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Ribeiro Neto ML, Jellis CL, Cremer PC, Harper LJ, Taimeh Z, Culver DA. Cardiac Sarcoidosis. Clin Chest Med 2024; 45:105-118. [PMID: 38245360 DOI: 10.1016/j.ccm.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
Cardiac involvement is a major cause of morbidity and mortality in patients with sarcoidosis. It is important to distinguish between clinical manifest diseases from clinically silent diseases. Advanced cardiac imaging studies are crucial in the diagnostic pathway. In suspected isolated cardiac sarcoidosis, it's key to rule out alternative diagnoses. Therapeutic options can be divided into immunosuppressive agents, guideline-directed medical therapy, antiarrhythmic medications, device/ablation therapy, and heart transplantation.
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Affiliation(s)
- Manuel L Ribeiro Neto
- Department of Pulmonary Medicine, Cleveland Clinic, 9500 Euclid Avenue / A90, Cleveland, OH 44195, USA.
| | - Christine L Jellis
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Paul C Cremer
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Logan J Harper
- Department of Pulmonary Medicine, Cleveland Clinic, 9500 Euclid Avenue / A90, Cleveland, OH 44195, USA
| | - Ziad Taimeh
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Daniel A Culver
- Department of Pulmonary Medicine, Cleveland Clinic, 9500 Euclid Avenue / A90, Cleveland, OH 44195, USA
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Inglis SS, Thomas SC, Bois MC, Rosenbaum AN. Case Series: Recurrence of Cardiac Sarcoidosis After Orthotopic Heart Transplantation. Transplant Proc 2023; 55:1688-1691. [PMID: 37407375 DOI: 10.1016/j.transproceed.2023.03.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 02/23/2023] [Accepted: 03/30/2023] [Indexed: 07/07/2023]
Abstract
Orthotopic heart transplantation for cardiac sarcoidosis (CS) is becoming increasingly common. Historically, there have been concerns regarding disease recurrence within the allograft. Although rarely reported in the literature, cases of recurrent CS tend to be observed in patients after dose reduction of immunosuppressive therapy and cessation of corticosteroids. Here, we present 2 cases of recurrent CS after orthotopic heart transplantation, confirmed on endomyocardial biopsy. Case 1 reports a 50-year-old man with a fulminant course of giant cell myocarditis who developed allograft recurrence with granulomas 5 years after transplantation despite maintenance corticosteroid therapy. Case 2 reports a 47-year-old man with CS who developed recurrence with the presence of giant cells 2 years after transplantation, with a benign clinical course. With these cases, we demonstrate the clinical overlap between CS and giant cell myocarditis and highlight the spectrum of the disease process. We also demonstrate that CS can recur despite corticosteroid maintenance therapy.
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Affiliation(s)
- Sara S Inglis
- Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
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Gazitt T, Kharouf F, Feld J, Haddad A, Hijazi N, Kibari A, Fuks A, Sabo E, Mor M, Peleg H, Asleh R, Zisman D. Real-Life Utilization of Criteria Guidelines for Diagnosis of Cardiac Sarcoidosis (CS). J Clin Med 2023; 12:5278. [PMID: 37629319 PMCID: PMC10455608 DOI: 10.3390/jcm12165278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/10/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
Despite the increasing recognition of cardiac involvement in systemic sarcoidosis, the diagnosis of cardiac sarcoidosis (CS) remains challenging. Our aim is to present a comprehensive, retrospective case series of CS patients, focusing on the current diagnostic guidelines and management of this life-threatening condition. In our case series, patient data were collected retrospectively, including hospital admission records and rheumatology and cardiology clinic visit notes, detailing demographic, clinical, laboratory, pathology, and imaging studies, as well as cardiac devices and prescribed medications. Cases were divided into definite and probable CS based on the 2014 Heart Rhythm Society guidelines as well as presumed CS based on imaging criteria and clinical findings. Overall, 19 CS patients were included, 17 of whom were diagnosed with probable or presumed CS based on cardiac magnetic resonance imaging (CMR) and/or cardiac positron emission tomography using 18F-Fluorodeoxyglucose (PET-FDG) without supporting endomyocardial biopsy (EMB). The majority of CS patients were male (53%), with a mean age of 52.9 ± 11.8, with CS being the initial manifestation of sarcoidosis in 63% of cases. Most patients presented with high-grade AVB (63%), followed by heart failure (42%) and ventricular tachyarrhythmia (VT) (26%). This case series highlights the significance of utilizing updated diagnostic criteria relying on CMR and PET-FDG given that cardiac involvement can be the initial manifestation of systemic sarcoidosis, requiring prompt diagnosis and treatment to prevent morbidity and mortality.
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Affiliation(s)
- Tal Gazitt
- Rheumatology Unit, Carmel Medical Center, Haifa 3436212, Israel (D.Z.)
- Division of Rheumatology, University of Washington Medical Center, Seattle, WA 98195-6428, USA
| | - Fadi Kharouf
- Rheumatology Unit, Hadassah Medical Center, Jerusalem 9112001, Israel
- Faculty of Medicine, Hadassah Medical Center, Jerusalem 9112001, Israel;
| | - Joy Feld
- Rheumatology Unit, Carmel Medical Center, Haifa 3436212, Israel (D.Z.)
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa 3200003, Israel
| | - Amir Haddad
- Rheumatology Unit, Carmel Medical Center, Haifa 3436212, Israel (D.Z.)
| | - Nizar Hijazi
- Rheumatology Unit, Carmel Medical Center, Haifa 3436212, Israel (D.Z.)
| | - Adi Kibari
- Rheumatology Unit, Carmel Medical Center, Haifa 3436212, Israel (D.Z.)
- Internal Medicine B, Carmel Medical Center, Haifa 3436212, Israel
| | - Alexander Fuks
- Department of Cardiology, Carmel Medical Center, Haifa 3436212, Israel
| | - Edmond Sabo
- Department of Pathology, Carmel Medical Center, Haifa 3436212, Israel
| | - Maya Mor
- Department of Radiology, Carmel Medical Center, Haifa 3436212, Israel
| | - Hagit Peleg
- Rheumatology Unit, Hadassah Medical Center, Jerusalem 9112001, Israel
- Faculty of Medicine, Hadassah Medical Center, Jerusalem 9112001, Israel;
| | - Rabea Asleh
- Faculty of Medicine, Hadassah Medical Center, Jerusalem 9112001, Israel;
- Department of Cardiology, Hadassah Medical Center, Jerusalem 9112001, Israel
| | - Devy Zisman
- Rheumatology Unit, Carmel Medical Center, Haifa 3436212, Israel (D.Z.)
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa 3200003, Israel
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Buttar C, Lakhdar S, Pavankumar T, Guzman-Perez L, Mahmood K, Collura G. Heart transplantation in end-stage heart failure secondary to cardiac sarcoidosis: an updated systematic review. Heart Fail Rev 2023; 28:961-966. [PMID: 36355274 DOI: 10.1007/s10741-022-10284-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 11/11/2022]
Abstract
The prevalence of cardiac sarcoidosis is increasing with improved cardiac imaging and may lead to severe heart failure, cardiomyopathy, and arrhythmias that warrant heart transplant consideration. This study aimed to evaluate the outcomes of heart transplantation in sarcoidosis. We systematically searched PubMed/MEDLINE, EMBASE and Cochrane Library following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. We identified 15 articles that examined patients with cardiac sarcoidosis. The study aimed to evaluate the outcomes of heart transplantation in cardiac sarcoidosis. We systematically searched EMBASE, PubMed/MEDLINE, and Cochrane Library following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. We identified 15 studies that examined 1075 patients with cardiac sarcoidosis who underwent heart transplantation. A total of five studies reported individual patient data. Forty-two patients have been pooled for further analysis. There were 22 male patients, 14 female patients, and 7 patients whose gender was not reported. Among these patients, 10 patients had concomitant pulmonary sarcoidosis at the time of diagnosis. The mean survival was reported for all 42 patients. The mean survival in months was 71.4 months, with a range of 2 days to 288 months. Three patients died of graft failure, 2 patients from septic shock, 2 patients from pneumonia, 1 patient from cervical cancer, and 1 patient from sudden cardiac death. One patient developed a malignant arrythmia in the setting of CMV myocarditis post-heart transplant. Sarcoidosis recurrence after heart transplant was reported in 3 of 30 patients..Patients with cardiac sarcoidosis have shown to have favorable outcomes after heart transplant. Despite these outcomes, some centers still hesitate to pursue heart transplant for CS patients. Carefully selected patients with advanced-stage heart failure due to cardiac sarcoidosis have encouraging outcomes after transplantation. Further studies will be needed to evaluate the outcomes of heart transplantation in sarcoidosis.
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Affiliation(s)
- Chandan Buttar
- Department of Cardiology, Tulane Hospital, New Orleans, LA, USA
| | - Sofia Lakhdar
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA, USA.
| | - Thota Pavankumar
- Department of Cardiology, Ochsner Medical Center, New Orleans, LA, USA
| | - Laura Guzman-Perez
- Department of Medicine, Icahn School of Medicine at Mount Sinai/NYC H+H/Queens, Queens, NY, USA
| | - Kiran Mahmood
- Department of Heart Failure and Transplant, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Giovina Collura
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, NYC H+H/Queens, Queens, NY, USA
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Abstract
About 5% of sarcoidosis patients develop clinically manifest cardiac features. Cardiac sarcoidosis (CS) typically presents with conduction abnormalities, ventricular arrhythmias and heart failure. Its diagnosis is challenging and requires a substantial degree of clinical suspicion as well as expertise in advanced cardiac imaging. Adverse events, particularly malignant arrhythmias and development of heart failure, are common among CS patients. A timely diagnosis is paramount to ameliorating outcomes for these patients. Despite weak evidence, immunosuppression (primarily with corticosteroids) is generally recommended in the presence of active inflammation in the myocardium. The burden of malignant arrhythmias remains important regardless of treatment, thus leading to the recommended use of an implantable cardioverter defibrillator in most patients with clinically manifest CS.
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Affiliation(s)
- Alessandro De Bortoli
- Division of Cardiology, University of Ottawa Heart Institute.,Department of Cardiology, Vestfold Hospital Trust
| | - David H Birnie
- Division of Cardiology, University of Ottawa Heart Institute
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Rosario KF, Brezitski K, Arps K, Milne M, Doss J, Karra R. Cardiac Sarcoidosis: Current Approaches to Diagnosis and Management. Curr Allergy Asthma Rep 2022; 22:171-182. [PMID: 36308680 DOI: 10.1007/s11882-022-01046-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Cardiac sarcoidosis (CS) is an important cause of non-ischemic cardiomyopathy and has specific diagnostic and therapeutic considerations. With advances in imaging techniques and treatment approaches, the approach to monitoring disease progression and management of CS continues to evolve. The purpose of this review is to highlight advances in CS diagnosis and treatment and present a center's multidisciplinary approach to CS care. RECENT FINDINGS In this review, we highlight advances in granuloma biology along with contemporary diagnostic approaches. Moreover, we expand on current targets of immunosuppression focused on granuloma biology and concurrent advances in the cardiovascular care of CS in light of recent guideline recommendations. Here, we review advances in the understanding of the sarcoidosis granuloma along with contemporary diagnostic and therapeutic considerations for CS. Additionally, we highlight knowledge gaps and areas for future research in CS treatment.
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Affiliation(s)
- Karen Flores Rosario
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA
| | - Kyla Brezitski
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA
| | - Kelly Arps
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA
| | - Megan Milne
- Division of Rheumatology, Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA
| | - Jayanth Doss
- Division of Rheumatology, Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA
| | - Ravi Karra
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA.
- Department of Pathology, Duke University Medical Center, Box 102152 DUMC, Durham, NC, 27710, USA.
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