range: 1 month-11 years), 8% of patients died, while 33% reached the composite endpoint. The annualized mortality rate was 2.7% and the 5- and 10-year mortality rates were 6.2% and 7.5%, respectively. Multivariate analysis showed serum brain natriuretic peptide (BNP) levels (hazard ratio [HR] 2.41, 95% confidence interval [CI] 1.34-4.31, p = 0.003), CMR left ventricular ejection fraction (LVEF) (HR 0.96, 95% CI 0.94-0.98, p < 0.0001) and maximum standardized uptake value of FDG-PET (HR 1.11, 95% CI 1.04-1.19, p = 0.001) to be independent predictors of outcome. These findings remained robust for different patient subgroups. CONCLUSION Cardiac sarcoidosis is associated with significant morbidity and mortality, particularly in those with cardiac involvement as the first manifestation. Higher BNP levels, lower LVEF and more active myocardial inflammation were independent predictors of outcomes.
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Affiliation(s)
- Vasileios Kouranos
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Rajdeep S Khattar
- National Heart & Lung Institute, Imperial College London, London, UK
- Department of Echocardiography, Royal Brompton Hospital, London, UK
| | - Joseph Okafor
- National Heart & Lung Institute, Imperial College London, London, UK
- Department of Echocardiography, Royal Brompton Hospital, London, UK
| | - Raheel Ahmed
- National Heart & Lung Institute, Imperial College London, London, UK
- Department of Cardiology, Royal Brompton Hospital, London, UK
| | - Alessia Azzu
- National Heart & Lung Institute, Imperial College London, London, UK
- Cardiac Magnetic Resonance Imaging Department, Royal Brompton Hospital, London, UK
| | - John Arun Baksi
- National Heart & Lung Institute, Imperial College London, London, UK
- Cardiac Magnetic Resonance Imaging Department, Royal Brompton Hospital, London, UK
| | - Kshama Wechalekar
- National Heart & Lung Institute, Imperial College London, London, UK
- Nuclear Medicine Department, Royal Brompton Hospital, London, UK
| | | | - Athol Umfrey Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Thomas F Lüscher
- National Heart & Lung Institute, Imperial College London, London, UK
- Department of Cardiology, Royal Brompton Hospital, London, UK
- King's College London, London, UK
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Zürich, Switzerland
| | - Rakesh Sharma
- National Heart & Lung Institute, Imperial College London, London, UK
- Department of Cardiology, Royal Brompton Hospital, London, UK
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17
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Crisci G, Bobbio E, Gentile P, Bromage DI, Bollano E, Ferone E, Israr MZ, Heaney LM, Polte CL, Cannatà A, Salzano A. Biomarkers in Acute Myocarditis and Chronic Inflammatory Cardiomyopathy: An Updated Review of the Literature. J Clin Med 2023; 12:7214. [PMID: 38068265 PMCID: PMC10706911 DOI: 10.3390/jcm12237214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/10/2023] [Accepted: 11/17/2023] [Indexed: 02/15/2024] Open
Abstract
Myocarditis is a disease caused by cardiac inflammation that can progress to dilated cardiomyopathy, heart failure, and eventually death. Several etiologies, including autoimmune, drug-induced, and infectious, lead to inflammation, which causes damage to the myocardium, followed by remodeling and fibrosis. Although there has been an increasing understanding of pathophysiology, early and accurate diagnosis, and effective treatment remain challenging due to the high heterogeneity. As a result, many patients have poor prognosis, with those surviving at risk of long-term sequelae. Current diagnostic methods, including imaging and endomyocardial biopsy, are, at times, expensive, invasive, and not always performed early enough to affect disease progression. Therefore, the identification of accurate, cost-effective, and prognostically informative biomarkers is critical for screening and treatment. The review then focuses on the biomarkers currently associated with these conditions, which have been extensively studied via blood tests and imaging techniques. The information within this review was retrieved through extensive literature research conducted on major publicly accessible databases and has been collated and revised by an international panel of experts. The biomarkers discussed in the article have shown great promise in clinical research studies and provide clinicians with essential tools for early diagnosis and improved outcomes.
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Affiliation(s)
- Giulia Crisci
- Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy;
- Italian Clinical Outcome Research and Reporting Program (I-CORRP), 80131 Naples, Italy
| | - Emanuele Bobbio
- Department of Cardiology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden; (E.B.); (E.B.)
- Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, 41390 Gothenburg, Sweden;
| | - Piero Gentile
- De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy;
| | - Daniel I. Bromage
- Department of Cardiology, King’s College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK; (D.I.B.); (E.F.)
- Department of Cardiovascular Sciences, Faculty of Life Sciences & Medicine, King’s College London, London SE5 8AF, UK
| | - Entela Bollano
- Department of Cardiology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden; (E.B.); (E.B.)
- Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, 41390 Gothenburg, Sweden;
| | - Emma Ferone
- Department of Cardiology, King’s College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK; (D.I.B.); (E.F.)
- Department of Cardiovascular Sciences, Faculty of Life Sciences & Medicine, King’s College London, London SE5 8AF, UK
| | - Muhammad Zubair Israr
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Groby Road, Leicester LE3 9QP, UK;
| | - Liam M. Heaney
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK;
| | - Christian L. Polte
- Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, 41390 Gothenburg, Sweden;
- Department of Clinical Physiology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Antonio Cannatà
- Department of Cardiology, King’s College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK; (D.I.B.); (E.F.)
- Department of Cardiovascular Sciences, Faculty of Life Sciences & Medicine, King’s College London, London SE5 8AF, UK
| | - Andrea Salzano
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Groby Road, Leicester LE3 9QP, UK;
- Cardiology Unit, AORN A Cardarelli, 80131 Naples, Italy
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18
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Tan JL, Tan BEX, Cheung JW, Ortman M, Lee JZ. Update on cardiac sarcoidosis. Trends Cardiovasc Med 2023; 33:442-455. [PMID: 35504422 DOI: 10.1016/j.tcm.2022.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 04/20/2022] [Accepted: 04/27/2022] [Indexed: 12/17/2022]
Abstract
Cardiac sarcoidosis is an inflammatory myocardial disease of unknown etiology. It is characterized by the deposition of non-caseating granulomas that may involve any part of the heart. Cardiac sarcoidosis is often under-diagnosed or recognized partly due to the heterogeneous clinical presentation of the disease. The three most frequent clinical manifestations of cardiac sarcoidosis are atrioventricular block, ventricular arrhythmias, and heart failure. A definitive diagnosis of cardiac sarcoidosis can be made with histology findings from an endomyocardial biopsy. However, the diagnosis in the majority of cases is based on findings from the clinical presentation and advanced imaging due to the low sensitivity of endomyocardial biopsy. The Heart Rhythm Society (HRS) 2014 expert consensus statement and the Japanese Ministry of Health and Welfare criteria are the two most commonly used diagnostic criteria sets. This review article summarizes the available evidence on cardiac sarcoidosis, focusing on the diagnostic criteria and stepwise approach to its management.
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Affiliation(s)
- Jian Liang Tan
- Division of Cardiovascular Disease, Cooper University Health Care/Cooper Medical School of Rowan University, Camden, New Jersey.
| | - Bryan E-Xin Tan
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY
| | - Jim W Cheung
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Matthew Ortman
- Division of Cardiovascular Disease, Cooper University Health Care/Cooper Medical School of Rowan University, Camden, New Jersey
| | - Justin Z Lee
- Department of Cardiology, Mayo Clinic Arizona, Phoenix, Arizona, USA
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19
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Baron T, Gerovasileiou S, Flachskampf FA. The role of imaging in the selection of patients for HFpEF therapy. Eur Heart J Cardiovasc Imaging 2023; 24:1343-1351. [PMID: 37399510 PMCID: PMC10531123 DOI: 10.1093/ehjci/jead137] [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: 05/30/2023] [Accepted: 06/06/2023] [Indexed: 07/05/2023] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) traditionally has been characterized as a form of heart failure without therapeutic options, in particular with a lack of response to the established therapies of heart failure with reduced ejection fraction (HFrEF). However, this is no longer true. Besides physical exercise, risk factor modification, aldosterone blocking agents, and sodium-glucose cotransporter 2 inhibitors, specific therapies are emerging for specific HFpEF etiologies, such as hypertrophic cardiomyopathy or cardiac amyloidosis. This development justifies increased efforts to arrive at specific diagnoses within the umbrella of HFpEF. Cardiac imaging plays by far the largest role in this effort and is discussed in the following review.
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Affiliation(s)
- Tomasz Baron
- Department of Medical Sciences, Cardiology and Clinical Physiology, Uppsala University and Uppsala University Hospital, 751 85 Uppsala, Sweden
- Uppsala Clinical Research, 751 85 Uppsala, Sweden
| | - Spyridon Gerovasileiou
- Department of Medical Sciences, Cardiology and Clinical Physiology, Uppsala University and Uppsala University Hospital, 751 85 Uppsala, Sweden
- VO Medicin, Lasarettet i Enköping, all 785 81 Uppsala, Sweden
| | - Frank A Flachskampf
- Department of Medical Sciences, Cardiology and Clinical Physiology, Uppsala University and Uppsala University Hospital, 751 85 Uppsala, Sweden
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20
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Bobbio E, Bollano E, Oldfors A, Hedner H, Björkenstam M, Svedlund S, Karason K, Bergh N, Polte CL. Phenotyping of giant cell myocarditis versus cardiac sarcoidosis using cardiovascular magnetic resonance. Int J Cardiol 2023; 387:131143. [PMID: 37364717 DOI: 10.1016/j.ijcard.2023.131143] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 06/05/2023] [Accepted: 06/23/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Giant cell myocarditis (GCM) and cardiac sarcoidosis (CS) are rare inflammatory diseases of the myocardium with poor prognosis. Little is known about the cardiovascular magnetic resonance (CMR) appearance of GCM and the methods ability to distinguish the two rare entities from one another. METHODS We assessed a total of 40 patients with endomyocardial biopsy-proven GCM (n = 14) and CS (n = 26) concerning their clinical and CMR appearance in a blinded manner. RESULTS Patients with GCM and CS were of similar median age (55 vs 56 years), and a male predominance was observed in both groups. In GCM, median levels of troponin T (313 vs 31 ng/L, p < 0.001), and natriuretic peptides (6560 vs 676 pg/mL, p < 0.001) were higher than in CS, and the clinical outcome worse (p = 0.04). On CMR imaging, the observed alterations of left and right ventricular (LV/RV) dimensions and function were similar. GCM showed multifocal LV late gadolinium enhancement (LGE) with a similar longitudinal, circumferential, and radial distribution as in CS, including suggested signature imaging biomarkers of CS like the "hook sign" (71% vs 77%, p = 0.702). The median LV LGE enhanced volume was 17% and 22% in GCM and CS (p = 0.150), respectively. The number of RV segments with pathologically increased T2 signal and/or LGE were most extensive in GCM. CONCLUSIONS The CMR appearance of both GCM and CS is highly similar, making the differentiation between the two rare entities solely based on CMR challenging. This stands in contrast to the clinical appearance, which seems to be more severe in GCM.
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Affiliation(s)
- Emanuele Bobbio
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Entela Bollano
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Anders Oldfors
- Department of Clinical Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Biomedicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Henrik Hedner
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marie Björkenstam
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Sara Svedlund
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Kristjan Karason
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Transplantation, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Niklas Bergh
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Christian L Polte
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
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21
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Janssen MTHF, Landewé RBM, Post MC, Erckens RJ, Mostard RLM. Organ involvement and assessment in sarcoidosis. Curr Opin Pulm Med 2023; 29:485-492. [PMID: 37461850 DOI: 10.1097/mcp.0000000000000997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
PURPOSE OF REVIEW In recent years new recommendations have been published about organ assessment in the diagnosis of sarcoidosis. RECENT FINDINGS Screening for pulmonary, cardiac, ocular, neurologic and renal involvement and hypercalcemia is recommended in the work-up for sarcoidosis, additionally, screening for hypercalciuria at the time of the diagnosis might be beneficial. SUMMARY One of the goals in the work-up of sarcoidosis is to assess the extent and severity of organ involvement. Timely and accurate assessment leads to determination of treatment indication. Screening for pulmonary involvement should include pulmonary imaging and pulmonary function tests. Screening for cardiac involvement should include a clear history including palpitations and collapse and a baseline electrocardiogram or 24-h Holter monitoring. At diagnosis, ophthalmological assessment is recommended. Furthermore, serum calcium level and serum creatinine level should be obtained. Although routine 24-h urinary calcium excretion is not included in the guidelines, performing this test routinely can be considered. On indication, neurologic, rheumatologic or dermatologic assessment can be performed.
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Affiliation(s)
| | - Robert B M Landewé
- Department of Rheumatology, Zuyderland Medical Centre, Heerlen, Limburg
- Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Centre, Amsterdam
| | - Marco C Post
- Department of Cardiology, St. Antonius Hospital Nieuwegein and Utrecht
- Department of Cardiology, University Medical Centre Utrecht, Utrecht
| | | | - Rémy L M Mostard
- Department of Pulmonology
- Department of Pulmonology, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands
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22
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Hutt E, Brizneda MV, Goldar G, Aguilera J, Wang TKM, Taimeh Z, Culver D, Callahan T, Tang WHW, Cremer PC, Jaber WA, Ribeiro Neto ML, Jellis CL. Optimal left ventricular ejection fraction in risk stratification of patients with cardiac sarcoidosis. Europace 2023; 25:euad273. [PMID: 37721485 PMCID: PMC10516712 DOI: 10.1093/europace/euad273] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 07/24/2023] [Accepted: 08/24/2023] [Indexed: 09/19/2023] Open
Abstract
AIMS Identifying patients with cardiac sarcoidosis (CS) who are at an increased risk of sudden cardiac death (SCD) poses a clinical challenge. We sought to identify the optimal cutoff for left ventricular ejection fraction (LVEF) in predicting ventricular arrhythmia (VA) and all-cause mortality and to identify clinical and imaging risk factors in patients with known CS. METHODS AND RESULTS This retrospective cohort included 273 patients with well-established CS. The primary endpoint was a composite of VA and all-cause mortality. A modified receiver operating curve analysis was utilized to identify the optimal cutoff for LVEF in predicting the primary composite endpoint. Cox proportional hazard regression analysis was used to identify independent risk factors of the outcomes. At median follow-up of 7.9 years, the rate of the primary endpoint was 38% (83 VAs and 32 all-cause deaths). The 5-year overall survival rate was 97%. The optimal cutoff LVEF for the primary composite endpoint was 42% in the entire cohort and in subjects without a history of VA. Younger age, history of VA, lower LVEF, and any presence of scar by cardiac magnetic resonance (CMR) imaging and/or positron emission tomography (PET) were found to be independent risk factors for the primary endpoint and for VA, whereas lower LVEF, baseline NT-proBNP, and any presence of scar were independent risk factor of all-cause mortality. CONCLUSION Among patients with CS, a mild reduction in LVEF of 42% was identified as the optimal cutoff for predicting VA and all-cause mortality. Prior VA and scar by CMR or PET are strong risk factors for future VA and all-cause mortality.
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Affiliation(s)
- Erika Hutt
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, OH 44195, USA
| | - Maria Vega Brizneda
- Department of Internal Medicine, Medicine Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Ghazaleh Goldar
- Department of Internal Medicine, Medicine Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Jose Aguilera
- Section of Cardiac Electrophysiology and Pacing, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Tom Kai Ming Wang
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, OH 44195, USA
| | - Ziad Taimeh
- Section of Heart Failure and Transplantation Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Daniel Culver
- Sarcoidosis Center, Respiratory Institute Cleveland Clinic, Cleveland, OH 44195, USA
| | - Thomas Callahan
- Section of Cardiac Electrophysiology and Pacing, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - W H Wilson Tang
- Section of Heart Failure and Transplantation Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Paul C Cremer
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, OH 44195, USA
| | - Wael A Jaber
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, OH 44195, USA
| | - Manuel L Ribeiro Neto
- Sarcoidosis Center, Respiratory Institute Cleveland Clinic, Cleveland, OH 44195, USA
| | - Christine L Jellis
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, OH 44195, USA
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23
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Okafor J, Khattar R, Sharma R, Kouranos V. The Role of Echocardiography in the Contemporary Diagnosis and Prognosis of Cardiac Sarcoidosis: A Comprehensive Review. Life (Basel) 2023; 13:1653. [PMID: 37629510 PMCID: PMC10455750 DOI: 10.3390/life13081653] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/23/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023] Open
Abstract
Cardiac sarcoidosis (CS) is a rare inflammatory disorder characterised by the presence of non-caseating granulomas within the myocardium. Contemporary studies have revealed that 25-30% of patients with systemic sarcoidosis have cardiac involvement, with detection rates increasing in the era of advanced cardiac imaging. The use of late gadolinium enhancement cardiac magnetic resonance and 18fluorodeoxy glucose positron emission tomography (FDG-PET) imaging has superseded endomyocardial biopsy for the diagnosis of CS. Echocardiography has historically been used as a screening tool with abnormalities triggering the need for advanced imaging, and as a tool to assess cardiac function. Regional wall thinning or aneurysm formation in a noncoronary distribution may indicate granuloma infiltration. Thinning of the basal septum in the setting of extracardiac sarcoidosis carries a high specificity for cardiac involvement. Abnormal myocardial echotexture and eccentric hypertrophy may be suggestive of active myocardial inflammation. The presence of right-ventricular involvement as indicated by free-wall aneurysms can mimic arrhythmogenic right-ventricular cardiomyopathy. More recently, the use of myocardial strain has increased the sensitivity of echocardiography in diagnosing cardiac involvement. Echocardiography is limited in prognostication, with impaired left-ventricular (LV) ejection fraction and LV dilatation being the only established independent predictors of mortality. More research is required to explore how advanced echocardiographic technologies can increase both the diagnostic sensitivity and prognostic ability of this modality in CS.
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Affiliation(s)
- Joseph Okafor
- Department of Echocardiography, Royal Brompton Hospital, London SW3 6NP, UK
- Cardiac Sarcoidosis Centre, Royal Brompton Hospital, London SW3 6NP, UK
| | - Rajdeep Khattar
- Department of Echocardiography, Royal Brompton Hospital, London SW3 6NP, UK
- Cardiac Sarcoidosis Centre, Royal Brompton Hospital, London SW3 6NP, UK
| | - Rakesh Sharma
- Cardiac Sarcoidosis Centre, Royal Brompton Hospital, London SW3 6NP, UK
| | - Vasilis Kouranos
- Cardiac Sarcoidosis Centre, Royal Brompton Hospital, London SW3 6NP, UK
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Eckstein J, Moghadasi N, Körperich H, Akkuzu R, Sciacca V, Sohns C, Sommer P, Berg J, Paluszkiewicz J, Burchert W, Piran M. Machine-Learning-Based Diagnostics of Cardiac Sarcoidosis Using Multi-Chamber Wall Motion Analyses. Diagnostics (Basel) 2023; 13:2426. [PMID: 37510168 PMCID: PMC10377893 DOI: 10.3390/diagnostics13142426] [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: 05/26/2023] [Revised: 07/13/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Hindered by its unspecific clinical and phenotypical presentation, cardiac sarcoidosis (CS) remains a challenging diagnosis. OBJECTIVE Utilizing cardiac magnetic resonance imaging (CMR), we acquired multi-chamber volumetrics and strain feature tracking for a support vector machine learning (SVM)-based diagnostic approach to CS. METHOD Forty-five CMR-negative (CMR(-), 56.5(53.0;63.0)years), eighteen CMR-positive (CMR(+), 64.0(57.8;67.0)years) sarcoidosis patients and forty-four controls (CTRL, 56.5(53.0;63.0)years)) underwent CMR examination. Cardiac parameters were processed using the classifiers of logistic regression, KNN(K-nearest-neighbor), DT (decision tree), RF (random forest), SVM, GBoost, XGBoost, Voting and feature selection. RESULTS In a three-cluster analysis of CTRL versus vs. CMR(+) vs. CMR(-), RF and Voting classifier yielded the highest prediction rates (81.82%). The two-cluster analysis of CTRL vs. all sarcoidosis (All Sarc.) yielded high prediction rates with the classifiers logistic regression, RF and SVM (96.97%), and low prediction rates for the analysis of CMR(+) vs. CMR(-), which were augmented using feature selection with logistic regression (89.47%). CONCLUSION Multi-chamber cardiac function and strain-based supervised machine learning provides a non-contrast approach to accurately differentiate between healthy individuals and sarcoidosis patients. Feature selection overcomes the algorithmically challenging discrimination between CMR(+) and CMR(-) patients, yielding high accuracy predictions. The study findings imply higher prevalence of cardiac involvement than previously anticipated, which may impact clinical disease management.
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Affiliation(s)
- Jan Eckstein
- Institute for Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine Westphalia, Bad Oeynhausen, University of Bochum, 32545 Bochum, Germany
| | - Negin Moghadasi
- Department of Engineering Systems & Environment, University of Virginia, Charlottesville, VA 22904, USA
| | - Hermann Körperich
- Institute for Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine Westphalia, Bad Oeynhausen, University of Bochum, 32545 Bochum, Germany
| | - Rehsan Akkuzu
- Institute for Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine Westphalia, Bad Oeynhausen, University of Bochum, 32545 Bochum, Germany
| | - Vanessa Sciacca
- Clinic for Electrophysiology, Heart and Diabetes Center North-Rhine Westphalia, Ruhr-University of Bochum, 32545 Bad Oeynhausen, Germany
| | - Christian Sohns
- Clinic for Electrophysiology, Heart and Diabetes Center North-Rhine Westphalia, Ruhr-University of Bochum, 32545 Bad Oeynhausen, Germany
| | - Philipp Sommer
- Clinic for Electrophysiology, Heart and Diabetes Center North-Rhine Westphalia, Ruhr-University of Bochum, 32545 Bad Oeynhausen, Germany
| | - Julian Berg
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North-Rhine Westphalia, Ruhr-University of Bochum, 32545 Bad Oeynhausen, Germany
| | - Jerzy Paluszkiewicz
- Cardiology Institute and Clinic, Poznan University of Medical Sciences, 61-701 Poznan, Poland
| | - Wolfgang Burchert
- Institute for Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine Westphalia, Bad Oeynhausen, University of Bochum, 32545 Bochum, Germany
| | - Misagh Piran
- Institute for Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine Westphalia, Bad Oeynhausen, University of Bochum, 32545 Bochum, Germany
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Kurashima S, Kitai T, Xanthopoulos A, Skoularigis J, Triposkiadis F, Izumi C. Diagnosis of cardiac sarcoidosis: histological evidence vs. imaging. Expert Rev Cardiovasc Ther 2023; 21:693-702. [PMID: 37776232 DOI: 10.1080/14779072.2023.2266367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 09/29/2023] [Indexed: 10/02/2023]
Abstract
INTRODUCTION The prognosis for cardiac sarcoidosis (CS) remains unfavorable. Although early and accurate diagnosis is crucial, the low detection rate of endomyocardial biopsy makes accurate diagnosis challenging. AREAS COVERED The Heart Rhythm Society (HRS) consensus statement and the Japanese Circulation Society (JCS) guidelines are two major diagnostic criteria for the diagnosis of CS. While the requirement of positive histology for the diagnosis in the HRS criteria can result in overlooked cases, the JCS guidelines advocate for a group of 'clinical' diagnoses based on advanced imaging, including cardiovascular magnetic resonance and 18F-fluorodeoxyglucose positron emission tomography, which do not require histological evidence. Recent studies have supported the usefulness of clinical diagnosis of CS. However, other evidence suggests that clinical CS may sometimes be inaccurate. This article describes the advantages and disadvantages of the current diagnostic criteria for CS, and typical imaging and clinical courses. EXPERT OPINION The diagnosis of clinical CS has been made possible by recent developments in multimodality imaging. However, it is still crucial to look for histological signs of sarcoidosis in other organs in addition to the endomyocardium. Additionally, phenotyping based on clinical manifestations such as heart failure, conduction abnormality or ventricular arrhythmia, and extracardiac abnormalities is clinically significant.
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Affiliation(s)
- Shinichi Kurashima
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Andrew Xanthopoulos
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece
| | - John Skoularigis
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece
| | | | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
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Yoshida S, Nakata T, Naya M, Momose M, Taniguchi Y, Fukushima Y, Moroi M, Okizaki A, Hashimoto A, Kiko T, Hida S, Takehana K, Nakajima K. Prognostic Implications of Sarcoidosis Granulomas - Insights From the Multicenter Registry, the Japanese Cardiac Sarcoidosis Prognostic Study. Circ Rep 2023; 5:252-259. [PMID: 37305793 PMCID: PMC10247353 DOI: 10.1253/circrep.cr-23-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/04/2023] [Indexed: 06/13/2023] Open
Abstract
Background: Definitions of cardiac sarcoidosis (CS) differ among guidelines. Any systemic histological finding of CS is essential for the diagnosis of CS in the 2014 Heart Rhythm Society statement, but not necessary in the Japanese Circulation Society 2016 guidelines. This study aimed to reveal the differences in outcomes by comparing 2 groups, namely CS patients with or without systemic histologically proven granuloma. Methods and Results: This study retrospectively included 231 consecutive patients with CS. CS with granulomas in ≥1 organs was diagnosed in 131 patients (Group G), whereas CS without any granulomas was diagnosed in the remaining 100 patients (Group NG). Left ventricular ejection fraction (LVEF) was significantly reduced in Group NG compared with Group G (44±13% vs. 50±16%, respectively; P=0.001). However, Kaplan-Meier curves showed that major adverse cardiovascular events (MACE)-free survival outcomes were comparable between the 2 groups (log-rank P=0.167). Univariable analyses showed that significant predictors of MACE were Groups G/NG, histological CS, LVEF, and high B-type natriuretic peptide (BNP) or N-terminal pro BNP concentrations, but none of these was significant in multivariable analyses. Conclusions: Overall risks of MACE were similar between the 2 groups despite different manifestations in cardiac dysfunction. The data not only validate the prognostic value of non-invasive diagnosis of CS, but also show the need for careful observation and therapeutic strategy in patients with CS without any granuloma.
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Affiliation(s)
- Shohei Yoshida
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Science Kanazawa Japan
| | | | - Masanao Naya
- Department of Cardiology, Hokkaido University Hospital Sapporo Japan
| | - Mitsuru Momose
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Woman's Medical University Tokyo Japan
| | - Yasuyo Taniguchi
- Department of General Medicine, Hyogo Harima-Himeji General Hospital Himeji Japan
| | | | - Masao Moroi
- Department of Cardiovascular Medicine, Toho University Ohashi Medical Center Tokyo Japan
| | - Atsutaka Okizaki
- Department of Radiology, Asahikawa Medical University Asahikawa Japan
| | | | - Takatoyo Kiko
- Department of Cardiology, Fukushima Medical University Fukushima Japan
| | - Satoshi Hida
- Department of Cardiology, Tokyo Medical University Tokyo Japan
| | - Kazuya Takehana
- Division of Cardiology, Department of Medicine II, Kansai Medical University Hirakata Japan
| | - Kenichi Nakajima
- Department of Functional Imaging and Artificial Intelligence, Kanazawa University Kanazawa Japan
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27
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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: 1] [Impact Index Per Article: 1.0] [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.
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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
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28
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Shah HH, Zehra SA, Shahrukh A, Waseem R, Hussain T, Hussain MS, Batool F, Jaffer M. Cardiac sarcoidosis: a comprehensive review of risk factors, pathogenesis, diagnosis, clinical manifestations, and treatment strategies. Front Cardiovasc Med 2023; 10:1156474. [PMID: 37273881 PMCID: PMC10235776 DOI: 10.3389/fcvm.2023.1156474] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/21/2023] [Indexed: 06/06/2023] Open
Abstract
Cardiac Sarcoidosis (CS) is a deadly consequence of systemic sarcoidosis that inflames all three layers of the heart, especially the myocardium-clinical signs of CS range from asymptomatic disease to abrupt cardiac death. CS generally remains undiagnosed secondary to a lack of definitive diagnostic criteria, a high percentage of false negative results on endomyocardial biopsy, and ill-defining clinical manifestations of the disease. Consequently, there is a lack of evidence-based recommendations for CS, and the present diagnostic and therapeutic management depend on expert opinion. The aetiology, risk factors, clinical symptoms, diagnosis, and therapy of CS will be covered in this review. A particular emphasis will be placed on enhanced cardiovascular imaging and early identification of CS. We review the emerging evidence regarding the use of Electrocardiograms (ECGs), Magnetic Resonance Imaging (MRI), and Positron Emission Tomography (PET) imaging of the heart to identify and quantify the extent of myocardial inflammation, as well as to guide the use of immunotherapy and other treatment regimens, such as ablation therapy, device therapy, and heart transplantation, to improve patient outcomes.
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29
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Vanchin B, Ka MM, Arendt CT, Escher F, Nagel E, Puntmann VO. Myocardial tissue changes detected by cardiac MRI in a patient with suspected systemic sarcoidosis. BMC Cardiovasc Disord 2023; 23:131. [PMID: 36906545 PMCID: PMC10007775 DOI: 10.1186/s12872-023-03133-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 02/19/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND The role of cardiac magnetic resonance imaging in the early management of chronic cardiac inflammatory conditions is growing. Our case enlightens the benefit of quantitative mapping in the monitoring and treatment guidance in systemic sarcoidosis. CASE PRESENTATION We report about a 29-year-old man with an ongoing dyspnea and bihilar lymphadenopathy, suggesting sarcoidosis. Cardiac magnetic resonance showed high mapping values, but no scarring. In follow-ups, cardiac remodeling was noted; cardioprotective treatment normalized cardiac function and mapping markers. Definitive diagnosis was achieved in extracardiac lymphatic tissue during a relapse. CONCLUSION This case shows the role that mapping markers can play in the detection and treatment at early stage of systemic sarcoidosis.
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Affiliation(s)
- Byambasuren Vanchin
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt Am Main, Germany.,Department of Cardiology, School of Medicine, Mongolia-Japan Teaching Hospital, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Mame Madjiguène Ka
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt Am Main, Germany.
| | - Christophe T Arendt
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt Am Main, Germany
| | - Felicitas Escher
- Department of Cardiology, University Hospital Berlin Charite, Berlin, Germany
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt Am Main, Germany
| | - Valentina O Puntmann
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Centre for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt Am Main, Germany
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30
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Judson MA. The management of sarcoidosis in the 2020's by the primary care physician. Am J Med 2023; 136:534-544. [PMID: 36889493 DOI: 10.1016/j.amjmed.2023.02.014] [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: 02/13/2023] [Revised: 02/20/2023] [Accepted: 02/20/2023] [Indexed: 03/08/2023]
Abstract
Sarcoidosis is an idiopathic granulomatous disease that occurs worldwide and may affect any organ. Because the presenting symptoms of sarcoidosis are not specific for the disease, the primary care physician is usually the first provider to assess these patients. In addition, patients who have previously been diagnosed with sarcoidosis are usually followed longitudinally by primary care physicians. Therefore, these physicians are often the first to address sarcoidosis patient symptoms related to exacerbations of the disease, as well as first observe complications of sarcoidosis medications. This article outlines the approach to the evaluation, treatment and monitoring of sarcoidosis patients by the primary care physician.
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Affiliation(s)
- Marc A Judson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Albany Medical College, 16 New Scotland Avenue, Albany, New York 12208 USA.
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31
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Strambu IR. Challenges of cardiac sarcoidosis. Front Med (Lausanne) 2023; 10:999066. [PMID: 36936210 PMCID: PMC10018021 DOI: 10.3389/fmed.2023.999066] [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: 07/20/2022] [Accepted: 02/14/2023] [Indexed: 03/06/2023] Open
Abstract
Sarcoidosis is a multisystem granulomatosis of unknown origin, which can involve almost any organ. Most frequently the disease involves the lungs and mediastinal lymph nodes, but it can affect the skin, the eyes, nervous system, the heart, kidneys, joints, muscles, calcium metabolism, and probably any other anecdotical organ involvement. Cardiac sarcoidosis is one of the most challenging involvements, as it can lead to cardiac mortality and morbidity, and also because the diagnosis may be difficult. With no specific symptoms, cardiac sarcoidosis may be difficult to suspect in a patient with no previous extra-cardiac sarcoidosis diagnosis. This manuscript reviews the current knowledge of the diagnosis and decision to treat cardiac sarcoidosis, and illustrates the information with a case presentation of a young adult with no risk factors, no previous diagnosis of sarcoidosis, and with cardiac symptoms impairing his quality of life.
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Affiliation(s)
- Irina R. Strambu
- Pulmonology Department, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
- Institute of Pneumophthysiology “Marius Nasta”, Bucharest, Romania
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32
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Benjamin MM, Shah P, Munir MS, Kinno M, Syed MA. Comparison of LGE quantitation methods in cardiac sarcoidosis to predict clinical outcomes. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:641-650. [PMID: 36424508 DOI: 10.1007/s10554-022-02751-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/20/2022] [Indexed: 11/25/2022]
Abstract
We sought to investigate the optimal method of quantifying late gadolinium enhancement (LGE) in cardiac sarcoidosis (CS) using cardiac magnetic resonance imaging (MRI). We retrospectively studied 53 patients with CS. LGE quantitation was performed using (a) semi-automated segmentation using Signal Threshold versus Reference Mean (STRM) cutoffs of > 2, > 3 and > 5 standard deviations (SD); (b) full-width-half-max (FWHM) method and (c) manual segmentation (MS) of affected myocardial segments. Primary outcome was a composite of cardiovascular death and ventricular tachyarrhythmia (VTA). A multivariate regression analysis was performed comparing the techniques adjusting for age, gender, NYHA class and LVEF. Mean age was 56.3 ± 12 years, 71.6% males, 66% white. Mean LVEF was 45.1% ± 14.7%. Over median follow-up of 28.1 months, 2 patients had cardiac death (3.7%) and 8 (15.1%) had VTA. On multivariate analysis, MS, > 2SD, > 3SD, > 5SD and FWHM had OR of 1.39 [CI 1.04-1.79], 1.09 [CI 0.99-1.21], 1.15 [CI 1.03-1.29], 1.16 [CI 1.04-1.27] and 1.08 [CI 0.96-1.21], respectively, for predicting the composite outcome. ROC curve analysis showed MS to have the highest AUC 0.89 followed by 0.81 for > 3SD and > 5SD, 0.75 for > 2SD and lowest 0.69 for FWHM method. Reproducibility was lower for manual method (ICC 0.7) than for > 3SD (ICC 0.991) and > 5SD (ICC 0.997). CS quantitation of LGE with MS or semi-automated quantitation with STRM > 3SD or > 5SD was significantly associated with the composite outcome of cardiac death and VTA. Semi-automated quantitation with STRM > 3SD provided the best combination of accuracy and reproducibility.
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Affiliation(s)
- Mina M Benjamin
- Division of Cardiovascular Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Parth Shah
- Department of Internal Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Muhammad S Munir
- Division of Cardiovascular Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Menhel Kinno
- Division of Cardiovascular Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Mushabbar A Syed
- Division of Cardiovascular Medicine, Loyola University Medical Center, Maywood, IL, USA.
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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: 15] [Impact Index Per Article: 15.0] [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.
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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.)
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Treiber J, Novak D, Fischer-Rasokat U, Wolter JS, Kriechbaum S, Weferling M, von Jeinsen B, Hain A, Rieth AJ, Siemons T, Keller T, Hamm CW, Rolf A. Regional extracellular volume within late gadolinium enhancement-positive myocardium to differentiate cardiac sarcoidosis from myocarditis of other etiology: a cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 2023; 25:8. [PMID: 36755275 PMCID: PMC9909902 DOI: 10.1186/s12968-023-00918-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 01/12/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) plays a pivotal role in diagnosing myocardial inflammation. In addition to late gadolinium enhancement (LGE), native T1 and T2 mapping as well as extracellular volume (ECV) are essential tools for tissue characterization. However, the differentiation of cardiac sarcoidosis (CS) from myocarditis of other etiology can be challenging. Positron-emission tomography-computed tomography (PET-CT) regularly shows the highest Fluordesoxyglucose (FDG) uptake in LGE positive regions. It was therefore the aim of this study to investigate, whether native T1, T2, and ECV measurements within LGE regions can improve the differentiation of CS and myocarditis compared with using global native T1, T2, and ECV values alone. METHODS PET/CT confirmed CS patients and myocarditis patients (both acute and chronic) from a prospective registry were compared with respect to regional native T1, T2, and ECV. Acute and chronic myocarditis were defined based on the 2013 European Society of Cardiology position paper on myocarditis. All parametric measures and ECV were acquired in standard fashion on three short-axis slices according to the ConSept study for global values and within PET-CT positive regions of LGE. RESULTS Between 2017 and 2020, 33 patients with CS and 73 chronic and 35 acute myocarditis patients were identified. The mean ECV (± SD) in LGE regions of CS patients was higher than in myocarditis patients (CS vs. acute and chronic, respectively: 0.65 ± 0.12 vs. 0.45 ± 0.13 and 0.47 ± 0.1; p < 0.001). Acute and chronic myocarditis patients had higher global native T1 values (1157 ± 54 ms vs. 1196 ± 63 ms vs. 1215 ± 74 ms; p = 0.001). There was no difference in global T2 and ECV values between CS and acute or chronic myocarditis patients. CONCLUSION This is the first study to show that the calculation of regional ECV within LGE-positive regions may help to differentiate CS from myocarditis. Further studies are warranted to corroborate these findings.
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Affiliation(s)
- Julia Treiber
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
- German Center for Cardiovascular Research (DZHK), Rhine-Main Partner Site, Frankfurt am Main, Germany
| | - Dijana Novak
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
| | - Ulrich Fischer-Rasokat
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
- German Center for Cardiovascular Research (DZHK), Rhine-Main Partner Site, Frankfurt am Main, Germany
| | - Jan Sebastian Wolter
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
- German Center for Cardiovascular Research (DZHK), Rhine-Main Partner Site, Frankfurt am Main, Germany
| | - Steffen Kriechbaum
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
- German Center for Cardiovascular Research (DZHK), Rhine-Main Partner Site, Frankfurt am Main, Germany
| | - Maren Weferling
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
- German Center for Cardiovascular Research (DZHK), Rhine-Main Partner Site, Frankfurt am Main, Germany
| | - Beatrice von Jeinsen
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
- German Center for Cardiovascular Research (DZHK), Rhine-Main Partner Site, Frankfurt am Main, Germany
| | - Andreas Hain
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
| | - Andreas J Rieth
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
- German Center for Cardiovascular Research (DZHK), Rhine-Main Partner Site, Frankfurt am Main, Germany
| | - Tamo Siemons
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
| | - Till Keller
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
- Medical Clinic 1, Justus-Liebig-Universität Giessen, Giessen, Germany
- German Center for Cardiovascular Research (DZHK), Rhine-Main Partner Site, Frankfurt am Main, Germany
| | - Christian W Hamm
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
- Medical Clinic 1, Justus-Liebig-Universität Giessen, Giessen, Germany
- German Center for Cardiovascular Research (DZHK), Rhine-Main Partner Site, Frankfurt am Main, Germany
| | - Andreas Rolf
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany.
- Medical Clinic 1, Justus-Liebig-Universität Giessen, Giessen, Germany.
- German Center for Cardiovascular Research (DZHK), Rhine-Main Partner Site, Frankfurt am Main, Germany.
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Abstract
About 5% of sarcoidosis patients develop clinically manifest cardiac features. Cardiac sarcoidosis (CS) typically presents with conduction abnormalities, ventricular arrhythmias and heart failure. Its diagnosis is challenging and requires a substantial degree of clinical suspicion as well as expertise in advanced cardiac imaging. Adverse events, particularly malignant arrhythmias and development of heart failure, are common among CS patients. A timely diagnosis is paramount to ameliorating outcomes for these patients. Despite weak evidence, immunosuppression (primarily with corticosteroids) is generally recommended in the presence of active inflammation in the myocardium. The burden of malignant arrhythmias remains important regardless of treatment, thus leading to the recommended use of an implantable cardioverter defibrillator in most patients with clinically manifest CS.
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Affiliation(s)
- Alessandro De Bortoli
- Division of Cardiology, University of Ottawa Heart Institute.,Department of Cardiology, Vestfold Hospital Trust
| | - David H Birnie
- Division of Cardiology, University of Ottawa Heart Institute
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Chareonthaitawee P, Gutberlet M. Clinical Utilization of Multimodality Imaging for Myocarditis and Cardiac Sarcoidosis. Circ Cardiovasc Imaging 2023; 16:e014091. [PMID: 36649452 DOI: 10.1161/circimaging.122.014091] [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] [Indexed: 01/19/2023]
Abstract
Myocarditis is defined as inflammation of the myocardium according to clinical, histological, biochemical, immunohistochemical, or imaging findings. Inflammation can be categorized histologically by cell type or pattern, and many causes have been implicated, including infectious, most commonly viral, systemic autoimmune diseases, vaccine-associated processes, environmental factors, toxins, and hypersensitivity to drugs. Sarcoid myocarditis is increasingly recognized as an important cause of cardiomyopathy and has important diagnostic, prognostic, and therapeutic implications in patients with systemic sarcoidosis. The clinical presentation of myocarditis may include an asymptomatic, subacute, acute, fulminant, or chronic course and may have focal or diffuse involvement of the myocardium depending on the cause and time point of the disease. For most causes of myocarditis except sarcoidosis, myocardial biopsy is the gold standard but is limited due to risk, cost, availability, and variable sensitivity. Diagnostic criteria have been established for both myocarditis and cardiac sarcoidosis and include clinical and imaging findings particularly the use of cardiac magnetic resonance and positron emission tomography. Beyond diagnosis, imaging findings may also provide prognostic value. This case-based review focuses on the current state of multimodality imaging for the diagnosis and management of myocarditis and cardiac sarcoidosis, highlighting multimodality imaging approaches with practical clinical vignettes, with a discussion of knowledge gaps and future directions.
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Abstract
Sarcoidosis is a granulomatous disease with the potential of multiple organ system involvement and its etiology remains unknown. Cardiac involvement is associated with worse clinical outcome, and has been reported to be 20-30% in white and as high as 58% in Japanese populations with sarcoidosis. Clinical manifestations of cardiac sarcoidosis highly depend on the extent and location of granulomatous inflammation. The most frequent presentations include heart block, tachyarrhythmia, or heart failure. Endomyocardial biopsy is the most specific diagnostic test, but has poor sensitivity due to often patchy involvement. The diagnosis of cardiac sarcoidosis remains challenging due to nonspecific imaging findings. Both 18 F-fluorodeoxyglucose-positron emission tomography (FDG-PET) and cardiac magnetic resonance imaging can be used to evaluate cardiac sarcoidosis, but evaluate different stages of the disease process. FDG-PET detects metabolically active inflammatory cells while cardiac magnetic resonance imaging with late gadolinium enhancement reveals areas of myocardial necrosis and fibrosis. Aggressive therapy of symptomatic cardiac sarcoidosis is often sought due to the high risk of sudden death and/or progression to heart failure. Prednisone 20-40 mg a day is the recommended initial treatment. In refractory or severe cases, higher doses of prednisone, 1-1.5 mg/kg/d (or its equivalent) and addition of a steroid-sparing agent have been utilized. Methotrexate is added most commonly. Long-term improvement has been reported with the use of a combination of weekly methotrexate and prednisone versus prednisone alone. After initiation of treatment, a cardiac FDG-PET scan may be performed 2-3 months later to assess treatment response.
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Affiliation(s)
- Chengyue Jin
- From the Department of Medicine, Westchester Medical Center, Valhalla, NY
| | - Liliya Gandrabur
- Division of Rheumatology, Department of Medicine, Westchester Medical Center, Valhalla, NY
| | - Woo Young Kim
- From the Department of Medicine, Westchester Medical Center, Valhalla, NY
| | - Stephen Pan
- Department of Medicine and Cardiology, Westchester Medical Center, Valhalla, NY
| | - Julia Y Ash
- Division of Rheumatology, Department of Medicine, Westchester Medical Center, Valhalla, NY
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Abstract
Sarcoidosis is a heterogeneous disease, which can affect virtually every body organ, even though lungs and intra thoracic lymph nodes are almost universally affected. The presence of noncaseating granulomas is the histopathological hallmark of the disease, and clinical picture depends on the organs affected. Data about interaction between sarcoidosis and comorbidities, such as cardiovascular and pulmonary diseases, autoimmune disorders, malignancy and drug-related adverse events are limited. Several lung conditions can be associated with sarcoidosis, such as pulmonary hypertension and fibrosis, making it difficult sometimes the differentiation between complications and distinctive pathologies. Their coexistence may complicate the diagnosis of sarcoidosis and contribute to the highly variable and unpredictable natural history, particularly if several diseases are recognised. A thorough assessment of specific disorders that can be associated with sarcoidosis should always be carried out, and future studies will need to evaluate sarcoidosis not only as a single disorder, but also in the light of possible concomitant conditions.Key messagesComorbidities in sarcoidosis are common, especially cardiovascular and pulmonary diseases.In the diagnostic workup, a distinction must be made between sarcoidosis-related complaints and complaints caused by other separate disorders. It can be very difficult to distinguish between complications of sarcoidosis and other concomitant conditions.The coexistence of multiple conditions may complicate the diagnosis of sarcoidosis, affect its natural course and response to treatment.
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Affiliation(s)
- Claudio Tana
- Geriatrics Clinic, Medicine Department, SS Annunziata Hospital of Chieti, Chieti, Italy
| | - Marjolein Drent
- Department of Pharmacology and Toxicology, Faculty of Health, Medicine and Life Science, Maastricht University, Maastricht, The Netherlands.,ILD Center of Excellence, Department of Respiratory Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands.,ILD Care Foundation Research Team, Ede, The Netherlands
| | - Hilario Nunes
- AP-HP, Hôpital Avicenne, Service de Pneumologie, Centre de Référence des Maladies Pulmonaires Rares de l'adulte, Université Sorbonne Paris Nord, Bobigny, France
| | - Vasilis Kouranos
- Interstitial Lung Disease Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College London, London, UK
| | - Francesco Cinetto
- Rare Diseases Referral Center, Internal Medicine 1, Ca' Foncello Hospital - AULSS2 Marca Trevigiana and Department of Medicine - DIMED, University of Padova, Italy
| | - Naomi T Jessurun
- ILD Care Foundation Research Team, Ede, The Netherlands.,Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, The Netherlands
| | - Paolo Spagnolo
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
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39
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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]
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40
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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.
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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
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41
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Nordenswan HK, Pöyhönen P, Lehtonen J, Ekström K, Uusitalo V, Niemelä M, Vihinen T, Kaikkonen K, Haataja P, Kerola T, Rissanen TT, Alatalo A, Pietilä-Effati P, Kupari M. Incidence of Sudden Cardiac Death and Life-Threatening Arrhythmias in Clinically Manifest Cardiac Sarcoidosis With and Without Current Indications for an Implantable Cardioverter Defibrillator. Circulation 2022; 146:964-975. [PMID: 36000392 PMCID: PMC9508990 DOI: 10.1161/circulationaha.121.058120] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 07/18/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Cardiac sarcoidosis (CS) predisposes to sudden cardiac death (SCD). Guidelines for implantable cardioverter defibrillators (ICDs) in CS have been issued by the Heart Rhythm Society in 2014 and the American College of Cardiology/American Heart Association/Heart Rhythm Society consortium in 2017. How well they discriminate high from low risk remains unknown. METHODS We analyzed the data of 398 patients with CS detected in Finland from 1988 through 2017. All had clinical cardiac manifestations. Histological diagnosis was myocardial in 193 patients (definite CS) and extracardiac in 205 (probable CS). Patients with and without Class I or IIa ICD indications at presentation were identified, and subsequent occurrences of SCD (fatal or aborted) and sustained ventricular tachycardia were recorded, as were ICD indications emerging first on follow-up. RESULTS Over a median of 4.8 years, 41 patients (10.3%) had fatal (n=8) or aborted (n=33) SCD, and 98 (24.6%) experienced SCD or sustained ventricular tachycardia as the first event. By the Heart Rhythm Society guideline, Class I or IIa ICD indications were present in 339 patients (85%) and absent in 59 (15%), of whom 264 (78%) and 30 (51%), respectively, received an ICD. Cumulative 5-year incidence of SCD was 10.7% (95% CI, 7.4%-15.4%) in patients with ICD indications versus 4.8% (95% CI, 1.2%-19.1%) in those without (χ2=1.834, P=0.176). The corresponding rates of SCD were 13.8% (95% CI, 9.1%-21.0%) versus 6.3% (95% CI, 0.7%-54.0%; χ2=0.814, P=0.367) in definite CS and 7.6% (95% CI, 3.8%-15.1%) versus 3.3% (95% CI, 0.5%-22.9%; χ2=0.680, P=0.410) in probable CS. In multivariable regression analysis, SCD was predicted by definite histological diagnosis (P=0.033) but not by Class I or IIa ICD indications (P=0.210). In patients without ICD indications at presentation, 5-year incidence of SCD, sustained ventricular tachycardia, and emerging Class I or IIa indications was 53% (95% CI, 40%-71%). By the American College of Cardiology/American Heart Association/Heart Rhythm Society guideline, all patients with complete data (n=245) had Class I or IIa indications for ICD implantation. CONCLUSIONS Current ICD guidelines fail to distinguish a truly low-risk group of patients with clinically manifest CS, the 5-year risk of SCD approaching 5% despite absent ICD indications. Further research is needed on prognostic factors, including the role of diagnostic histology. Meanwhile, all patients with CS presenting with clinical cardiac manifestations should be considered for an ICD implantation.
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MESH Headings
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/epidemiology
- Arrhythmias, Cardiac/therapy
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Defibrillators, Implantable/adverse effects
- Humans
- Incidence
- Myocarditis/complications
- Risk Factors
- Sarcoidosis/complications
- Sarcoidosis/diagnosis
- Sarcoidosis/epidemiology
- Tachycardia, Ventricular/diagnosis
- Tachycardia, Ventricular/epidemiology
- Tachycardia, Ventricular/therapy
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Affiliation(s)
- Hanna-Kaisa Nordenswan
- Heart and Lung Center (H.-K.N., P.P., J.L., K.E., M.N., M.K.), Helsinki University Hospital and University of Helsinki, Finland
| | - Pauli Pöyhönen
- Heart and Lung Center (H.-K.N., P.P., J.L., K.E., M.N., M.K.), Helsinki University Hospital and University of Helsinki, Finland
- Radiology (P.P., V.U.), Helsinki University Hospital and University of Helsinki, Finland
| | - Jukka Lehtonen
- Heart and Lung Center (H.-K.N., P.P., J.L., K.E., M.N., M.K.), Helsinki University Hospital and University of Helsinki, Finland
| | - Kaj Ekström
- Heart and Lung Center (H.-K.N., P.P., J.L., K.E., M.N., M.K.), Helsinki University Hospital and University of Helsinki, Finland
| | - Valtteri Uusitalo
- Radiology (P.P., V.U.), Helsinki University Hospital and University of Helsinki, Finland
- Clinical Physiology and Nuclear Medicine (V.U.), Helsinki University Hospital and University of Helsinki, Finland
| | - Meri Niemelä
- Heart and Lung Center (H.-K.N., P.P., J.L., K.E., M.N., M.K.), Helsinki University Hospital and University of Helsinki, Finland
| | | | - Kari Kaikkonen
- Medical Research Center Oulu, University and University Hospital of Oulu, Finland (K.K.)
| | - Petri Haataja
- Heart Hospital, Tampere University Hospital, Finland (P.H.)
| | - Tuomas Kerola
- Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland (T.K.)
| | | | - Aleksi Alatalo
- South Ostrobothnia Central Hospital, Seinäjoki, Finland (A.A.)
| | | | - Markku Kupari
- Heart and Lung Center (H.-K.N., P.P., J.L., K.E., M.N., M.K.), Helsinki University Hospital and University of Helsinki, Finland
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42
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Mavrogeni S, Pepe A, Nijveldt R, Ntusi N, Sierra-Galan LM, Bratis K, Wei J, Mukherjee M, Markousis-Mavrogenis G, Gargani L, Sade LE, Ajmone-Marsan N, Seferovic P, Donal E, Nurmohamed M, Cerinic MM, Sfikakis P, Kitas G, Schwitter J, Lima JAC, Dawson D, Dweck M, Haugaa KH, Keenan N, Moon J, Stankovic I, Donal E, Cosyns B. Cardiovascular magnetic resonance in autoimmune rheumatic diseases: a clinical consensus document by the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2022; 23:e308-e322. [PMID: 35808990 DOI: 10.1093/ehjci/jeac134] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 11/12/2022] Open
Abstract
Autoimmune rheumatic diseases (ARDs) involve multiple organs including the heart and vasculature. Despite novel treatments, patients with ARDs still experience a reduced life expectancy, partly caused by the higher prevalence of cardiovascular disease (CVD). This includes CV inflammation, rhythm disturbances, perfusion abnormalities (ischaemia/infarction), dysregulation of vasoreactivity, myocardial fibrosis, coagulation abnormalities, pulmonary hypertension, valvular disease, and side-effects of immunomodulatory therapy. Currently, the evaluation of CV involvement in patients with ARDs is based on the assessment of cardiac symptoms, coupled with electrocardiography, blood testing, and echocardiography. However, CVD may not become overt until late in the course of the disease, thus potentially limiting the therapeutic window for intervention. More recently, cardiovascular magnetic resonance (CMR) has allowed for the early identification of pathophysiologic structural/functional alterations that take place before the onset of clinically overt CVD. CMR allows for detailed evaluation of biventricular function together with tissue characterization of vessels/myocardium in the same examination, yielding a reliable assessment of disease activity that might not be mirrored by blood biomarkers and other imaging modalities. Therefore, CMR provides diagnostic information that enables timely clinical decision-making and facilitates the tailoring of treatment to individual patients. Here we review the role of CMR in the early and accurate diagnosis of CVD in patients with ARDs compared with other non-invasive imaging modalities. Furthermore, we present a consensus-based decision algorithm for when a CMR study could be considered in patients with ARDs, together with a standardized study protocol. Lastly, we discuss the clinical implications of findings from a CMR examination.
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Affiliation(s)
- S Mavrogeni
- Onassis Cardiac Surgery Center, Leof. Andrea Siggrou 356, Kallithea 176 74, Greece.,Exercise Physiology and Sport Medicine Clinic, Center for Adolescent Medicine and UNESCO Chair in Adolescent Health Care, First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Aghia Sophia Children's Hospital, 115 27 Athens, Greece
| | - A Pepe
- Institute of Radiology, Department of Medicine, University of Padua, 35122 Padua, Italy
| | - R Nijveldt
- Department of Cardiology, Radboud University Medical Center, 6525 GA, Nijmegen, the Netherlands
| | - N Ntusi
- University of Cape Town & Groote Schuur Hospital, City of Cape Town, 7700 Western Cape, South Africa
| | - L M Sierra-Galan
- Department of Cardiology, American British Cowdray Medical Center, 05330 Mexico City, Mexico
| | - K Bratis
- Department of Cardiology, Manchester Royal Infirmary, Manchester M13 9WL, UK
| | - J Wei
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA 90048, USA.,Preventive and Rehabilitative Cardiac Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA 90048, USA
| | - M Mukherjee
- Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | | | - L Gargani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy
| | - L E Sade
- University of Pittsburgh, University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, PA 15260, USA.,Department of Cardiology, Baskent University, 06790 Ankara, Turkey
| | - N Ajmone-Marsan
- Department of Cardiology, Leiden University Medical Center, 2311 EZ Leiden, the Netherlands
| | - P Seferovic
- Department of Cardiology, Belgrade University, 11000 Belgrade, Serbia
| | - E Donal
- Université RENNES-1, CHU, 35000 Rennes, France
| | - M Nurmohamed
- Amsterdam Rheumatology Immunology Center, Amsterdam University Medical Centers, 1105 AZ, Amsterdam, the Netherlands
| | - M Matucci Cerinic
- Experimental and Clinical Medicine, Division of Internal Medicine and Rheumatology, Azienda Ospedaliera Universitaria Careggi, University of Florence, 50121 Florence, Italy.,Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS, San Raffaele Hospital, 20132 Milan, Italy
| | - P Sfikakis
- First Department of Propeudeutic and Internal medicine, Laikon Hospital, Athens University Medical School, 115 27 Athens, Greece
| | - G Kitas
- Arthritis Research UK Epidemiology Unit, Manchester University, Manchester M13 9PL, UK
| | - J Schwitter
- Lausanne University Hospital, CHUV, CH-1011 Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, 1015 UniL, Switzerland.,Director CMR Center of the University Hospital Lausanne, CHUV, CH-1011 Lausanne, Switzerland
| | - J A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD 21287, USA
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43
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Lu C, Wang YG, Zaman F, Wu X, Adhaduk M, Chang A, Ji J, Wei T, Suksaranjit P, Christodoulidis G, Scalzetti E, Han Y, Feiglin D, Liu K. Predicting adverse cardiac events in sarcoidosis: deep learning from automated characterization of regional myocardial remodeling. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1825-1836. [PMID: 35194707 DOI: 10.1007/s10554-022-02564-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 02/11/2022] [Indexed: 12/11/2022]
Abstract
Recognizing early cardiac sarcoidosis (CS) imaging phenotypes can help identify opportunities for effective treatment before irreversible myocardial pathology occurs. We aimed to characterize regional CS myocardial remodeling features correlating with future adverse cardiac events by coupling automated image processing and data analysis on cardiac magnetic resonance (CMR) imaging datasets. A deep convolutional neural network (DCNN) was used to process a CMR database of a 10-year cohort of 117 consecutive biopsy-proven sarcoidosis patients. The maximum relevance - minimum redundancy method was used to select the best subset of all the features-24 (from manual processing) and 232 (from automated processing) left ventricular (LV) structural/functional features. Three machine learning (ML) algorithms, logistic regression (LogR), support vector machine (SVM) and multi-layer neural networks (MLP), were used to build classifiers to categorize endpoints. Over a median follow-up of 41.8 (inter-quartile range 20.4-60.5) months, 35 sarcoidosis patients experienced a total of 43 cardiac events. After manual processing, LV ejection fraction (LVEF), late gadolinium enhancement, abnormal segmental wall motion, LV mass (LVM), LVMI index (LVMI), septal wall thickness, lateral wall thickness, relative wall thickness, and wall thickness of 9 (out of 17) individual LV segments were significantly different between patients with and without endpoints. After automated processing, LVEF, end-diastolic volume, end-systolic volume, LV mass and wall thickness of 92 (out of 216) individual LV segments were significantly different between patients with and without endpoints. To achieve the best predictive performance, ML algorithms selected lateral wall thickness, abnormal segmental wall motion, septal wall thickness, and increased wall thickness of 3 individual segments after manual image processing, and selected end-diastolic volume and 7 individual segments after automated image processing. LogR, SVM and MLP based on automated image processing consistently showed better predictive accuracies than those based on manual image processing. Automated image processing with a DCNN improves data resolution and regional CS myocardial remodeling pattern recognition, suggesting that a framework coupling automated image processing with data analysis can help clinical risk stratification.
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Affiliation(s)
- Chenying Lu
- Departments of Medicine and Radiology, State University of New York, Upstate Medical University Hospital, Syracuse, USA
- Zhejiang Provincial Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Yi Grace Wang
- Department of Mathematics, California State University Dominguez Hills, Carson, USA
| | - Fahim Zaman
- Department of Electrical and Electronic Engineering, University of Iowa, Iowa City, USA
| | - Xiaodong Wu
- Department of Electrical and Electronic Engineering, University of Iowa, Iowa City, USA
| | - Mehul Adhaduk
- Division of Cardiology, Department of Medicine, University of Iowa, Iowa City, USA
| | - Amanda Chang
- Division of Cardiology, Department of Medicine, University of Iowa, Iowa City, USA
| | - Jiansong Ji
- Zhejiang Provincial Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Tiemin Wei
- Zhejiang Provincial Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Promporn Suksaranjit
- Division of Cardiology, Department of Medicine, University of Iowa, Iowa City, USA
| | | | - Ernest Scalzetti
- Departments of Medicine and Radiology, State University of New York, Upstate Medical University Hospital, Syracuse, USA
| | - Yuchi Han
- Cardiovascular Division, University of Pennsylvania, Philadelphia, USA
| | - David Feiglin
- Departments of Medicine and Radiology, State University of New York, Upstate Medical University Hospital, Syracuse, USA
| | - Kan Liu
- Departments of Medicine and Radiology, State University of New York, Upstate Medical University Hospital, Syracuse, USA.
- Division of Cardiology and Heart Vascular Center, University of Iowa, Iowa City, IA, 52242, USA.
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44
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Adverse Cardiac Events in Cardiac Sarcoidosis Prediction by 123I-betamethyl-p-iodophenyl-pentadecanoic Acid Single-Photon Emission Computed Tomography and Cardiac Magnetic Resonance Late Gadolinium Enhancement. Am J Cardiol 2022; 180:149-154. [DOI: 10.1016/j.amjcard.2022.06.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/26/2022] [Accepted: 06/06/2022] [Indexed: 11/21/2022]
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45
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Aitken M, Chan MV, Urzua Fresno C, Farrell A, Islam N, McInnes MDF, Iwanochko M, Balter M, Moayedi Y, Thavendiranathan P, Metser U, Veit-Haibach P, Hanneman K. Diagnostic Accuracy of Cardiac MRI versus FDG PET for Cardiac Sarcoidosis: A Systematic Review and Meta-Analysis. Radiology 2022; 304:566-579. [PMID: 35579526 DOI: 10.1148/radiol.213170] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background There is limited consensus regarding the relative diagnostic performance of cardiac MRI and fluorodeoxyglucose (FDG) PET for cardiac sarcoidosis. Purpose To perform a systematic review and meta-analysis to compare the diagnostic accuracy of cardiac MRI and FDG PET for cardiac sarcoidosis. Materials and Methods Medline, Ovid Epub, Cochrane Central Register of Controlled Trials, Embase, Emcare, and Scopus were searched from inception until January 2022. Inclusion criteria included studies that evaluated the diagnostic accuracy of cardiac MRI or FDG PET for cardiac sarcoidosis in adults. Data were independently extracted by two investigators. Summary accuracy metrics were obtained by using bivariate random-effects meta-analysis. Meta-regression was used to assess the effect of different covariates. Risk of bias was assessed using the Quality Assessment Tool for Diagnostic Accuracy Studies-2 tool. The study protocol was registered a priori in the International Prospective Register of Systematic Reviews (Prospero protocol CRD42021214776). Results Thirty-three studies were included (1997 patients, 687 with cardiac sarcoidosis); 17 studies evaluated cardiac MRI (1031 patients) and 26 evaluated FDG PET (1363 patients). Six studies directly compared cardiac MRI and PET in the same patients (303 patients). Cardiac MRI had higher sensitivity than FDG PET (95% vs 84%; P = .002), with no difference in specificity (85% vs 82%; P = .85). In a sensitivity analysis restricted to studies with direct comparison, point estimates were similar to those from the overall analysis: cardiac MRI and FDG PET had sensitivities of 92% and 81% and specificities of 72% and 82%, respectively. Covariate analysis demonstrated that sensitivity for FDG PET was highest with quantitative versus qualitative evaluation (93% vs 76%; P = .01), whereas sensitivity for MRI was highest with inclusion of T2 imaging (99% vs 88%; P = .001). Thirty studies were at risk of bias. Conclusion Cardiac MRI had higher sensitivity than fluorodeoxyglucose PET for diagnosis of cardiac sarcoidosis but similar specificity. Limitations, including risk of bias and few studies with direct comparison, necessitate additional study. © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Matthew Aitken
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Michael Vinchill Chan
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Camila Urzua Fresno
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Ashley Farrell
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Nayaar Islam
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Matthew D F McInnes
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Mark Iwanochko
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Meyer Balter
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Yasbanoo Moayedi
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Paaladinesh Thavendiranathan
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Ur Metser
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Patrick Veit-Haibach
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Kate Hanneman
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
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46
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Ohira H, Sato T, Manabe O, Oyama-Manabe N, Hayashishita A, Nakaya T, Nakamura J, Suzuki N, Sugimoto A, Furuya S, Tsuneta S, Watanabe T, Tsujino I, Konno S. Underdiagnosis of cardiac sarcoidosis by ECG and echocardiography in cases of extracardiac sarcoidosis. ERJ Open Res 2022; 8:00516-2021. [PMID: 35539437 PMCID: PMC9081545 DOI: 10.1183/23120541.00516-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 03/09/2022] [Indexed: 11/29/2022] Open
Abstract
Background Although screening with 12-lead electrocardiography and transthoracic echocardiography for cardiac involvement has been recommended for patients with biopsy-proven extracardiac sarcoidosis, cardiac sarcoidosis has been reported even in patients with normal electrocardiography and echocardiography findings. We investigated the prevalence and characteristics of these patient cohorts. Methods We studied 112 consecutive patients (age, 55±17 years, 64% females) with biopsy-proven extracardiac sarcoidosis who had undergone 18F-fluorodeoxyglucose positron emission tomography and cardiac magnetic resonance imaging for cardiac sarcoidosis evaluation. The patients were categorised as those showing normal findings both in electrocardiography and transthoracic echocardiography (normal group) and those showing abnormal findings in one or both examinations (abnormal group). Results 33 (29%) and 79 (71%) patients were categorised into the normal and abnormal groups, respectively, of which 6 (18%) and 43 (54%) patients, respectively, were diagnosed with cardiac sarcoidosis (p<0.01). Of these six patients in the normal group, two with multiple-organ sarcoidosis showed clinical deterioration of cardiac involvement and required steroid therapy; three with small cardiac involvement showed natural remission over follow-up assessments; and one underwent steroid therapy and showed an improvement in the left ventricular ejection fraction to within normal limits. Conclusions The prevalence of cardiac sarcoidosis in patients with biopsy-proven extracardiac sarcoidosis and normal electrocardiography and transthoracic echocardiography findings was ∼20%. Electrocardiography and transthoracic echocardiography may not detect cardiac sarcoidosis in patients without conduction and morphological abnormalities. However, some of these patients may subsequently show clinically manifested cardiac sarcoidosis. Physicians should be mindful of this population. ECG and transthoracic echocardiography may not detect cardiac sarcoidosis in patients without conduction and morphological abnormalities. Some of these patients may subsequently develop clinically manifested cardiac sarcoidosis.https://bit.ly/3qeQuff
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Affiliation(s)
- Hiroshi Ohira
- Dept of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Takahiro Sato
- Dept of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Osamu Manabe
- Dept of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan.,Dept of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Noriko Oyama-Manabe
- Dept of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan.,Dept of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Akiko Hayashishita
- Dept of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Toshitaka Nakaya
- Dept of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Junichi Nakamura
- Dept of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Naoko Suzuki
- Dept of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Ayako Sugimoto
- Dept of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Sho Furuya
- Dept of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Satonori Tsuneta
- Dept of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Taku Watanabe
- Dept of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Ichizo Tsujino
- Dept of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Satoshi Konno
- Dept of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
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47
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Chow KL, O'Donnell JL, Crozier I. Prevalence, incidence and survival outcomes of cardiac sarcoidosis in the South Island, New Zealand. Int J Cardiol 2022; 357:128-133. [PMID: 35395288 DOI: 10.1016/j.ijcard.2022.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/04/2022] [Accepted: 04/01/2022] [Indexed: 11/05/2022]
Abstract
AIMS Cardiac sarcoidosis (CS) is an important cause of mortality in patients with sarcoidosis. The aim of this retrospective cohort study was to characterize the prevalence, incidence, clinical features and outcomes of CS in the southern region of New Zealand. METHODS AND RESULTS 45 patients were identified: 23 fulfilling international classification criteria, 9 fulfilling physician consensus criteria, and 13 classified as possible CS. As of June 2021, 26 patients were living and domiciled in the Canterbury district; estimated point prevalence was 4.43 cases per 100,000 people. The average annual incidence was 0.24 cases per 100,000 people between 2016 and 2020. We estimated a 5.14% frequency of CS in patients with sarcoidosis. Median age at presentation was 56 years (range 31-72). Common presentations included heart failure, heart block and life threatening ventricular and supraventricular arrhythmias. Electrocardiogram abnormalities were found in 93.3% and cardiac MRI was often relied upon by physicians for diagnosis. The 10-year survival was 94% (95% CI 78-99%). CONCLUSION Our study provides further insight into the epidemiology of CS. In this retrospective cohort the frequency of CS amongst patients with sarcoidosis was estimated at 5%, whilst the estimated point prevalence of the disease was twice that of a contemporary report from the Northern hemisphere. The 10-year survival was similar to contemporaneous reports from other developed countries.
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Affiliation(s)
- Ke Li Chow
- Immunology Registrar, Department of Immunology, Canterbury Health Laboratories, Christchurch, New Zealand
| | - John Liston O'Donnell
- Consultant Immunologist, Immunopathologist and Head of Unit, Department of Immunology, Canterbury Health Laboratories, Christchurch, New Zealand.
| | - Ian Crozier
- Consultant Cardiologist, Department of Cardiology, Christchurch Hospital, Christchurch, New Zealand
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48
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Mathai SV, Patel S, Jorde UP, Rochlani Y. Epidemiology, Pathogenesis, and Diagnosis of Cardiac Sarcoidosis. Methodist Debakey Cardiovasc J 2022; 18:78-93. [PMID: 35414851 PMCID: PMC8932386 DOI: 10.14797/mdcvj.1057] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/07/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Sheetal V. Mathai
- Jacobi Medical Center and Albert Einstein College of Medicine, Bronx, New York, US
| | - Snehal Patel
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, US
| | - Ulrich P. Jorde
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, US
| | - Yogita Rochlani
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, US
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49
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Desbois A, Charpentier E, Chapelon C, Bergeret S, Badenco N, Redheuil A, Cacoub P, Saadoun D. Sarcoïdose cardiaque : stratégies diagnostiques et thérapeutiques actuelles. Rev Med Interne 2022; 43:212-224. [DOI: 10.1016/j.revmed.2021.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/22/2021] [Accepted: 08/01/2021] [Indexed: 11/26/2022]
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50
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Sève P, Jamilloux Y, Bert A, El Jammal T, Valeyre D. Qu’apportent les nouvelles recommandations sur le diagnostic et le traitement de la sarcoïdose ? Rev Med Interne 2022; 43:199-205. [DOI: 10.1016/j.revmed.2022.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/20/2022] [Indexed: 12/25/2022]
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