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Lemay S, Massot M, Philippon F, Belzile D, Turgeon PY, Beaudoin J, Laliberté C, Fortin S, Dion G, Milot J, Trottier M, Gosselin J, Charbonneau É, Birnie DH, Sénéchal M. Ten Questions Cardiologists Should Be Able to Answer About Cardiac Sarcoidosis: Case-Based Approach and Contemporary Review. CJC Open 2021; 3:532-548. [PMID: 34027358 PMCID: PMC8129447 DOI: 10.1016/j.cjco.2020.11.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/24/2020] [Indexed: 12/17/2022] Open
Abstract
Sarcoidosis is an inflammatory multisystemic disease of unknown etiology characterized by the formation of noncaseating epithelioid cell granulomas. Cardiac sarcoidosis might be life-threatening and its diagnosis and treatment remain a challenge nowadays. The aim of this review is to provide an updated overview of cardiac sarcoidosis and, through 10 practical clinical questions and real-life challenging case scenarios, summarize the main clinical presentation, diagnostic criteria, imaging findings, and contemporary treatment.
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Affiliation(s)
- Sylvain Lemay
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec City, Québec, Canada
| | - Montse Massot
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec City, Québec, Canada
| | - François Philippon
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec City, Québec, Canada
| | - David Belzile
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec City, Québec, Canada
| | - Pierre Yves Turgeon
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec City, Québec, Canada
| | - Jonathan Beaudoin
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec City, Québec, Canada
| | - Claudine Laliberté
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec City, Québec, Canada
| | - Sophie Fortin
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec City, Québec, Canada
| | - Geneviève Dion
- Department of Pneumology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec City, Québec, Canada
| | - Julie Milot
- Department of Pneumology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec City, Québec, Canada
| | - Mikaël Trottier
- Department of Nuclear Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec City, Québec, Canada
| | - Justin Gosselin
- Department of Internal Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec City, Québec, Canada
| | - Éric Charbonneau
- Department of Cardiac Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec City, Québec, Canada
| | - David H. Birnie
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Mario Sénéchal
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec City, Québec, Canada
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Orii M, Tanimoto T, Ota S, Takagi H, Tanaka R, Fujiwara J, Akasaka T, Yoshioka K. Diagnostic accuracy of cardiac magnetic resonance imaging for cardiac sarcoidosis in complete heart block patients implanted with magnetic resonance-conditional pacemaker. J Cardiol 2020; 76:191-7. [PMID: 32184028 DOI: 10.1016/j.jjcc.2020.02.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 01/19/2020] [Accepted: 02/09/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) imaging has become the principal noninvasive imaging modality for the diagnosis of cardiac sarcoidosis (CS) patients. This study aimed to determine the diagnostic performance of CMR imaging for CS in new-onset complete heart block (CHB) patients implanted with magnetic resonance-conditional pacemaker (MRCP). METHODS Fifty CHB patients implanted with MRCP were enrolled in this study. Clinical CS was diagnosed if there was a histological diagnosis of extra-cardiac sarcoidosis in patients with CHB based on the consensus statement; clinical CS was the reference standard. The diagnostic performance of CMR sequences, including cine magnetic resonance imaging (MRI), increased T2-weighted signal (T2WS), and late gadolinium enhancement (LGE), for clinical CS was investigated. We also compared the diagnostic performance of CMR sequences between the entire left ventricle (LV) and the basal septum, which involves the electrical pathway of atrioventricular conduction. RESULTS In total, 8 of the 50 patients with CHB were confirmed to have extra-cardiac sarcoidosis and were diagnosed with clinical CS. The accuracy, sensitivity, and specificity of LGE in the basal septum and entire LV were 94%, 100%, and 93% and 80% (p = 0.023), 100% (p = 1.00), and 76% (p = 0.023), respectively. The accuracy, sensitivity, and specificity of increased T2WS and cine MRI in the basal septum were 94%, 75%, and 98% and 90%, 38%, and 100%, respectively. There was no statistical difference between the entire LV and the basal septum for the diagnostic performance of increased T2WS and cine MRI. CONCLUSIONS CMR can be a diagnostic tool for evaluating clinical CS in patients with CHB implanted with MRCP. LGE in the basal septum might provide the overall best diagnostic performance for clinical CS with CHB.
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Sano M, Satoh H, Suwa K, Saotome M, Urushida T, Katoh H, Hayashi H, Saitoh T. Intra-cardiac distribution of late gadolinium enhancement in cardiac sarcoidosis and dilated cardiomyopathy. World J Cardiol 2016; 8:496-503. [PMID: 27721933 PMCID: PMC5037324 DOI: 10.4330/wjc.v8.i9.496] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 06/23/2016] [Accepted: 08/01/2016] [Indexed: 02/06/2023] Open
Abstract
Cardiac involvement of sarcoid lesions is diagnosed by myocardial biopsy which is frequently false-negative, and patients with cardiac sarcoidosis (CS) who have impaired left ventricular (LV) systolic function are sometimes diagnosed with dilated cardiomyopathy (DCM). Late gadolinium enhancement (LE) in magnetic resonance imaging is now a critical finding in diagnosing CS, and the novel Japanese guideline considers myocardial LE to be a major criterion of CS. This article describes the value of LE in patients with CS who have impaired LV systolic function, particularly the diagnostic and clinical significance of LE distribution in comparison with DCM. LE existed at all LV segments and myocardial layers in patients with CS, whereas it was localized predominantly in the midwall of basal to mid septum in those with DCM. Transmural (nodular), circumferential, and subepicardial and subendocardial LE distribution were highly specific in patients with CS, whereas the prevalence of striated midwall LE were high both in patients with CS and with DCM. Since sarcoidosis patients with LE have higher incidences of heart failure symptoms, ventricular tachyarrhythmia and sudden cardiac death, the analyses of extent and distribution of LE are crucial in early diagnosis and therapeutic approach for patients with CS.
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Abstract
Sarcoidosis is a multisystem granulomatous disease of unknown cause that can affect the heart. Cardiac sarcoidosis may be present in as many as 25% of patients with systemic sarcoidosis, and it is frequently underdiagnosed. The early and accurate diagnosis of myocardial involvement is challenging. Advanced imaging techniques play important roles in the diagnosis and management of patients with cardiac sarcoidosis.
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Affiliation(s)
- Irving E Perez
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY. 1825 Eastchester Road Bronx, NY, 10461, USA.
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Watanabe H, Eguchi K, Saitou T, Shimpo M, Hiroe M, Kario K. Cardiac sarcoidosis, the complete atrioventricular block of which was completely recovered by intravenous steroid pulse therapy. J Cardiol Cases 2015; 13:21-24. [PMID: 30546603 DOI: 10.1016/j.jccase.2015.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 09/13/2015] [Accepted: 09/14/2015] [Indexed: 11/26/2022] Open
Abstract
Atrioventricular block (AVB) in individuals with cardiac sarcoidosis (CS) is one of the major complications caused by inflammation of the conducting system of the heart, as a sign of worse prognosis. We report the case of a 53-year-old Japanese woman whose electrocardiogram showed complete AVB by the clinical diagnosis of CS. We administered intravenous methylpredonisolone (1 g/day) for 3 days. On the second day of steroid pulse therapy, the complete AVB improved to sinus rhythm of 1st degree AVB and complete right bundle branch block. Normal sinus rhythm was then observed after oral steroid therapy. These results suggest that in cases of complete AVB, steroid pulse therapy with a strong anti-inflammatory effect may be recommended first. <Learning objective: This case illustrates a typical case of CS with complete AVB, but the cardiac contraction was normal. In this setting, steroid pulse therapy may be effective when (1) the active inflammation of the conduction system can be suppressed by steroid pulse therapy; (2) the time to start steroid therapy is short enough to recover.>.
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Affiliation(s)
- Hiroaki Watanabe
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Kazuo Eguchi
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Toshinobu Saitou
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Masahisa Shimpo
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
| | - Michiaki Hiroe
- Department of Cardiology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Shimotsuke, Tochigi, Japan
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