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Özütemiz C, Koksel Y, Froelich JW, Rubin N, Bhargava M, Roukoz H, Cogswell R, Markowitz J, Perlman DM, Steinberger D. The active papillary muscle sign in 18F-FDG PET/CT cardiac sarcoidosis exams and its relationship with myocardial suppression. Ann Nucl Med 2024; 38:391-399. [PMID: 38430406 DOI: 10.1007/s12149-024-01910-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/25/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVE Papillary muscle (PM) activity may demonstrate true active cardiac sarcoidosis (CS) or mimic CS in 18FDG-PET/CT if adequate myocardial suppression (MS) is not achieved. We aim to examine whether PM uptake can be used as a marker of failed MS and measure the rate of PM activity presence in active CS with different dietary preparations. MATERIALS AND METHODS We retrospectively reviewed PET/CTs obtained with three different dietary preparations. Diet-A: 24-h ketogenic diet with overnight fasting (n = 94); Diet-B: 18-h fasting (n = 44); and Diet-C: 72-h daytime ketogenic diet with 3-day overnight fasting (n = 98). Each case was evaluated regarding CS diagnosis (negative, positive, and indeterminant) and presence of PM activity. MaxSUV was measured from bloodpool, liver, and the most suppressed normal myocardium. Linear mixed-effects models were used to compare these factors between those with PM activity and those without. RESULTS PM activity was markedly lower in the Diet-C group compared with others: Diet-C: 6 (6.1%), Diet-A: 36 (38.3%), and Diet-B: 26 (59.1%) (p < 0.001). MyocardiumMaxSUV was higher, and MyocardiummaxSUV/BloodpoolmaxSUV, MyocardiummaxSUV/LivermaxSUV ratios were significantly higher in the cases with PM activity (p < 0.001). Among cases that used Diet-C and had PM activity, 66.7% were positive and 16.7% were indeterminate. If Diet-A or Diet-B was used, those with PM activity had a higher proportion of indeterminate cases (Diet-A: 61.1%, Diet-B: 61.5%) than positive cases (Diet-A: 36.1%, Diet-B: 38.5%). CONCLUSION Lack of PM activity can be a sign of appropriate MS. PM activity is less common with a specific dietary preparation (72-h daytime ketogenic diet with 3-day overnight fasting), and if it is present with this particular preparation, the likelihood that the case being true active CS might be higher than the other traditional dietary preparations.
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Affiliation(s)
- Can Özütemiz
- Department of Radiology, University of Minnesota, 420 Delaware St. SE, MMC 292, Minneapolis, MN, 55455, USA.
| | - Yasemin Koksel
- Department of Radiology, University of Minnesota, 420 Delaware St. SE, MMC 292, Minneapolis, MN, 55455, USA
| | - Jerry W Froelich
- Department of Radiology, University of Minnesota, 420 Delaware St. SE, MMC 292, Minneapolis, MN, 55455, USA
| | - Nathan Rubin
- Biostatistics Core, Masonic Cancer Center, University of Minnesota, 717 Delaware Street SE, Second Floor, Minneapolis, MN, 55414, USA
| | - Maneesh Bhargava
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, 420 Delaware Street SE, MMC 276, Minneapolis, MN, 55455, USA
| | - Henri Roukoz
- Department of Medicine, Division of Cardiovascular Medicine, University of Minnesota, 420 Delaware Street SE, MMC 508, Minneapolis, MN, 55455, USA
| | - Rebecca Cogswell
- Department of Medicine, Division of Cardiovascular Medicine, University of Minnesota, 420 Delaware Street SE, MMC 508, Minneapolis, MN, 55455, USA
| | - Jeremy Markowitz
- Department of Medicine, Division of Cardiovascular Medicine, University of Minnesota, 420 Delaware Street SE, MMC 508, Minneapolis, MN, 55455, USA
| | - David M Perlman
- Department of Medicine, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, 420 Delaware Street SE, MMC 276, Minneapolis, MN, 55455, USA
| | - Daniel Steinberger
- Department of Radiology, University of Minnesota, 420 Delaware St. SE, MMC 292, Minneapolis, MN, 55455, USA
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Musigk N, Suwalski P, Golpour A, Fairweather D, Klingel K, Martin P, Frustaci A, Cooper LT, Lüscher TF, Landmesser U, Heidecker B. The inflammatory spectrum of cardiomyopathies. Front Cardiovasc Med 2024; 11:1251780. [PMID: 38464847 PMCID: PMC10921946 DOI: 10.3389/fcvm.2024.1251780] [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: 07/02/2023] [Accepted: 01/29/2024] [Indexed: 03/12/2024] Open
Abstract
Infiltration of the myocardium with various cell types, cytokines and chemokines plays a crucial role in the pathogenesis of cardiomyopathies including inflammatory cardiomyopathies and myocarditis. A more comprehensive understanding of the precise immune mechanisms involved in acute and chronic myocarditis is essential to develop novel therapeutic approaches. This review offers a comprehensive overview of the current knowledge of the immune landscape in cardiomyopathies based on etiology. It identifies gaps in our knowledge about cardiac inflammation and emphasizes the need for new translational approaches to improve our understanding thus enabling development of novel early detection methods and more effective treatments.
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Affiliation(s)
- Nicolas Musigk
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
| | - Phillip Suwalski
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
| | - Ainoosh Golpour
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
| | - DeLisa Fairweather
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
- Department of Environmental Health Sciences and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Center for Clinical and Translational Science, Mayo Clinic, Rochester, MN, United States
| | - Karin Klingel
- Cardiopathology Institute for Pathology, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Pilar Martin
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Centro de Investigación Biomédica en Red Cardiovascular (CIBER-CV, ISCIII), Madrid, Spain
| | | | - Leslie T. Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Thomas F. Lüscher
- GZO-Zurich Regional Health Centre, Wetzikon & Cardioimmunology, Centre for Molecular Cardiology, University of Zurich, Zurich, Switzerland
- Royal Brompton & Harefield Hospitals and National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Ulf Landmesser
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
| | - Bettina Heidecker
- Deutsches Herzzentrum der Charité, Department of Cardiology, Angiology and Intensive Care Medicine, Berlin, Germany
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3
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Wasef M, Guha K. A novel combination of filamin C mutation and cardiorespiratory sarcoidosis in a patient with left ventricular systolic dysfunction. BMJ Case Rep 2024; 17:e257482. [PMID: 38167413 PMCID: PMC10773316 DOI: 10.1136/bcr-2023-257482] [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: 01/05/2024] Open
Abstract
Cardiac sarcoidosis is an unpredictable, rare and potentially lethal condition whereby patients are exposed to sudden cardiac death. However, despite sophisticated imaging techniques and the need for careful multidisciplinary team assessment and management, the contribution from genetic mutations is uncertain. Hence, the case describes a novel observation of a patient who possessed both a filamin C mutation and cardiac sarcoidosis. The case highlights the need for detailed dedicated investigation and highlights the need for the consideration of genetic screening within patients with cardiac sarcoidosis.
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Affiliation(s)
- Mohammad Wasef
- Cardiology, Portsmouth Hospitals University Hospital NHS Trust, Portsmouth, Hampshire, UK
| | - Kaushik Guha
- Cardiology, Portsmouth Hospitals University NHS Trust, Portsmouth, Hampshire, UK
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4
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Casipit BA, Lo KB, Casipit CG, Idowu A, Amanullah A. Impact of comorbid heart failure among hospitalized patients with sarcoidosis: A United States population-based cohort study. IJC HEART & VASCULATURE 2023; 49:101275. [PMID: 37822667 PMCID: PMC10562780 DOI: 10.1016/j.ijcha.2023.101275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/05/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023]
Abstract
Background There is paucity of data regarding the impact of concomitant heart failure (HF) on the in-hospital outcomes among hospitalized sarcoidosis patients. We aim to investigate the factors associated with concomitant HF and its impact on in-hospital outcomes among hospitalized sarcoidosis patients. Methods We utilized the 2018-2020 National Inpatient Sample (NIS) Database in conducting this study. Multivariable logistic and linear regression models were used to examine the factors associated with HF and hospital-associated outcomes among patients with sarcoidosis. Results A total of 36,864 hospitalized patients with sarcoidosis were identified, of which 24.78 % (n = 9135/36,864) had concomitant HF. Factors associated with concomitant HF were age (aOR 1.03; 95 % CI: 1.02-1.03, p value ≤ 0.001), black race (aOR 1.74; 95 % CI: 1.47-2.05, p value ≤ 0.001), not being female (aOR 0.79; 95 % CI: 0.69-0.91, p value ≤ 0.001), and arrhythmias (aOR 2.50; 95 % CI: 2.10-2.98, p value ≤ 0.001) specifically atrial fibrillation and ventricular tachycardia. Comorbidities associated with concomitant HF in this population were hyperlipidemia, obesity, coronary artery disease, cardiac device implantation history, and chronic kidney disease stage 1-4. Concomitant HF was not an independent predictor of in-hospital mortality or length of stay (LOS). However, age (aOR 1.04; 95 % CI, 1.03-1.06; p ≤ 0.001) and arrhythmia burden (aOR 2.08; 95 % CI, 1.47-2.95; p ≤ 0.001), specifically ventricular tachycardia and fibrillation, were independently associated with in-hospital mortality among sarcoidosis patients. Conclusion Traditional cardiovascular risk factors were associated with concomitant HF among hospitalized sarcoidosis patients. Moreover, concomitant HF among sarcoidosis patients was not significantly associated with in-hospital mortality or LOS.
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Affiliation(s)
- Bruce Adrian Casipit
- Department of Medicine, Einstein Medical Center Philadelphia, Philadelphia, PA, United States
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Kevin Bryan Lo
- Department of Medicine, Einstein Medical Center Philadelphia, Philadelphia, PA, United States
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | | | - Abdiodun Idowu
- Department of Medicine, Einstein Medical Center Philadelphia, Philadelphia, PA, United States
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Aman Amanullah
- Department of Cardiovascular Disease, Einstein Medical Center Philadelphia, Philadelphia, PA, United States
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
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Chauveau B, Taton B, Pfirmann P. A Patient with Lymphadenopathy, Hypercalcemia, and Kidney Injury. KIDNEY360 2023; 4:e1341-e1342. [PMID: 37332104 PMCID: PMC10547216 DOI: 10.34067/kid.0000000000000176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 04/20/2023] [Indexed: 06/20/2023]
Affiliation(s)
- Bertrand Chauveau
- CHU de Bordeaux, Service de Pathologie, Hôpital Pellegrin, Bordeaux, France
- ImmunoConcEpT, CNRS, Université de Bordeaux, UMR 5164, Bordeaux, France
| | - Benjamin Taton
- CHU de Bordeaux, Service de Néphrologie-Transplantation-Dialyse-Aphérèses, Hôpital Pellegrin, Bordeaux, France
| | - Pierre Pfirmann
- CHU de Bordeaux, Service de Néphrologie-Transplantation-Dialyse-Aphérèses, Hôpital Pellegrin, Bordeaux, France
- Maison du rein – AURAD aquitaine, Gradignan, France
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6
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Jolobe OM. High-risk and low prevalence disease: Cardiac sarcoidosis and some of its mimics. IJC HEART & VASCULATURE 2023; 47:101221. [PMID: 37252195 PMCID: PMC10209807 DOI: 10.1016/j.ijcha.2023.101221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/11/2023] [Accepted: 05/11/2023] [Indexed: 05/31/2023]
Abstract
In this narrative review of cardiac sarcoidosis, based on a literature search using the terms "cardiac sarcoidosis", "tuberculous myocarditis", "Whipple's disease and myocarditis", and"idiopathic giant cell myocarditis", I have defined cardiac sarcoidosis as a disorder which can be diagnosed either by documentation of the presence of sarcoid-related granulomas in myocardial tissue or by documentation of the association of the presence of sarcoid-related granulomas in extracardiac tissue and symptoms such as complete heart block, ventricular tachyarrhythmia, sudden death or dilated cardiomyopathy which are typical of cardiac sarcoidosis. The differential diagnosis of cardiac sarcoidosis includes granulomatous myocarditis attributable to underlying causes such as such as tuberculosis, Whipple's disease, and idiopathic giant cell myocarditis. Diagnostic pathways for cardiac sarcoidosis include biopsy of cardiac and extracardiac tissue, nuclear magnetic resonance imaging, positron emission tomography, and a diagnostic trial of empiric therapy. Problem areas include differentiation between noncaseating granulomatosis attributable to sarcoidosis versus noncaseating granulomatosis attributable to tuberculosis and whether or not the workup of suspected cardiac sarcoidosis should always include evaluation of biopsy tissue by molecular methods for M tuberculosis DNA as well as by mycobacterium tuberculosis culture. The diagnostic significance of necrotising granulomatosis is also unclear. Evaluation of patients on long term immunotherapy should also take due account of the risk of tuberculosis attributable to the use of tumor necrosis factor-alpha antagonists.
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Affiliation(s)
- Oscar M.P. Jolobe
- Address: Flat 6 Souchay Court, 1 Clothorn Road, Manchester M20 6BR, United Kingdom.
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Patel R, Mistry AM, Mulukutla V, Prajapati K. Cardiac Sarcoidosis: A Literature Review of Current Recommendations on Diagnosis and Management. Cureus 2023; 15:e41451. [PMID: 37546036 PMCID: PMC10404059 DOI: 10.7759/cureus.41451] [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: 07/06/2023] [Indexed: 08/08/2023] Open
Abstract
Cardiac sarcoidosis (CS) is a rare multisystem disorder characterized by granulomatous infiltration of the myocardium, which can lead to significant morbidity and mortality. Its clinical manifestations range from asymptomatic conduction abnormalities to severe heart failure (HF) and sudden cardiac death. This comprehensive review aims to provide an overview of the diagnosis, clinical features, and current medical management strategies for CS. Additionally, the role of implantable cardioverter-defibrillators (ICDs) and the potential use of positron emission tomography in guiding management decisions are explored. A comprehensive understanding of the medical management of CS is essential for improving patient outcomes and guiding future research endeavors.
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Affiliation(s)
- Rutul Patel
- Internal Medicine, Texas Tech University Health Sciences Center, El Paso, USA
| | - Anuja Mahesh Mistry
- Internal Medicine, Texas Tech University Health Sciences Center, El Paso, USA
| | | | - Krupal Prajapati
- Internal Medicine, Nathiba Hargovandas Lakhmichand (NHL) Municipal Medical College, Ahmedabad, IND
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8
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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: 0] [Impact Index Per Article: 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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9
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Antipushina DN, Zaitsev AA, Shakhnovich PG, Chernov SA, Kurbanov SI, Kazantsev DN. Cardiac sarcoidosis: is early diagnosis possible? Case report. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2023. [DOI: 10.15829/1728-8800-2022-3448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Cardiac involvement in sarcoidosis is difficult to diagnose due to the asymptomatic course in 95% of cases, the inaccessibility and low information content of a heart biopsy, the absence of pathological disorders in routine examination methods or their non-specificity. At the same time, it is cardiac sarcoidosis, along with damage to the nervous system, that is the main cause of mortality in sarcoidosis. Early diagnosis is of decisive importance for preventing complications associated with heart involvement and choosing the right treatment tactics. The positron emission tomography-computed tomography (PET-CT) is a method that can help the doctor in assessing the prevalence of sarcoidosis and verifying latent localizations in patients with a morphologically confirmed disease. The article describes a case of the use of PET/CT for the diagnosis of cardiac sarcoidosis.
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Affiliation(s)
- D. N. Antipushina
- National Medical Research Center for Therapy and Preventive Medicine
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10
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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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11
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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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12
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Taha A, Assaf O, Champsi A, Nadarajah R, Patel PA. Outcomes after transvenous defibrillator implantation in cardiac sarcoidosis: A systematic review. J Arrhythm 2022; 38:710-722. [PMID: 36237869 PMCID: PMC9535799 DOI: 10.1002/joa3.12753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 06/23/2022] [Accepted: 06/25/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Sarcoidosis is a systemic inflammatory disorder associated with ventricular arrhythmias (VAs) and sudden death in the context of cardiac involvement. Guidelines advocate implantable cardioverter‐defibrillator (ICD) implantation in specific subcohorts, but there is a paucity of data on outcomes. Methods and Results A systematic review was performed to assess outcomes in patients with definite or probable cardiac sarcoidosis (CS) treated with ICD. Observational studies were identified from multiple databases from inception to 21st May 2021. Outcomes of interest included appropriate and inappropriate ICD therapies in addition to all‐cause mortality. Study quality was assessed individually using the Newcastle Ottawa Scale (NOS). Eight studies were identified comprising 530 patients, with follow‐up period of 24–66 months (weighted average 40 months). Mean age was 53.9 years with ejection fraction of 41.3%. Overall incidence of appropriate therapy was 38.1% during follow‐up. Left ventricular systolic dysfunction (LVSD) with ejection fraction <40% was a predictor of appropriate therapy in the majority of studies, as were sustained VAs during electrophysiological testing (EP) in one study. There was no interaction with device indication (i.e. primary or secondary). Where documented, inappropriate therapy was primarily driven by atrial arrhythmias. All‐cause mortality was 6.0% over a median follow‐up period of 42 months. Only three studies achieved good quality in the comparability domain of NOS. Conclusions Appropriate ICD therapy in patients with CS is commonly associated with LVSD, which can act as a surrogate for scar burden. The utility of EP testing in this setting remains unclear.
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Affiliation(s)
- Ahmed Taha
- Department of Cardiology, Leeds General Infirmary Leeds UK
| | - Omar Assaf
- Department of Cardiology Blackpool Victoria Hospital Blackpool UK
| | - Asgher Champsi
- Department of Cardiology New Cross Hospital Wolverhampton UK
| | | | - Peysh A. Patel
- Department of Cardiology Queen Elizabeth Hospital Birmingham UK
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13
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Elwazir MY, Bird JG, AbouEzzeddine OF, Chareonthaitawee P, Blauwet LA, Collins JD, Gibbons RJ, Rodriguez-Porcel M, Kamal HM, Abdellah AT, Bois JP. Performance of cardiac PET/CT with and without phase analysis for detection of scar in cardiac sarcoidosis: Comparison to cardiac magnetic resonance imaging. J Nucl Cardiol 2022; 29:1389-1401. [PMID: 33474694 DOI: 10.1007/s12350-020-02473-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/16/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The presence of myocardial scar in CS patients results in poor prognosis and worse outcomes. 18F-fluorodeoxyglucose (18F-FDG) PET/CT excels at visualizing inflammation but is suboptimal at detecting scar. We evaluated PET/CT sensitivity to detect scar and investigated the incremental diagnostic value of automated PET-derived data. METHODS 176 patients who underwent cardiac magnetic resonance (CMR) and N-13 ammonia/18F-FDG cardiac PET/CT for suspected CS within 3 months were enrolled. Scar was defined as late gadolinium enhancement (LGE) on CMR without concordant 18F-FDG uptake on 18F-FDG PET/CT. Accuracy of cardiac PET/CT at detecting scar (perfusion defect without concordant 18F-FDG uptake) was assessed before and after addition of automated PET-derived data. RESULTS Sensitivity of PET/CT for scar detection was 45.3% (specificity 88.9%). Addition of PET-derived LV volumes and function in a logistic regression model improved sensitivity to 57.0% (specificity: 80.0%, AUC 0.72). Addition of phase analysis maximum segmental onset of myocardial contraction > 61 improved AUC to 0.75, correctly relabeling 16.3% of patients as scar (net reclassification index 8.2%). CONCLUSION Sensitivity of gated PET MPI alone for scar detection in CS is suboptimal. Adding PET-derived volumes/function and phase analysis data results in improved detection and characterization of scar.
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Affiliation(s)
- Mohamed Y Elwazir
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Cardiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Jared G Bird
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Omar F AbouEzzeddine
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | - Lori A Blauwet
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | - Raymond J Gibbons
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Martin Rodriguez-Porcel
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Hanan M Kamal
- Department of Cardiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Ahmed T Abdellah
- Department of Cardiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - John P Bois
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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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: 0] [Impact Index Per Article: 0] [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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15
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Kato S, Sakai Y, Okabe A, Kawashima Y, Kuwahara K, Shiogama K, Abe M, Ito H, Morimoto S. Histology of Cardiac Sarcoidosis with Novel Considerations Arranged upon a Pathologic Basis. J Clin Med 2022; 11:jcm11010251. [PMID: 35011991 PMCID: PMC8746035 DOI: 10.3390/jcm11010251] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/26/2021] [Accepted: 12/31/2021] [Indexed: 11/16/2022] Open
Abstract
Sarcoidosis is a rare disease of isolated or diffuse granulomatous inflammation. Although any organs can be affected by sarcoidosis, cardiac sarcoidosis is a fatal disorder, and it is crucial to accurately diagnose it to prevent sudden death due to dysrhythmia. Although endomyocardial biopsy is invasive and has limited sensitivity for identifying granulomas, it is the only modality that yields a definitive diagnosis of cardiac sarcoidosis. It is imperative to develop novel pathological approaches for the precise diagnosis of cardiac sarcoidosis. Here, we aimed to discuss commonly used diagnostic criteria for cardiac sarcoidosis and to summarize useful and novel histopathologic criteria of cardiac sarcoidosis. While classical histologic observations including noncaseating granulomas and multinucleated giant cells (typically Langhans type) are the most important findings, others such as microgranulomas, CD68+ CD163- pro-inflammatory (M1) macrophage accumulation, CD4/CD8 T-cell ratio, Cutibacterium acnes components, lymphangiogenesis, confluent fibrosis, and fatty infiltration may help to improve the sensitivity of endomyocardial biopsy for detecting cardiac sarcoidosis. These novel histologic findings are based on the pathology of cardiac sarcoidosis. We also discussed the principal histologic differential diagnoses of cardiac sarcoidosis, such as tuberculosis myocarditis, fungal myocarditis, giant cell myocarditis, and dilated cardiomyopathy.
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Affiliation(s)
- Shu Kato
- Postgraduate Clinical Training Center, Fujita Health University Hospital, Aichi 470-1192, Japan;
| | - Yasuhiro Sakai
- Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University School of Medicine, Aichi 470-1192, Japan;
- Correspondence: ; Tel.: +81-562-93-9934
| | - Asako Okabe
- Department of Diagnostic Pathology, Kansai Medical University Hospital, Osaka 573-1191, Japan;
| | - Yoshiaki Kawashima
- Department of Pathology, Fujita Health University Bantane Hospital, Aichi 454-8509, Japan;
| | - Kazuhiko Kuwahara
- Department of Diagnostic Pathology, Fujita Health University School of Medicine, Aichi 470-1192, Japan;
| | - Kazuya Shiogama
- Department of Morphology and Pathological Diagnosis, Fujita Health University School of Medical Sciences, Aichi 470-1192, Japan; (K.S.); (M.A.)
| | - Masato Abe
- Department of Morphology and Pathological Diagnosis, Fujita Health University School of Medical Sciences, Aichi 470-1192, Japan; (K.S.); (M.A.)
| | - Hiroyasu Ito
- Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University School of Medicine, Aichi 470-1192, Japan;
| | - Shin’ichiro Morimoto
- Department of Cardiology, Fujita Health University School of Medicine, Aichi 470-1192, Japan;
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16
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PET Imaging in Cardiac Sarcoidosis: A Narrative Review with Focus on Novel PET Tracers. Pharmaceuticals (Basel) 2021; 14:ph14121286. [PMID: 34959686 PMCID: PMC8704408 DOI: 10.3390/ph14121286] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 01/04/2023] Open
Abstract
Sarcoidosis is a multi-system inflammatory disease characterized by the development of inflammation and noncaseating granulomas that can involve nearly every organ system, with a predilection for the pulmonary system. Cardiac involvement of sarcoidosis (CS) occurs in up to 70% of cases, and accounts for a significant share of sarcoid-related mortality. The clinical presentation of CS can range from absence of symptoms to conduction abnormalities, heart failure, arrhythmias, valvular disease, and sudden cardiac death. Given the significant morbidity and mortality associated with CS, timely diagnosis is important. Traditional imaging modalities and histologic evaluation by endomyocardial biopsy often provide a low diagnostic yield. Cardiac positron emission tomography (PET) has emerged as a leading advanced imaging modality for the diagnosis and management of CS. This review article will summarize several aspects of the current use of PET in CS, including indications for use, patient preparation, image acquisition and interpretation, diagnostic and prognostic performance, and evaluation of treatment response. Additionally, this review will discuss novel PET radiotracers currently under study or of potential interest in CS.
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17
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Alba AC, Gupta S, Kugathasan L, Ha A, Ochoa A, Balter M, Sosa Liprandi A, Sosa Liprandi MI. Cardiac Sarcoidosis: A Clinical Overview. Curr Probl Cardiol 2021; 46:100936. [PMID: 34400001 DOI: 10.1016/j.cpcardiol.2021.100936] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 07/17/2021] [Indexed: 12/26/2022]
Abstract
Cardiac sarcoidosis (CS) with clinical manifestation occurs in about 5-8% of patients with sarcoidosis. CS may be clinically suspected by the presence of ventricular arrhythmia, conduction abnormalities, and heart failure (HF). However, 20%-25% of patients may present with silent CS, having asymptomatic cardiac involvement. The diagnosis of CS is based on findings from nuclear studies, cardiac magnetic resonance, and extra-cardiac tissue biopsy. Due to the inflammatory nature of the disease, immunosuppressive medications are a cornerstone of therapy. The treatment also includes recommended HF medical therapies. Since CS patients are at risk of sudden cardiac death resulting from progression of cardiac dysfunction or the presence of scar originating from fatal arrhythmias, implantable cardioverter-defibrillators should be considered, with special indication beyond accepted recommendations in HF. In CS, the extent of left ventricular dysfunction is the most important mortality predictor. Heart transplant or mechanical circulatory support may represent life saving strategies in selective CS patients.
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Affiliation(s)
- Ana Carolina Alba
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
| | - Shyla Gupta
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Lakshmi Kugathasan
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Andrew Ha
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Alejandro Ochoa
- Echocardiography, Cardioestudio, Clinica Las Vegas, Medellin, Colombia
| | - Meyer Balter
- Division of Respiratory Medicine, Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada
| | - Alvaro Sosa Liprandi
- Department of Cardiology and Heart Failure, Sanatorio Güemes, Buenos Aires, Argentina
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18
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Rapoport EA, Chidharla A, Mortoti SS. A case of cardiac sarcoidosis with concurrent myocardial ischemia. HeartRhythm Case Rep 2021; 7:479-483. [PMID: 34307035 PMCID: PMC8283541 DOI: 10.1016/j.hrcr.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Eliot A Rapoport
- University of Illinois College of Medicine Peoria, Peoria, Illinois
| | - Anusha Chidharla
- University of Illinois College of Medicine Peoria, Peoria, Illinois.,OSF St. Francis Medical Center, UICOMP, Peoria, Illinois
| | - Samuel S Mortoti
- University of Illinois College of Medicine Peoria, Peoria, Illinois.,OSF St. Francis Medical Center, UICOMP, Peoria, Illinois
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19
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Abstract
Sarcoidosis is a chronic multi-system disorder with an unknown etiology that can affect the cardiac tissue, resulting in Cardiac Sarcoidosis (CS). The majority of these CS cases are clinically silent, and when there are symptoms, the symptoms are vague and can have a lot in common with other common cardiac diseases. These symptoms can range from arrhythmias to heart failure. If CS goes undetected, it can lead to detrimental outcomes for patients. Diagnosis depends on timely utilization of imaging modalities and non-invasive testing, while in some cases, it does necessitate biopsy. Early diagnosis and treatment with immunosuppressive agents are crucial, and it is essential that follow-up testing be performed to ensure resolution and remission. This manuscript provides an in-depth review of CS and the current literature regarding CS diagnosis and treatment.
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20
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Abstract
Cardiac sarcoidosis (CS) is a complex disease that can manifest as a diverse array of arrhythmias. CS patients may be at higher risk for sudden cardiac death (SCD), and, in some cases, SCD may be the first presenting symptom of the underlying disease. As such, identification, risk stratification, and management of CS-related arrhythmia are crucial in the care of these patients. Left untreated, CS carries significant arrhythmogenic morbidity and mortality. Cardiac manifestations of CS are a consequence of an inflammatory process resulting in the myocardial deposition of noncaseating granulomas. Endomyocardial biopsy remains the gold standard for diagnosis; however, biopsy yield is limited by the patchy distribution of the granulomas. As such, recent guidelines have improved clinical diagnostic pathways relying on advanced cardiac imaging to help in the diagnosis of CS. To date, corticosteroids are the best studied agent to treat CS but are associated with significant risks and limited benefits. Implantable cardioverter-defibrillators have an important role in SCD risk reduction. Catheter ablation in conjunction with antiarrhythmics seems to reduce ventricular arrhythmia burden. However, the appropriate selection of these patients is crucial as ablation is likely more helpful in the setting of a myocardial scar substrate versus arrhythmia driven by active inflammation. Further studies investigating CS pathophysiology, the pathway to diagnosis, arrhythmogenic manifestations, and SCD risk stratification will be crucial to reduce the high morbidity and mortality of this disease.
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Affiliation(s)
| | - Michael I Gurin
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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21
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Gajawada P, Cetinkaya A, von Gerlach S, Kubin N, Burger H, Näbauer M, Grinninger C, Rolf A, Schönburg M, Choi YH, Kubin T, Richter M. Myocardial Accumulations of Reg3A, Reg3γ and Oncostatin M Are Associated with the Formation of Granulomata in Patients with Cardiac Sarcoidosis. Int J Mol Sci 2021; 22:ijms22084148. [PMID: 33923774 PMCID: PMC8072627 DOI: 10.3390/ijms22084148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/24/2021] [Accepted: 04/10/2021] [Indexed: 12/13/2022] Open
Abstract
Cardiac sarcoidosis (CS) is a poorly understood disease and is characterized by the focal accumulation of immune cells, thus leading to the formation of granulomata (GL). To identify the developmental principles of fatal GL, fluorescence microscopy and Western blot analysis of CS and control patients is presented here. CS is visualized macroscopically by positron emission tomography (PET)/ computed tomography (CT). A battery of antibodies is used to determine structural, cell cycle and inflammatory markers. GL consist of CD68+, CD163+ and CD206+ macrophages surrounded by T-cells within fibrotic areas. Cell cycle markers such as phospho-histone H3, phospho-Aurora and Ki67 were moderately present; however, the phosphorylated ERM (ezrin, radixin and moesin) and Erk1/2 proteins, strong expression of the myosin motor protein and the macrophage transcription factor PU.1 indicate highly active GL. Mild apoptosis is consistent with PI3 kinase and Akt activation. Massive amounts of the IL-1R antagonist reflect a mild activation of stress and inflammatory pathways in GL. High levels of oncostatin M and the Reg3A and Reg3γ chemokines are in accordance with macrophage accumulation in areas of remodeling cardiomyocytes. We conclude that the formation of GL occurs mainly through chemoattraction and less by proliferation of macrophages. Furthermore, activation of the oncostatin/Reg3 axis might help at first to wall-off substances but might initiate the chronic development of heart failure.
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Affiliation(s)
- Praveen Gajawada
- Department of Cardiac Surgery, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany; (P.G.); (A.C.); (N.K.); (H.B.); (M.S.)
| | - Ayse Cetinkaya
- Department of Cardiac Surgery, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany; (P.G.); (A.C.); (N.K.); (H.B.); (M.S.)
- Campus Kerckhoff, Justus-Liebig-University Giessen, 61231 Bad Nauheim, Germany;
| | - Susanne von Gerlach
- Universitätsklinikum Giessen und Marburg GmbH, Standort Marburg, Baldingerstr., 35033 Marburg, Germany;
| | - Natalia Kubin
- Department of Cardiac Surgery, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany; (P.G.); (A.C.); (N.K.); (H.B.); (M.S.)
| | - Heiko Burger
- Department of Cardiac Surgery, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany; (P.G.); (A.C.); (N.K.); (H.B.); (M.S.)
- Campus Kerckhoff, Justus-Liebig-University Giessen, 61231 Bad Nauheim, Germany;
| | - Michael Näbauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistr. 15, 81377 Munich, Germany; (M.N.); (C.G.)
| | - Carola Grinninger
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistr. 15, 81377 Munich, Germany; (M.N.); (C.G.)
| | - Andreas Rolf
- Campus Kerckhoff, Justus-Liebig-University Giessen, 61231 Bad Nauheim, Germany;
- Department of Cardiology, Kerckhoff Heart and Lung Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany
| | - Markus Schönburg
- Department of Cardiac Surgery, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany; (P.G.); (A.C.); (N.K.); (H.B.); (M.S.)
- Campus Kerckhoff, Justus-Liebig-University Giessen, 61231 Bad Nauheim, Germany;
| | - Yeong-Hoon Choi
- Department of Cardiac Surgery, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany; (P.G.); (A.C.); (N.K.); (H.B.); (M.S.)
- Campus Kerckhoff, Justus-Liebig-University Giessen, 61231 Bad Nauheim, Germany;
- German Center for Cardiovascular Research (DZHK), Partner Site RhineMain, 60549 Frankfurt/Main, Germany
- Correspondence: (Y.-H.C.); (T.K.); (M.R.)
| | - Thomas Kubin
- Department of Cardiac Surgery, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany; (P.G.); (A.C.); (N.K.); (H.B.); (M.S.)
- Correspondence: (Y.-H.C.); (T.K.); (M.R.)
| | - Manfred Richter
- Department of Cardiac Surgery, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany; (P.G.); (A.C.); (N.K.); (H.B.); (M.S.)
- Campus Kerckhoff, Justus-Liebig-University Giessen, 61231 Bad Nauheim, Germany;
- Correspondence: (Y.-H.C.); (T.K.); (M.R.)
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22
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Advanced Nuclear Medicine and Molecular Imaging in the Diagnosis of Cardiomyopathy. AJR Am J Roentgenol 2020; 215:1208-1217. [PMID: 32901569 DOI: 10.2214/ajr.20.22790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE. The purpose of this article is to summarize the protocol, interpretation, and diagnostic performance of nuclear medicine and molecular imaging in imaging two distinctive, underdiagnosed cardiomyopathies: cardiac amyloidosis and cardiac sarcoidosis. CONCLUSION. Emerging new radiotracers and advanced molecular imaging modalities enable us to noninvasively characterize certain types of cardiomyopathies, including cardiac amyloidosis and cardiac sarcoidosis, with great confidence. We expect to improve recognition and promote the application of such advanced techniques in the imaging and management of these potentially lethal cardiomyopathies.
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23
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Okasha O, Kazmirczak F, Chen KHA, Farzaneh-Far A, Shenoy C. Myocardial Involvement in Patients With Histologically Diagnosed Cardiac Sarcoidosis: A Systematic Review and Meta-Analysis of Gross Pathological Images From Autopsy or Cardiac Transplantation Cases. J Am Heart Assoc 2020; 8:e011253. [PMID: 31070111 PMCID: PMC6585321 DOI: 10.1161/jaha.118.011253] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background In patients with suspected cardiac sarcoidosis, late gadolinium enhancement on cardiovascular magnetic resonance imaging and/or 18F‐fluorodeoxyglucose uptake on positron emission tomography are often used to reach a clinical diagnosis of cardiac sarcoidosis. On the basis of data from the imaging literature of clinical cardiac sarcoidosis, no specific features of myocardial involvement are regarded as pathognomonic for cardiac sarcoidosis. Thus, a diagnosis of cardiac sarcoidosis is challenging to make. There has been no systematic analysis of histologically diagnosed cardiac sarcoidosis for patterns of myocardial involvement. We hypothesized that certain patterns of myocardial involvement are more frequent in histologically diagnosed cardiac sarcoidosis. Methods and Results We performed a systematic review and meta‐analysis of gross pathological images from the published literature of patients with histologically diagnosed cardiac sarcoidosis who underwent autopsy or cardiac transplantation. Thirty‐three eligible articles provided images of 49 unique hearts. Analysis of these hearts revealed certain features of myocardial involvement in >90% of cases: left ventricular (LV) subepicardial, LV multifocal, septal, and right ventricular free wall involvement. In contrast, other patterns were seen in 0% to 6% of cases: absence of gross LV myocardial involvement, isolated LV midmyocardial involvement, isolated LV subendocardial involvement, isolated LV transmural involvement, absence of septal involvement, or isolated involvement of only one LV level. Conclusions In this systematic review and meta‐analysis of histologically diagnosed cardiac sarcoidosis, we identified certain features of myocardial involvement that occurred frequently and others that occurred rarely or never. These patterns could aid the interpretation of cardiovascular magnetic resonance imaging and positron emission tomography imaging and improve the diagnosis and the prognostication of patients with suspected cardiac sarcoidosis. See Editorial Patel et al
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Affiliation(s)
- Osama Okasha
- 1 Cardiovascular Division Department of Medicine University of Minnesota Medical School Minneapolis MN
| | - Felipe Kazmirczak
- 1 Cardiovascular Division Department of Medicine University of Minnesota Medical School Minneapolis MN
| | - Ko-Hsuan Amy Chen
- 1 Cardiovascular Division Department of Medicine University of Minnesota Medical School Minneapolis MN
| | - Afshin Farzaneh-Far
- 2 Section of Cardiology Department of Medicine University of Illinois at Chicago Chicago IL
| | - Chetan Shenoy
- 1 Cardiovascular Division Department of Medicine University of Minnesota Medical School Minneapolis MN
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24
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Cha MJ, Seo JW, Oh S, Park EA, Lee SH, Kim MY, Park JY. Indirect pathological indicators for cardiac sarcoidosis on endomyocardial biopsy. J Pathol Transl Med 2020; 54:396-410. [PMID: 32717775 PMCID: PMC7483025 DOI: 10.4132/jptm.2020.06.10] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/10/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The definitive pathologic diagnosis of cardiac sarcoidosis requires observation of a granuloma in the myocardial tissue. It is common, however, to receive a "negative" report for a clinically probable case. We would like to advise pathologists and clinicians on how to interpret "negative" biopsies. METHODS Our study samples were 27 endomyocardial biopsies from 25 patients, three cardiac transplantation and an autopsied heart with suspected cardiac sarcoidosis. Pathologic, radiologic, and clinical features were compared. RESULTS The presence of micro-granulomas or increased histiocytic infiltration was always (6/6 or 100%) associated with fatty infiltration and confluent fibrosis, and they showed radiological features of sarcoidosis. Three of five cases (60%) with fatty change and confluent fibrosis were probable for cardiac sarcoidosis on radiology. When either confluent fibrosis or fatty change was present, one-third (3/9) were radiologically probable for cardiac sarcoidosis. We interpreted cases with micro-granuloma as positive for cardiac sarcoidosis (five of 25, 20%). Cases with both confluent fibrosis and fatty change were interpreted as probable for cardiac sarcoidosis (seven of 25, 28%). Another 13 cases, including eight cases with either confluent fibrosis or fatty change, were interpreted as low probability based on endomyocardial biopsy. CONCLUSIONS The presence of micro-granuloma could be an evidence for positive diagnosis of cardiac sarcoidosis. Presence of both confluent fibrosis and fatty change is necessary for probable cardiac sarcoidosis in the absence of granuloma. Either of confluent fibrosis or fatty change may be an indirect pathological evidence but they are interpreted as nonspecific findings.
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Affiliation(s)
- Myung-Jin Cha
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jeong-Wook Seo
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Seil Oh
- Department of Internal Medicine and Interdisciplinary Program for Bioengineering, Seoul National University College of Medicine, Seoul, Korea.,Cardiology Division, Cardiovascular Center, and Cardiac Electrophysiology Lab, Seoul National University Hospital, Seoul, Korea
| | - Eun-Ah Park
- Division of Cardiovascular Imaging, Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Sang-Han Lee
- Department of Forensic Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.,Department of Pathology, Kyungpook National University Hospital, Daegu, Korea
| | - Moon Young Kim
- Department of Radiology, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jae-Young Park
- Department of Pathology, Sejong Hospital, Bucheon, Korea
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25
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Ricci F, Mantini C, Grigoratos C, Bianco F, Bucciarelli V, Tana C, Mastrodicasa D, Caulo M, Donato Aquaro G, Raffaele Cotroneo A, Gallina S. The Multi-modality Cardiac Imaging Approach to Cardiac Sarcoidosis. Curr Med Imaging 2020; 15:10-20. [PMID: 31964322 DOI: 10.2174/1573405614666180522074320] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Revised: 09/03/2017] [Accepted: 04/07/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Sarcoidosis is a multisystem granulomatous disease with a neglected but high prevalence of life-threatening cardiac involvement. DISCUSSION The clinical presentation of Cardiac Sarcoidosis (CS) depends upon the location and extent of the granulomatous inflammation, with left ventricular free wall the most common location followed by interventricular septum. The lack of a diagnostic gold standard and the unpredictable risk of sudden cardiac death pose serious challenges for the validation of accurate and effective screening test and the management of the disease. In the last few years advanced cardiac imaging modalities such as Cardiac Magnetic Resonance (CMR) and Positron Emission Tomography (PET) have significantly improved our knowledge and understanding of CS, and have also contributed in risk stratification, assessment of inflammatory activity and therapeutic monitoring of the disease. CONCLUSION In this review, we will discuss the state of the art in the diagnosis of CS focusing on the role and importance of multi-modality cardiac imaging.
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Affiliation(s)
- Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, School of Advanced Studies, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, Section of Diagnostic Imaging and Therapy, Radiology Division, Italy
| | | | - Francesco Bianco
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Cardiology, Italy
| | - Valentina Bucciarelli
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Cardiology, Italy
| | - Claudio Tana
- Internal Medicine and Critical Subacute Care Unit, Medicine Geriatric-Rehabilitation Department, University-Hospital of Parma, Parma, Italy
| | - Domenico Mastrodicasa
- Department of Neuroscience, Imaging and Clinical Sciences, Section of Diagnostic Imaging and Therapy, Radiology Division, Italy
| | - Massimo Caulo
- Department of Neuroscience, Imaging and Clinical Sciences, Section of Diagnostic Imaging and Therapy, Radiology Division, Italy
| | | | - Antonio Raffaele Cotroneo
- Department of Neuroscience, Imaging and Clinical Sciences, Section of Diagnostic Imaging and Therapy, Radiology Division, Italy
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Cardiology, Italy
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26
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Ekström K, Räisänen-Sokolowski A, Lehtonen J, Nordenswan HK, Mäyränpää MI, Kupari M. Idiopathic giant cell myocarditis or cardiac sarcoidosis? A retrospective audit of a nationwide case series. ESC Heart Fail 2020; 7:1362-1370. [PMID: 32343481 PMCID: PMC7261562 DOI: 10.1002/ehf2.12725] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/26/2020] [Accepted: 04/01/2020] [Indexed: 12/19/2022] Open
Abstract
Aims Cardiac sarcoidosis (CS) and giant cell myocarditis (GCM) are inflammatory cardiomyopathies sharing histopathological and clinical features. Their differentiation is difficult and susceptible of confusion and apparent mistakes. The possibility that they represent different phenotypes of a single disease has been debated. Methods and results We made a retrospective audit of 73 cases of GCM diagnosed in Finland since the late 1980s. All available histological material was reanalyzed as were other examinations pertinent to the distinction between GCM and CS. Finding granulomas in or outside the heart was considered diagnostic of CS and exclusive of GCM. Altogether 45 of the 73 cases of GCM (62%) were reclassified as CS. In all except one case, this was based on finding sarcoid granulomas that either had been originally missed (n = 29) or misinterpreted (n = 11) or were found in additional posttransplant myocardial specimens (n = 3) or samples of extracardiac tissue (n = 1) accrued over the disease course. Supporting the reclassification, patients relocated to the CS group had less heart failure at presentation (prevalence 20% vs. 46%, P = 0.017) and better 1 year transplant‐free survival (82% vs. 45%, P = 0.011) than patients considered to represent true GCM. Conclusions Recognizing granulomas in or outside the heart remains a challenge for the pathologist. Given that CS and GCM are considered distinct diseases and granulomas exclusive of GCM, many cases of GCM, if thoroughly scrutinized, may need reclassification as CS. However, whether CS and GCM are truly different entities or parts of a one‐disease continuum has not yet been conclusively settled.
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Affiliation(s)
- Kaj Ekström
- Heart and Lung Center, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Anne Räisänen-Sokolowski
- Department of Pathology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Jukka Lehtonen
- Heart and Lung Center, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Hanna-Kaisa Nordenswan
- Heart and Lung Center, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Mikko I Mäyränpää
- Department of Pathology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Markku Kupari
- Heart and Lung Center, Helsinki University and Helsinki University Hospital, Helsinki, Finland
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27
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Smedema JP, Ainslie G, Crijns HJGM. Review: Contrast-enhanced magnetic resonance in the diagnosis and management of cardiac sarcoidosis. Prog Cardiovasc Dis 2020; 63:271-307. [PMID: 32330463 DOI: 10.1016/j.pcad.2020.03.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 03/22/2020] [Indexed: 01/14/2023]
Abstract
Sarcoidosis is a relatively rare inflammatory condition which potentially carries high morbidity and substantial mortality. Due to the fact that it does not subject patients to ionizing radiation, has high temporal, spatial and contrast resolutions, cardiovascular magnetic resonance imaging (CMR) has become an important diagnostic and prognostic modality in the evaluation for cardiac involvement in this condition. This review provides relevant clinical and pathophysiological background on cardiac sarcoidosis, whilst detailing the role of CMR imaging in the diagnosis, and management of this condition.
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Affiliation(s)
| | - Gillian Ainslie
- Respiratory Clinic, Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa.
| | - Harry J G M Crijns
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands.
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28
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Abstract
OBJECTIVES The objective of this study was to review and illustrate the sometimes diagnostically challenging features of cardiac sarcoidosis. We emphasize variable phenotypes presented at explant and biopsy evaluation and review literature regarding ancillary clinical and pathologic studies to enhance diagnostic accuracy. METHODS A literature review was performed and two cardiac sarcoidosis cases were illustrated. RESULTS Our cases and literature review demonstrate the pathologic spectrum of cardiac sarcoidosis. Irregular left ventricular free wall involvement is most common, followed by the interventricular septum and right ventricle. Although granulomas are often composed of tight epithelioid macrophage aggregates, early granulomas comprise loosely associated macrophages with lymphocyte predominance. Chronic disease leads to fibrosis and end-stage heart failure. Sampling errors and variable histology cause low endomyocardial biopsy sensitivity. CONCLUSIONS Current guidelines use clinical, radiologic, and immunohistologic criteria for diagnosing cardiac sarcoidosis. Knowledge of these guidelines will assist pathologists in making accurate diagnosis of this disease.
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Affiliation(s)
- Virian D Serei
- Department of Pathology and Laboratory Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Billie Fyfe
- Department of Pathology and Laboratory Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ
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29
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Terasaki F, Azuma A, Anzai T, Ishizaka N, Ishida Y, Isobe M, Inomata T, Ishibashi-Ueda H, Eishi Y, Kitakaze M, Kusano K, Sakata Y, Shijubo N, Tsuchida A, Tsutsui H, Nakajima T, Nakatani S, Horii T, Yazaki Y, Yamaguchi E, Yamaguchi T, Ide T, Okamura H, Kato Y, Goya M, Sakakibara M, Soejima K, Nagai T, Nakamura H, Noda T, Hasegawa T, Morita H, Ohe T, Kihara Y, Saito Y, Sugiyama Y, Morimoto SI, Yamashina A. JCS 2016 Guideline on Diagnosis and Treatment of Cardiac Sarcoidosis - Digest Version. Circ J 2019; 83:2329-2388. [PMID: 31597819 DOI: 10.1253/circj.cj-19-0508] [Citation(s) in RCA: 199] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Fumio Terasaki
- Medical Education Center / Department of Cardiology, Osaka Medical College
| | - Arata Azuma
- Department of Pulmonary Medicine, Nippon Medical School
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Nobukazu Ishizaka
- Department of Internal Medicine (III) / Department of Cardiology, Osaka Medical College
| | - Yoshio Ishida
- Department of Internal Medicine, Kaizuka City Hospital
| | - Mitsuaki Isobe
- Department of Cardiovascular Medicine, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University
| | - Takayuki Inomata
- Department of Cardiology, Kitasato University Kitasato Institute Hospital
| | | | - Yoshinobu Eishi
- Department of Human Pathology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University
| | - Masafumi Kitakaze
- Department of Clinical Medicine and Development, National Cerebral and Cardiovascular Center
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | | | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Takatomo Nakajima
- Division of Cardiology, Saitama Cardiovascular and Respiratory Center
| | - Satoshi Nakatani
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School of Medicine
| | - Taiko Horii
- Department of Cardiovascular Surgery, Kagawa University School of Medicine
| | | | - Etsuro Yamaguchi
- Department of Respiratory Medicine and Allergology, Aichi Medical University School of Medicine
| | | | - Tomomi Ide
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
| | - Hideo Okamura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Masahiko Goya
- Department of Cardiology, Tokyo Medical and Dental University
| | - Mamoru Sakakibara
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Kyoko Soejima
- Department of Cardiology, Kyorin University Faculty of Medicine
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takuya Hasegawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Tohru Ohe
- Department of Cardiology, Sakakibara Heart Institute of Okayama
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Yoshihiko Saito
- Department of Cardiorenal Medicine and Metabolic Disease, Nara Medical University
| | - Yukihiko Sugiyama
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University
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30
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Ramirez R, Trivieri M, Fayad ZA, Ahmadi A, Narula J, Argulian E. Advanced Imaging in Cardiac Sarcoidosis. J Nucl Med 2019; 60:892-898. [PMID: 31171594 DOI: 10.2967/jnumed.119.228130] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 06/03/2019] [Indexed: 12/14/2022] Open
Abstract
Sarcoidosis is a chronic disease of unknown etiology characterized by the presence of noncaseating granulomas. Cardiac involvement in sarcoidosis may lead to adverse outcomes such as advanced heart block, arrhythmias, cardiomyopathy, or death. Cardiac sarcoidosis can occur in patients with established sarcoidosis, or it can be the sole manifestation of the disease. Traditional diagnostic techniques, including echocardiography, have poor sensitivity for diagnosing cardiac sarcoidosis. The accumulating evidence supports the essential role of advanced cardiac imaging modalities such as MRI and PET in diagnosis, risk stratification, and management of patients with cardiac sarcoidosis. The current review highlights important theoretic and practical aspects of using cardiac imaging tools in the evaluation of patients with suspected or established cardiac sarcoidosis.
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Affiliation(s)
- Roberto Ramirez
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Maria Trivieri
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Zahi A Fayad
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Amir Ahmadi
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jagat Narula
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Edgar Argulian
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
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31
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Chareonthaitawee P, Beanlands RS, Chen W, Dorbala S, Miller EJ, Murthy VL, Birnie DH, Chen ES, Cooper LT, Tung RH, White ES, Borges-Neto S, Di Carli MF, Gropler RJ, Ruddy TD, Schindler TH, Blankstein R. Joint SNMMI-ASNC Expert Consensus Document on the Role of 18F-FDG PET/CT in Cardiac Sarcoid Detection and Therapy Monitoring. J Nucl Med 2018; 58:1341-1353. [PMID: 28765228 DOI: 10.2967/jnumed.117.196287] [Citation(s) in RCA: 145] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 05/18/2017] [Indexed: 12/16/2022] Open
Affiliation(s)
| | - Rob S Beanlands
- Division of Cardiology, Department of Medicine,University of Ottawa Heart Institute, Ottawa, Canada
| | - Wengen Chen
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Sharmila Dorbala
- Division of Nuclear Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Edward J Miller
- Section of Cardiovascular Medicine, Yale University, New Haven, Connecticut
| | - Venkatesh L Murthy
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - David H Birnie
- Division of Cardiology, Department of Medicine,University of Ottawa Heart Institute, Ottawa, Canada
| | - Edward S Chen
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Leslie T Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida
| | - Roderick H Tung
- Division of Cardiology, University of Chicago Medicine, Chicago, Illinois
| | - Eric S White
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.,Division of Pulmonary Medicine, University of Michigan, Ann Arbor, Michigan
| | - Salvador Borges-Neto
- Department of Radiology and Nuclear Medicine, Duke University, Durham, North Carolina; and
| | - Marcelo F Di Carli
- Division of Nuclear Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Robert J Gropler
- Department of Radiology, Mallinckrodt Institute of Radiology, St. Louis, Missouri
| | - Terrence D Ruddy
- Division of Cardiology, Department of Medicine,University of Ottawa Heart Institute, Ottawa, Canada
| | | | - Ron Blankstein
- Division of Nuclear Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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32
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Kiko T, Yoshihisa A, Kanno Y, Yokokawa T, Abe S, Miyata-Tatsumi M, Misaka T, Oikawa M, Kobayashi A, Ishida T, Takeishi Y. A Multiple Biomarker Approach in Patients with Cardiac Sarcoidosis. Int Heart J 2018; 59:996-1001. [PMID: 30101857 DOI: 10.1536/ihj.17-695] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Sarcoidosis is a systemic granulomatous disease including heart (cardiac sarcoidosis, CS). It has recently been reported that isolated CS, which presenting primarily cardiac symptoms without clinical evidence of sarcoid involvement in other organs. Diagnostic and prognostic biomarkers of CS, especially in isolated CS, have not yet been established.We studied plasma levels of angiotensin-converting enzyme (ACE), soluble interleukin-2 receptor (sIL-2R), B-type natriuretic peptide (BNP) and cardiac troponin I (cTnI) in consecutive 172 patients with diagnosed sarcoidosis. We compared these markers between non-cardiac sarcoidosis (non-CS, n = 123, 71.5%) and CS patients (n = 49, 28.5%), including non-isolated CS (n = 30, 17.4%) and isolated CS (n = 19, 11.1%). ROC analysis revealed that BNP identified CS with AUC of 0.85 (P < 0.01) in sarcoidosis patients. In addition, ACE and sIL-2R levels were significantly higher in non-isolated CS than in isolated CS (P < 0.05). Furthermore, in the Cox proportional hazard analysis, cTnI, but not ACE, IL2R or BNP, was a predictor of fatal arrhythmia in sarcoidosis patients (HR 2.418, P = 0.003).Higher ACE and sIL2-R are associated with systemic lesions, whereas BNP is a useful marker for detecting cardiac involvement in sarcoidosis patients. cTnI is a predictor of fatal arrhythmia in CS patients. A multiple biomarker approach supports comprehensive management of sarcoidosis.
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Affiliation(s)
- Takatoyo Kiko
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University.,Department of Advanced Cardiac Therapeutics, Fukushima Medical University
| | - Yuki Kanno
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Tetsuro Yokokawa
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Satoshi Abe
- Department of Cardiovascular Medicine, Fukushima Medical University
| | | | - Tomofumi Misaka
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Masayoshi Oikawa
- Department of Cardiovascular Medicine, Fukushima Medical University
| | | | - Takafumi Ishida
- Department of Cardiovascular Medicine, Fukushima Medical University
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33
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Fowler MR, Mambo NC. A Case of Severe Cardiac Sarcoidosis with Minimal Pulmonary Involvement: A Case Report with Literature Review. Acad Forensic Pathol 2018; 8:407-415. [PMID: 31240050 DOI: 10.1177/1925362118782082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 04/16/2018] [Indexed: 12/18/2022]
Abstract
Sarcoidosis is a granulomatous disease of unknown etiology. Although sarcoidosis is a systemic disease, there appears to be a predilection for involvement of certain organs. The pulmonary system is the most commonly affected system among all racial groups. Cardiac and respiratory complications are the leading causes of death due to sarcoidosis and in certain patient populations about half of these deaths are attributed to cardiac sarcoidosis. There are few autopsy case reports of cardiac sarcoidosis with minimal respiratory involvement making this case report relevant to the importance of the recognition and awareness of this entity. Acad Forensic Pathol. 2018 8(2): 407-415.
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34
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Patel B, Shah M, Gelaye A, Dusaj R. A complete heart block in a young male: a case report and review of literature of cardiac sarcoidosis. Heart Fail Rev 2018; 22:55-64. [PMID: 27817119 DOI: 10.1007/s10741-016-9585-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Cardiac sarcoidosis is one of the uncommon causes of heart failure. Generally, it presents in the form of varying clinical manifestations ranging from asymptomatic to fatal arrhythmias such as ventricular tachycardia and complete heart block. It is difficult to make a diagnosis strictly based on clinical grounds. However, in the setting of extracardiac sarcoidosis and patients presenting with advanced heart block or ventricular arrhythmia, direct cardiac involvement should be suspected. The definitive diagnosis of cardiac sarcoidosis can be made from endomyocardial biopsy, but it is falling out of favor due to patchy myocardial involvement, considerable procedure-related risks, and advancement in additional imaging modalities. Once cardiac sarcoidosis has been diagnosed, management of the disease remains challenging. Steroids are considered the mainstay of therapy, and implantable cardioverter defibrillator therapy can be considered in a selected group of patients at greater risk for malignant ventricular arrhythmias.
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Affiliation(s)
- Brijesh Patel
- Department of Cardiology, Lehigh Valley Hospital, Allentown, PA, USA.
| | - Mahek Shah
- Department of Cardiology, Lehigh Valley Hospital, Allentown, PA, USA
| | - Alehegn Gelaye
- Department of Pulmonary and Critical Care, Providence-Providence Park Hospital, Southfield, MI, USA
| | - Raman Dusaj
- Department of Cardiology, Lehigh Valley Hospital, Allentown, PA, USA
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35
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Forotan H, Rowe MK, Korczyk D, Kaye G. Cardiac Sarcoidosis, Left Ventricular Impairment and Chronic Right Ventricular Pacing: Pacing or Pathology? Heart Lung Circ 2017; 26:1175-1182. [DOI: 10.1016/j.hlc.2017.03.167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 03/30/2017] [Indexed: 10/19/2022]
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36
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Chareonthaitawee P, Beanlands RS, Chen W, Dorbala S, Miller EJ, Murthy VL, Birnie DH, Chen ES, Cooper LT, Tung RH, White ES, Borges-Neto S, Di Carli MF, Gropler RJ, Ruddy TD, Schindler TH, Blankstein R. Joint SNMMI-ASNC expert consensus document on the role of 18F-FDG PET/CT in cardiac sarcoid detection and therapy monitoring. J Nucl Cardiol 2017; 24:1741-1758. [PMID: 28770463 DOI: 10.1007/s12350-017-0978-9] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | - Rob S Beanlands
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Wengen Chen
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sharmila Dorbala
- Division of Nuclear Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Edward J Miller
- Section of Cardiovascular Medicine, Yale University, New Haven, CT, USA
| | - Venkatesh L Murthy
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - David H Birnie
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Edward S Chen
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Leslie T Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Roderick H Tung
- Division of Cardiology, University of Chicago Medicine, Chicago, IL, USA
| | - Eric S White
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
- Division of Pulmonary Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Marcelo F Di Carli
- Division of Nuclear Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Robert J Gropler
- Department of Radiology, Mallinckrodt Institute of Radiology, St. Louis, MO, USA
| | - Terrence D Ruddy
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | | | - Ron Blankstein
- Division of Nuclear Medicine, Brigham and Women's Hospital, Boston, MA, USA
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37
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Abstract
Giant cell myocarditis (GCM) is a rapidly progressive and frequently fatal disease that mainly affects young to middle-aged previously healthy individuals. Early diagnosis is critical, as recent studies have shown that rapidly instituted cyclosporine-based immunosuppression can reduce inflammation and improve transplant-free survival. Before the 1980s, GCM was mainly a diagnosis made at autopsy. Owing to advancements in diagnostic and therapeutic options, it is now increasingly diagnosed on the basis of endomyocardial biopsies, explanted hearts, or apical wedge sections removed at the time of ventricular assist device placement. Histologic examination remains the gold standard for diagnosis; however, there are many possible etiologies for cardiac giant cells. Having a working knowledge of the clinicopathologic features that distinguish GCM from other giant cell-containing lesions is essential, since such lesions can have widely divergent management and outcome.
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Affiliation(s)
- Jin Xu
- From the Department of Pathology and Laboratory Medicine, University of Wisconsin Hospital and Clinics, Madison
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38
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Ishibashi-Ueda H, Matsuyama TA, Ohta-Ogo K, Ikeda Y. Significance and Value of Endomyocardial Biopsy Based on Our Own Experience. Circ J 2017; 81:417-426. [DOI: 10.1253/circj.cj-16-0927] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Keiko Ohta-Ogo
- Department of Pathology, National Cerebral and Cardiovascular Center
| | - Yoshihiko Ikeda
- Department of Pathology, National Cerebral and Cardiovascular Center
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39
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Regional myocardial damage and active inflammation in patients with cardiac sarcoidosis detected by non-invasive multi-modal imaging. Ann Nucl Med 2016; 31:135-143. [PMID: 27804054 DOI: 10.1007/s12149-016-1136-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 10/26/2016] [Indexed: 10/20/2022]
Abstract
AIMS Cardiac sarcoidosis (CS) can be diagnosed using 18F-FDG-PET/CT (PET), cardiovascular magnetic resonance (CMR), and 123I-BMIPP/201TlCl dual myocardial SPECT. This study aims to clarify the relationships among the three modalities with respect to CS. METHODS AND RESULTS We evaluated 16 patients (male n = 11; age 55 ± 13 years) with confirmed CS who underwent PET, CMR, and dual SPECT with gated SPECT before starting steroid therapy. The left ventricular myocardium was divided into 17 segments to obtain SUVmax for PET images, defect scores from 0 to 4 (0 normal; 4 absent), and mismatch scores for dual SPECT (BMDS, TLDS, and MS) images and late gadolinium enhancement (LGE) scores (0 none; 1 partly positive; 2 homogeneous) on CMR images. Summed BMDS, TLDS, and MS were 18.6 ± 12.6, 12.9 ± 10.9, and 5.7 ± 3.1, respectively. The segmental BMDS and TLDS scores became significantly higher as the LGE scores increased. The MS scores were significantly higher in areas of LGE with a score of 1 than 0 (both, p < 0.001), but did not significantly differ between areas with LGE scores of 1 and 2. The SUVmax was significantly higher in LGE areas with a score of 1 than 0 (p < 0.025), but did not significantly differ between those with scores of 1 or 2. CONCLUSION Regions with a higher SUVmax indicating active myocardial inflammation were mainly located in areas with LGE, where BMIPP and TL mismatches were evident in patients with CS.
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40
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Sampson B, Hammers J. Forensic Aspects of Cardiovascular Pathology. Cardiovasc Pathol 2016. [DOI: 10.1016/b978-0-12-420219-1.00020-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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41
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Siqueira WC, da Cruz SG, Asimaki A, Saffitz JE, Moreira MDCV, Brasileiro G, Rocha LOS. Cardiac sarcoidosis with severe involvement of the right ventricle: a case report. AUTOPSY AND CASE REPORTS 2015; 5:53-63. [PMID: 26894046 PMCID: PMC4757920 DOI: 10.4322/acr.2015.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 11/30/2015] [Indexed: 11/23/2022] Open
Abstract
We present the case of a patient who underwent cardiac transplantation with the diagnosis of idiopathic dilated cardiomyopathy. Once the explanted heart was examined, a type of granulomatous myocarditis compatible with cardiac sarcoidosis was observed. However, there was severe involvement of the right ventricle, with markedly reduced width of the muscular layer and extensive fibrofatty replacement, findings similar to the ones encountered in cases of arrhythmogenic right ventricular cardiomyopathy (ARVC). Confocal immunofluorescence analysis revealed a reduced signal for plakoglobin and desmoplakin at the cardiac intercalated disks. The immunoreactive signal for desmin showed the typical sarcomeric distribution but not a concentrated signal at the intercalated disks, a pattern previously seen in an 11-year-old girl with Carvajal syndrome bearing a C-terminal truncating mutation in the desmoplakin gene. This case illustrates the difficult and challenging work involved in performing a differential diagnosis among idiopathic dilated cardiomyopathy, isolated cardiac sarcoidosis, and ARVC, all of which are clinical entities known to masquerade as one another.
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Affiliation(s)
- Weverton César Siqueira
- Internal Medicine Department - Faculty of Medicine - Federal University of Minas Gerais, Belo Horizonte/MG - Brazil
| | - Samuel Gonçalves da Cruz
- Internal Medicine Department - Faculty of Medicine - Federal University of Minas Gerais, Belo Horizonte/MG - Brazil
| | - Angeliki Asimaki
- Department of Pathology - Beth Israel Deaconess Medical Center - Harvard Medical School, Boston/MA - USA
| | - Jeffrey Ern Saffitz
- Department of Pathology - Beth Israel Deaconess Medical Center - Harvard Medical School, Boston/MA - USA
| | | | - Geraldo Brasileiro
- Pathology and Forensic Department - Faculty of Medicine - Federal University of Minas Gerais, Belo Horizonte/MG - Brazil
| | - Luiz Otávio Savassi Rocha
- Internal Medicine Department - Faculty of Medicine - Federal University of Minas Gerais, Belo Horizonte/MG - Brazil
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42
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Abstract
Sarcoidosis is a chronic multisystem disorder without any defined etiology. Cardiac sarcoidosis (CS) is detected in 2-7% of patients with sarcoidosis and more than 20% of the cases of sarcoidosis are clinically silent. Cardiac involvement in systemic sarcoidosis (SS) and isolated cardiac sarcoidosis (iCS) are associated with arrhythmia and severe heart failure (HF) and have a poor prognosis. Early diagnosis of CS and prompt initiation of corticosteroid therapy with or without other immunosuppressants is crucial. Electrocardiography, Holter monitoring, and Doppler echocardiography with speckle tracking imaging can serve as the initial steps to diagnosis of CS. Cardiac magnetic resonance (CMR) imaging and positron emission tomography (PET) are promising techniques for both diagnosis and follow-up of CS. This review discusses the main aspects of cardiac involvement in sarcoidosis.
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Affiliation(s)
- Emrah Ipek
- Department of Cardiology, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Selami Demirelli
- Department of Cardiology, Erzurum Education and Research Hospital, Erzurum, Turkey
- Address correspondence to: Dr. Selami Demirelli, Department of Cardiology, Erzurum Education and Research Hospital, Erzurum, Turkey. E-mail:
| | - Emrah Ermis
- Department of Cardiology, Erzurum Education and Research Hospital, Erzurum, Turkey
| | - Sinan Inci
- Department of Cardiology, Aksaray State Hospital, Aksaray, Turkey
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43
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Vasaturo S, Ploeg DE, Buitrago G, Zeppenfeld K, Veselic-Charvat M, Kroft LJM. Right ventricular cardiomyopathy meeting the arrhythmogenic right ventricular dysplasia revised criteria? Don't forget sarcoidosis! Korean J Radiol 2015; 16:668-72. [PMID: 25995699 PMCID: PMC4435999 DOI: 10.3348/kjr.2015.16.3.668] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 01/12/2015] [Indexed: 11/30/2022] Open
Abstract
A 53-year-old woman was referred for ventricular fibrillation with resuscitation. A CT-angiography showed signs of a right ventricular enlargement without obvious cause. A cardiac MRI demonstrated a dilated and hypokinetic right ventricle with extensive late gadolinium enhancement. Arrhythmogenic right ventricular dysplasia (ARVD) was suspected according to the "revised ARVD task force criteria". An endomyocardial biopsy was inconclusive. The patient developed purulent pericarditis after epicardial ablation therapy and died of toxic shock syndrome. The post-mortem pathologic examination demonstrated sarcoidosis involving the heart, lungs, and thyroid gland.
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Affiliation(s)
- Sabina Vasaturo
- Department of Radiology, Leiden University Medical Center, Leiden 2333 ZA, The Netherlands
| | - David E Ploeg
- Department of Pathology, Leiden University Medical Center, Leiden 2333 ZA, The Netherlands
| | - Guadalupe Buitrago
- Department of Radiology, Hospital General Universitario Gregorio Maranon, Madrid 28007, Spain
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Leiden 2333 ZA, The Netherlands
| | - Maud Veselic-Charvat
- Department of Pathology, Leiden University Medical Center, Leiden 2333 ZA, The Netherlands
| | - Lucia J M Kroft
- Department of Radiology, Leiden University Medical Center, Leiden 2333 ZA, The Netherlands
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44
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Wicks EC, Menezes LJ, Elliott PM. Improving the diagnostic accuracy for detecting cardiac sarcoidosis. Expert Rev Cardiovasc Ther 2015; 13:223-36. [DOI: 10.1586/14779072.2015.1001367] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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45
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Kanaroglou S, Nair V, Fernandes JR. Sudden cardiac death due to coronary artery dissection as a complication of cardiac sarcoidosis. Cardiovasc Pathol 2015; 24:244-6. [PMID: 25638512 DOI: 10.1016/j.carpath.2015.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 12/31/2014] [Accepted: 01/01/2015] [Indexed: 12/16/2022] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS), cardiac tamponade and sudden cardiac death that typically affects young women in the postpartum period. Rarely, it can be caused by systemic inflammatory conditions such as sarcoidosis. Sarcoidosis is an inflammatory disease most often affecting the lung and lymph nodes that can sometimes affect the heart. The authors report a case of sudden cardiac death caused by SCAD in the context of undiagnosed and subclinical cardiac sarcoidosis. The decedent was a 47-year-old male with a relatively innocuous past medical history. He was found dead in bed. At autopsy, there was a lethal hemopericardium resulting in cardiac tamponade. Gross examination of the heart revealed dissection of the posterior descending coronary branch of the right coronary artery. Histologically, the coronary artery showed acute and organizing dissection with evidence of vasculitis. A chronic inflammatory infiltrate consisting of lymphocytes, histiocytes, eosinophils and giant cells was seen. Sections of the myocardium showed myocarditis with a nonnecrotizing granuloma. The death was attributed to cardiac tamponade secondary to SCAD in the context of systemic sarcoidosis. The presented case demonstrates two concurrent rare pathologies and highlights the importance of considering SCAD in cases of sudden cardiac death at autopsy.
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Affiliation(s)
- Savas Kanaroglou
- Hamilton Centre for Kidney Research, St. Joseph's Hospital, Hamilton, Ontario, Canada L8N 4A6.
| | - Vidhya Nair
- Hamilton General Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada L8L2X2; Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada L8N3ZS.
| | - John R Fernandes
- Hamilton General Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada L8L2X2; Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada L8N3ZS.
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Isobe M, Tezuka D. Isolated cardiac sarcoidosis: clinical characteristics, diagnosis and treatment. Int J Cardiol 2014; 182:132-40. [PMID: 25577749 DOI: 10.1016/j.ijcard.2014.12.056] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 11/12/2014] [Accepted: 12/21/2014] [Indexed: 02/07/2023]
Abstract
Sarcoidosis is a systemic disease characterized by the development of noncaseating epithelioid granulomas in multiple organs. Despite extensive investigations over a long period of time, the etiology of this disease remains unknown. Cardiac involvement of this disease is the most ominous complication leading to fatal outcome. Recently, attention has been focused on isolated cardiac sarcoidosis, which exists without clinically apparent sarcoidosis elsewhere. One of the critical issues of isolated cardiac sarcoidosis is difficulty in diagnosis, since existence of the cardiac lesion should be detected from cardiac manifestations alone. Because specificity of biomarkers or sensitivity of histological examination of biopsied sample is very low, diagnosis of isolated cardiac sarcoidosis mainly depends on imaging modalities. In this review article we summarized current knowledge on the pathogenesis of sarcoidosis, clinical features of cardiac sarcoidosis especially that isolated to the heart by showing some typical cases. Utilities and problems of diagnostic imaging tests for this condition including echocardiography, cardiac magnetic resonance imaging, and fluorodeoxyglucose-positron emission tomography are discussed. Advances in pharmacological and nonpharmacological treatment for cardiac sarcoidosis have improved the prognosis of cardiac sarcoidosis to a great deal; however, there are many issues that remain to be solved in the management of isolated cardiac sarcoidosis.
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Affiliation(s)
- Mitsuaki Isobe
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan.
| | - Daisuke Tezuka
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan
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Roberts WC, Chung MS, Ko JM, Capehart JE, Hall SA. Morphologic features of cardiac sarcoidosis in native hearts of patients having cardiac transplantation. Am J Cardiol 2014; 113:706-12. [PMID: 24393258 DOI: 10.1016/j.amjcard.2013.11.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 11/09/2013] [Accepted: 11/09/2013] [Indexed: 11/27/2022]
Abstract
Described herein are 10 patients who underwent cardiac transplantation (CT) for severe chronic systolic heart failure resulting from cardiac sarcoidosis. None had the diagnosis of sarcoidosis established before CT except for the 3 patients who earlier had had a portion of left ventricular wall excised for insertion of a left ventricular assist device and non-caseating granulomas were present in the removed myocardium. Although none of the 10 patients had significant narrowing of any of the epicardial coronary arteries, all had focal scarring of the walls of the left and right ventricles and ventricular septum and all had dilated ventricular cavities. The patients with the most ventricular wall scarring tended to have the fewest sarcoid granulomas in the ventricular walls. Two patients had no sarcoid granulomas in the excised heart although one did have typical sarcoid granulomas in the portion of left ventricular wall excised to insert a left ventricular assist device. Patients with cardiac sarcoidosis severe enough to warrant CT had characteristic cardiac ventricular morphologic findings, and no dysfunction of other non-cardiac organs, making clinical diagnosis of cardiac sarcoidosis rather difficult.
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Ermakov S, Hoffmayer KS, Gerstenfeld EP, Scheinman MM. Combination drug therapy for patients with intractable ventricular tachycardia associated with right ventricular cardiomyopathy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 37:90-4. [PMID: 24102153 DOI: 10.1111/pace.12250] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 07/09/2013] [Accepted: 07/09/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND Drug therapy for patients with right ventricular (RV) cardiomyopathy refractory to single-drug therapy and ablation has not been well defined. METHODS We reviewed our entire RV cardiomyopathy database (31 patients) and found four patients presenting with ventricular arrhythmias of RV origin refractory to single-drug therapy. These patients underwent complete evaluation for arrhythmogenic right ventricular cardiomyopathy (ARVC). RESULTS Following the revised 2010 task force criteria, of these four patients, three were diagnosed with ARVC, and one with cardiac sarcoidosis. These patients proved to be refractory to drug monotherapy and either failed or deemed to not be candidates for endocardial ablation. Their arrhythmias were ultimately controlled with combinations of sotalol, flecainide, and mexiletine. CONCLUSIONS In our experience, combination drug therapy is an effective treatment strategy for patients with ventricular tachycardia refractory to monotherapy and, in some cases, ablation. In addition, flecainide appears to be safe and effective for those with RV cardiomyopathy without significant left ventricular dysfunction.
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Affiliation(s)
- Simon Ermakov
- Cardiovascular Division, Department of Medicine, University of California San Francisco, San Francisco, California
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Yang Y, Safka K, Graham JJ, Roifman I, Zia MI, Wright GA, Balter M, Dick AJ, Connelly KA. Correlation of late gadolinium enhancement MRI and quantitative T2 measurement in cardiac sarcoidosis. J Magn Reson Imaging 2013; 39:609-16. [PMID: 23720077 DOI: 10.1002/jmri.24196] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 04/05/2013] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To investigate the potentially improved detection and quantification of cardiac involvement using novel late-gadolinium-enhancement (LGE) cardiac magnetic resonance imaging (MRI) and quantitative T2 measurement to achieve better myocardial tissue characterization in systemic sarcoidosis. MATERIALS AND METHODS Twenty-eight patients with systemic sarcoidosis underwent a cardiac magnetic resonance imaging (CMR) study on a 1.5T system. Precontrast CMR included left ventricular (LV) and right ventricular (RV) function and quantitative T2 measurement. Postcontrast LGE-MRI included inversion-recovery fast-gradient-echo (IR-FGRE) and multicontrast late-enhancement imaging (MCLE). RESULTS LV functional parameters were normal in all patients (LVEF=61.2±8.5%) including with cardiac involvement (LVEF=59.4±12.1%) and without (LVEF=61.7±7.5%) while the average RV function was comparatively decreased (RVEF=48.0±6.6%, P<0.0001). 21.4% of patients had cardiac involvement showing patchy or multiple focal hyperenhancement patterns in LV free wall, papillary muscles (PM), or interventricular septum. In two cases with PM involvement, the PM abnormal LGE foci were only observed on MCLE. For precontrast T2 measurements, a significantly decreased T2 measurement was observed in regions demonstrating LGE, compared to the LGE-negative group (focal LGE-positive regions vs. negative: 40.0±2.4 msec vs. 53.0±2.6 msec, P<0.0001). CONCLUSION LGE-MRI can identify cardiac involvement in systemic sarcoidosis. MCLE might be more sensitive at detecting subtle myocardial lesion. The decreased T2 observed in cardiac sarcoid may reflect its inactive phase, thus might provide a noninvasive method for monitoring disease activity or therapy.
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Affiliation(s)
- Yuesong Yang
- Imaging Research and Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Diffuse diseases of the myocardium: MRI-pathologic review of cardiomyopathies with dilatation. AJR Am J Roentgenol 2013; 200:W274-82. [PMID: 23436872 DOI: 10.2214/ajr.12.9634] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE In this radiologic-pathologic review of the cardiomyopathies, we present the pertinent imaging findings of diffuse myocardial diseases that are associated with ventricular dilatation, including ischemic cardiomyopathy, nonischemic dilated cardiomyopathy, cardiac sarcoidosis, and iron overload cardiomyopathy. CONCLUSION Correlation of the key radiologic findings with gross and microscopic pathologic features is presented, to provide the reader with a focused and in-depth review of the pathophysiology underlying each entity and the basis for the corresponding imaging characteristics.
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