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Jankowska H, Dorniak K, Dudziak M, Glińska A, Sienkiewicz K, Kulawiak-Gałąska D, Fijałkowska J, Dubaniewicz A, Hellmann M. The usefulness of speckle tracking echocardiography for the prediction of cardiac involvement in patients with biopsy-proven sarcoidosis. Echocardiography 2024; 41:e15777. [PMID: 38526991 DOI: 10.1111/echo.15777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 03/27/2024] Open
Abstract
INTRODUCTION Cardiac sarcoidosis (CS) is commonly diagnosed based on clinical criteria and abnormalities in noninvasive imaging reported in patients with biopsy-proven extracardiac sarcoidosis. Electrocardiogram and two-dimensional echocardiography have a low sensitivity for CS detection. Cardiovascular magnetic resonance imaging (CMR) and positron emission tomography (PET) have limitations in terms of cost and availability. OBJECTIVES This study aimed to assess the usefulness of left ventricular longitudinal strain, measured using two-dimensional speckle tracking echocardiography (STE), for the prediction of late gadolinium enhancement (LGE) presence in CMR in patients with biopsy-proven sarcoidosis. PATIENTS AND METHODS A total of 119 patients with biopsy-proven extracardiac sarcoidosis were divided, according to the clinical criteria proposed by the 2014 Heart Rhythm Society expert consensus statement (HRS 2014), into two groups: 43 individuals with "probable cardiac sarcoidosis", CS(+) and 76 individuals without cardiac sarcoidosis, CS (-). Data from echocardiography, CMR, 12-lead ECG and 24 h Holter monitoring were analyzed. RESULTS Left ventricular global longitudinal strain (LV-GLS) was slightly reduced in the entire sarcoidosis group (-18.61± 2.96), no difference between the CS (+) and CS (-) subgroups was found (-18.0% ± 3.2% and -18.9% ± 2.8%, respectively; p = .223). No cut-off value for LV-GLS was identified that could predict the presence of LGE. Segmental longitudinal strain impairment partially correlated with the presence of LGE on CMR. CONCLUSIONS In our cohort of sarcoidosis patients, segmental longitudinal strain proved more helpful in the diagnostic process than LV-GLS. The ultimate role of STE in the diagnosis of CS remains to be established.
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Affiliation(s)
- Hanna Jankowska
- Department of Cardiac Diagnostics, Medical University of Gdańsk, Gdańsk, Poland
| | - Karolina Dorniak
- Department of Cardiac Diagnostics, Medical University of Gdańsk, Gdańsk, Poland
| | - Maria Dudziak
- Department of Cardiac Diagnostics, Medical University of Gdańsk, Gdańsk, Poland
| | - Anna Glińska
- Second Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland
| | | | | | - Jadwiga Fijałkowska
- Second Department of Radiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Anna Dubaniewicz
- Department of Pulmonology, Medical University of Gdańsk, Gdańsk, Poland
| | - Marcin Hellmann
- Department of Cardiac Diagnostics, Medical University of Gdańsk, Gdańsk, Poland
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Okafor J, Khattar R, Sharma R, Kouranos V. The Role of Echocardiography in the Contemporary Diagnosis and Prognosis of Cardiac Sarcoidosis: A Comprehensive Review. Life (Basel) 2023; 13:1653. [PMID: 37629510 PMCID: PMC10455750 DOI: 10.3390/life13081653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/23/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023] Open
Abstract
Cardiac sarcoidosis (CS) is a rare inflammatory disorder characterised by the presence of non-caseating granulomas within the myocardium. Contemporary studies have revealed that 25-30% of patients with systemic sarcoidosis have cardiac involvement, with detection rates increasing in the era of advanced cardiac imaging. The use of late gadolinium enhancement cardiac magnetic resonance and 18fluorodeoxy glucose positron emission tomography (FDG-PET) imaging has superseded endomyocardial biopsy for the diagnosis of CS. Echocardiography has historically been used as a screening tool with abnormalities triggering the need for advanced imaging, and as a tool to assess cardiac function. Regional wall thinning or aneurysm formation in a noncoronary distribution may indicate granuloma infiltration. Thinning of the basal septum in the setting of extracardiac sarcoidosis carries a high specificity for cardiac involvement. Abnormal myocardial echotexture and eccentric hypertrophy may be suggestive of active myocardial inflammation. The presence of right-ventricular involvement as indicated by free-wall aneurysms can mimic arrhythmogenic right-ventricular cardiomyopathy. More recently, the use of myocardial strain has increased the sensitivity of echocardiography in diagnosing cardiac involvement. Echocardiography is limited in prognostication, with impaired left-ventricular (LV) ejection fraction and LV dilatation being the only established independent predictors of mortality. More research is required to explore how advanced echocardiographic technologies can increase both the diagnostic sensitivity and prognostic ability of this modality in CS.
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Affiliation(s)
- Joseph Okafor
- Department of Echocardiography, Royal Brompton Hospital, London SW3 6NP, UK
- Cardiac Sarcoidosis Centre, Royal Brompton Hospital, London SW3 6NP, UK
| | - Rajdeep Khattar
- Department of Echocardiography, Royal Brompton Hospital, London SW3 6NP, UK
- Cardiac Sarcoidosis Centre, Royal Brompton Hospital, London SW3 6NP, UK
| | - Rakesh Sharma
- Cardiac Sarcoidosis Centre, Royal Brompton Hospital, London SW3 6NP, UK
| | - Vasilis Kouranos
- Cardiac Sarcoidosis Centre, Royal Brompton Hospital, London SW3 6NP, UK
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3
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Cabuk AK, Cabuk G. Real-time three-dimensional echocardiography for detection of cardiac sarcoidosis in the early stage: a cross-sectional single-centre study. Acta Cardiol 2022; 77:699-707. [PMID: 35442140 DOI: 10.1080/00015385.2022.2064062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Sarcoidosis with cardiac involvement has a relatively high morbidity and mortality, and early diagnose of cardiac sarcoidosis is a critical issue. Systolic dyssynchrony index (SDI) measured by three-dimensional echocardiography was used in our study for detection of subclinical left ventricular (LV) systolic dysfunction in patients with sarcoidosis and normal LV function on two-dimensional echocardiography. METHODS Forty-four patients diagnosed with sarcoidosis (without clinically apparent cardiac involvement) and 44 healthy control subjects were included in this study. Two-dimensional echocardiographic parameters, also LV volumes and SDI measured by 3D echocardiography were analyzed in all participants. RESULTS While two-dimensional echocardiographic results of both study groups were similar; SDI_16 (SDI for 16 segments of LV) results were significantly higher in sarcoidosis group compared to healthy controls (6.99 ±5.02 vs 2.89 ± 1.32, p < 0.0001). CONCLUSION SDI_16 was higher in patients with sarcoidosis compared to healthy controls probably due to patchy infiltration characteristic of the disease. This parameter could be used as a marker to identify patients with cardiac involvement of sarcoidosis in the early phase.
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Affiliation(s)
- Ali Kemal Cabuk
- Department of Cardiology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Gizem Cabuk
- Department of Cardiology, Tepecik Training and Research Hospital, Izmir, Turkey
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Lu C, Wang YG, Zaman F, Wu X, Adhaduk M, Chang A, Ji J, Wei T, Suksaranjit P, Christodoulidis G, Scalzetti E, Han Y, Feiglin D, Liu K. Predicting adverse cardiac events in sarcoidosis: deep learning from automated characterization of regional myocardial remodeling. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1825-1836. [PMID: 35194707 DOI: 10.1007/s10554-022-02564-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 02/11/2022] [Indexed: 12/11/2022]
Abstract
Recognizing early cardiac sarcoidosis (CS) imaging phenotypes can help identify opportunities for effective treatment before irreversible myocardial pathology occurs. We aimed to characterize regional CS myocardial remodeling features correlating with future adverse cardiac events by coupling automated image processing and data analysis on cardiac magnetic resonance (CMR) imaging datasets. A deep convolutional neural network (DCNN) was used to process a CMR database of a 10-year cohort of 117 consecutive biopsy-proven sarcoidosis patients. The maximum relevance - minimum redundancy method was used to select the best subset of all the features-24 (from manual processing) and 232 (from automated processing) left ventricular (LV) structural/functional features. Three machine learning (ML) algorithms, logistic regression (LogR), support vector machine (SVM) and multi-layer neural networks (MLP), were used to build classifiers to categorize endpoints. Over a median follow-up of 41.8 (inter-quartile range 20.4-60.5) months, 35 sarcoidosis patients experienced a total of 43 cardiac events. After manual processing, LV ejection fraction (LVEF), late gadolinium enhancement, abnormal segmental wall motion, LV mass (LVM), LVMI index (LVMI), septal wall thickness, lateral wall thickness, relative wall thickness, and wall thickness of 9 (out of 17) individual LV segments were significantly different between patients with and without endpoints. After automated processing, LVEF, end-diastolic volume, end-systolic volume, LV mass and wall thickness of 92 (out of 216) individual LV segments were significantly different between patients with and without endpoints. To achieve the best predictive performance, ML algorithms selected lateral wall thickness, abnormal segmental wall motion, septal wall thickness, and increased wall thickness of 3 individual segments after manual image processing, and selected end-diastolic volume and 7 individual segments after automated image processing. LogR, SVM and MLP based on automated image processing consistently showed better predictive accuracies than those based on manual image processing. Automated image processing with a DCNN improves data resolution and regional CS myocardial remodeling pattern recognition, suggesting that a framework coupling automated image processing with data analysis can help clinical risk stratification.
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Affiliation(s)
- Chenying Lu
- Departments of Medicine and Radiology, State University of New York, Upstate Medical University Hospital, Syracuse, USA
- Zhejiang Provincial Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Yi Grace Wang
- Department of Mathematics, California State University Dominguez Hills, Carson, USA
| | - Fahim Zaman
- Department of Electrical and Electronic Engineering, University of Iowa, Iowa City, USA
| | - Xiaodong Wu
- Department of Electrical and Electronic Engineering, University of Iowa, Iowa City, USA
| | - Mehul Adhaduk
- Division of Cardiology, Department of Medicine, University of Iowa, Iowa City, USA
| | - Amanda Chang
- Division of Cardiology, Department of Medicine, University of Iowa, Iowa City, USA
| | - Jiansong Ji
- Zhejiang Provincial Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Tiemin Wei
- Zhejiang Provincial Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, The Fifth Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Promporn Suksaranjit
- Division of Cardiology, Department of Medicine, University of Iowa, Iowa City, USA
| | | | - Ernest Scalzetti
- Departments of Medicine and Radiology, State University of New York, Upstate Medical University Hospital, Syracuse, USA
| | - Yuchi Han
- Cardiovascular Division, University of Pennsylvania, Philadelphia, USA
| | - David Feiglin
- Departments of Medicine and Radiology, State University of New York, Upstate Medical University Hospital, Syracuse, USA
| | - Kan Liu
- Departments of Medicine and Radiology, State University of New York, Upstate Medical University Hospital, Syracuse, USA.
- Division of Cardiology and Heart Vascular Center, University of Iowa, Iowa City, IA, 52242, USA.
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5
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Desbois A, Charpentier E, Chapelon C, Bergeret S, Badenco N, Redheuil A, Cacoub P, Saadoun D. Sarcoïdose cardiaque : stratégies diagnostiques et thérapeutiques actuelles. Rev Med Interne 2022; 43:212-224. [DOI: 10.1016/j.revmed.2021.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/22/2021] [Accepted: 08/01/2021] [Indexed: 11/26/2022]
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Panovský R, Doubková M, Mojica-Pisciotti ML, Holeček T, Máchal J, Feitová V, Masárová L, Opatřil L, Kincl V, Víšková J. Left ventricular myocardial deformation assessment in asymptomatic patients with recently diagnosed sarcoidosis of the respiratory tract and/or extrapulmonary sarcoidosis. Orphanet J Rare Dis 2021; 16:405. [PMID: 34587975 PMCID: PMC8482629 DOI: 10.1186/s13023-021-02038-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 09/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sarcoidosis is a systemic granulomatous disease affecting different organs including the heart. Myocardial strain analysis could potentially detect the early stages of cardiac dysfunction in sarcoidosis patients. The present study aims to assess the use of cardiac magnetic resonance (CMR) strain analysis using feature tracking (FT) in the detection of early cardiac involvement in asymptomatic patients with sarcoidosis. METHODS One hundred and thirteen CMR studies of patients with sarcoidosis of the respiratory tract and/or extrapulmonary sarcoidosis without pre-existing known cardiovascular disease were included in the study and analysed using FT and compared to 22 age and gender-matched controls. Global longitudinal strain (GLS), global circumferential strain (GCS) and global radial strain (GRS) of the left ventricle (LV) were measured. RESULTS The sarcoidosis patients did not significantly differ from the controls in basic demographic data and had normal global and regional systolic LV function-LV ejection fraction (EF) 66 ± 7% vs 65 ± 5% in the controls (p = NS). No statistically significant differences were found in all strain parameters between patients and controls: GLS (- 13.9 ± 3.1 vs. - 14.2 ± 2.5), GCS (- 23.4 ± 4.0 vs. - 22.2 ± 2.9) and GRS (53.4 ± 13.5 vs. 51.2 ± 13.6%) (p = NS). CONCLUSION Patients with sarcoidosis of the respiratory tract and/or extrapulmonary sarcoidosis had normal myocardial deformation measured by CMR-FT derived global strain.
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Affiliation(s)
- Roman Panovský
- International Clinical Research Center, St. Anne's Faculty Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,1St Department of Internal Medicine and Cardioangiology, St. Anne's Faculty Hospital, Faculty of Medicine, Masaryk University, Pekarska 53, 656 91, Brno, Czech Republic
| | - Martina Doubková
- Department of Pulmonary Diseases and Tuberculosis, Faculty of Medicine and University Hospital, Masaryk University, Brno, Czech Republic
| | - Mary Luz Mojica-Pisciotti
- International Clinical Research Center, St. Anne's Faculty Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Tomáš Holeček
- International Clinical Research Center, St. Anne's Faculty Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Medical Imaging, St. Anne's Faculty Hospital, Brno, Czech Republic
| | - Jan Máchal
- International Clinical Research Center, St. Anne's Faculty Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Pathophysiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Věra Feitová
- International Clinical Research Center, St. Anne's Faculty Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Medical Imaging, St. Anne's Faculty Hospital, Brno, Czech Republic
| | - Lucia Masárová
- International Clinical Research Center, St. Anne's Faculty Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,1St Department of Internal Medicine and Cardioangiology, St. Anne's Faculty Hospital, Faculty of Medicine, Masaryk University, Pekarska 53, 656 91, Brno, Czech Republic
| | - Lukáš Opatřil
- International Clinical Research Center, St. Anne's Faculty Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic. .,1St Department of Internal Medicine and Cardioangiology, St. Anne's Faculty Hospital, Faculty of Medicine, Masaryk University, Pekarska 53, 656 91, Brno, Czech Republic.
| | - Vladimír Kincl
- International Clinical Research Center, St. Anne's Faculty Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,1St Department of Internal Medicine and Cardioangiology, St. Anne's Faculty Hospital, Faculty of Medicine, Masaryk University, Pekarska 53, 656 91, Brno, Czech Republic
| | - Jana Víšková
- International Clinical Research Center, St. Anne's Faculty Hospital, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Medical Imaging, St. Anne's Faculty Hospital, Brno, Czech Republic
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7
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Kusunose K, Fujiwara M, Yamada H, Nishio S, Saijo Y, Yamada N, Hirata Y, Torii Y, Ise T, Yamaguchi K, Fukuda D, Yagi S, Soeki T, Wakatsuki T, Sata M. Deterioration of biventricular strain is an early marker of cardiac involvement in confirmed sarcoidosis. Eur Heart J Cardiovasc Imaging 2021; 21:796-804. [PMID: 31566217 DOI: 10.1093/ehjci/jez235] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/19/2019] [Accepted: 08/28/2019] [Indexed: 12/20/2022] Open
Abstract
AIMS Risk assessment of developing cardiac involvement in systemic sarcoidosis can be challenging because of limited data. Recently, attention has been given to left ventricular and right ventricular (LV and RV) involvement in cardiac sarcoidosis (CS) and its prevalence, relevance, and prognostic value. The aim of this study was to assess the role of biventricular strain to predict prognosis in confirmed sarcoidosis patients. METHODS AND RESULTS LV and RV longitudinal strains (LSs) were evaluated by 2D speckle tracking in 139 consecutive confirmed sarcoidosis patients without other pre-existing structural heart diseases, and 52 age- and gender-matched control subjects. The primary endpoint was CS-related events (cardiac death or development of cardiac involvement). Sarcoidosis without cardiac involvement had significantly lower LV and RV free wall LS compared with control subjects. Basal LS had a higher area under the curve for differentiation of sarcoidosis in patients without cardiac involvement compared to control (cut-off value: -18% with 89% sensitivity and 69% specificity). During a median period of 50 months, the occurrence of CS-related events was observed in 20 patients. In a multivariate analysis, basal LV LS and RV free wall LS were associated with the events [hazard ratio (HR) 0.72, P < 0.001 and HR: 0.83, P = 0.006, respectively]. Patients with impaired biventricular function had significantly shorter event-free survival than those with preserved biventricular function (P < 0.001). CONCLUSION Deterioration of biventricular strain was associated with CS-related events. This information might be useful for clinical evaluation and follow-up in sarcoidosis.
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Affiliation(s)
- Kenya Kusunose
- Department of Cardiovascular Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, 770-8503 Tokushima, Japan
| | - Mika Fujiwara
- Department of Community medicine for cardiology, Tokushima Graduate School of Biomedical Sciences, Tokushima University, 2-50-1 Kuramoto, 770-8503 Tokushima, Japan
| | - Hirotsugu Yamada
- Department of Community medicine for cardiology, Tokushima Graduate School of Biomedical Sciences, Tokushima University, 2-50-1 Kuramoto, 770-8503 Tokushima, Japan
| | - Susumu Nishio
- Ultrasound Examination Center, Tokushima University Hospital, Tokushima, 2-50-1 Kuramoto, 770-8503 Tokushima, Japan
| | - Yoshihito Saijo
- Department of Cardiovascular Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, 770-8503 Tokushima, Japan
| | - Nao Yamada
- Department of Cardiovascular Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, 770-8503 Tokushima, Japan
| | - Yukina Hirata
- Ultrasound Examination Center, Tokushima University Hospital, Tokushima, 2-50-1 Kuramoto, 770-8503 Tokushima, Japan
| | - Yuta Torii
- Ultrasound Examination Center, Tokushima University Hospital, Tokushima, 2-50-1 Kuramoto, 770-8503 Tokushima, Japan
| | - Takayuki Ise
- Department of Cardiovascular Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, 770-8503 Tokushima, Japan
| | - Koji Yamaguchi
- Department of Cardiovascular Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, 770-8503 Tokushima, Japan
| | - Daiju Fukuda
- Department of Cardiovascular Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, 770-8503 Tokushima, Japan
| | - Shusuke Yagi
- Department of Cardiovascular Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, 770-8503 Tokushima, Japan
| | - Takeshi Soeki
- Department of Cardiovascular Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, 770-8503 Tokushima, Japan
| | - Tetsuzo Wakatsuki
- Department of Cardiovascular Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, 770-8503 Tokushima, Japan
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, 770-8503 Tokushima, Japan
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8
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Narula N, Iannuzzi M. Sarcoidosis: Pitfalls and Challenging Mimickers. Front Med (Lausanne) 2021; 7:594275. [PMID: 33505980 PMCID: PMC7829200 DOI: 10.3389/fmed.2020.594275] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/30/2020] [Indexed: 12/17/2022] Open
Abstract
Sarcoidosis, a systemic granulomatous disease of unknown etiology, may mimic other conditions at presentation often resulting in delayed diagnosis. These conditions include infections, neoplasms, autoimmune, cardiovascular, and drug-induced diseases. This review highlights the most common sarcoidosis mimics that often lead to pitfalls in diagnosis and delay in appropriate treatment. Prior to invasive testing and initiating immunosuppressants (commonly corticosteroids), it is important to exclude sarcoid mimickers.
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Affiliation(s)
- Naureen Narula
- Staten Island University Hospital, New York, NY, United States
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9
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Barssoum K, Altibi AM, Rai D, Kumar A, Kharsa A, Chowdhury M, Thakkar S, Shahid S, Abdelazeem M, Abuzaid AS, Baibhav B, Parikh V, Feitell SC, Balmer-Swain M, Rao M, Amsallem M, Nanda NC. Speckle tracking echocardiography can predict subclinical myocardial involvement in patients with sarcoidosis: A meta-analysis. Echocardiography 2020; 37:2061-2070. [PMID: 33058271 DOI: 10.1111/echo.14886] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/09/2020] [Accepted: 09/20/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND This meta-analysis aims to evaluate the utility of speckle tracking echocardiography (STE) as a tool to evaluate for cardiac sarcoidosis (CS) early in its course. Electrocardiography and echocardiography have limited sensitivity in this role, while advanced imaging modalities such as cardiac magnetic resonance (CMR) and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) are limited by cost and availability. METHODS We compiled English language articles that reported left ventricular global longitudinal strain (LVGLS) or global circumferential strain (GCS) in patients with confirmed extra-cardiac sarcoidosis versus healthy controls. Studies that exclusively included patients with probable or definite CS were excluded. Continuous data were pooled as a standard mean difference (SMD), comparing sarcoidosis group with healthy controls. A random-effect model was adopted in all analyses. Heterogeneity was assessed using Q and I2 statistics. RESULTS Nine studies were included in our final analysis with an aggregate of 967 patients. LVGLS was significantly lower in the extra-cardiac sarcoidosis group as compared with controls, SMD -3.98, 95% confidence interval (CI): -5.32, -2.64, P < .001, also was significantly lower in patients who suffered major cardiac events (MCE), -3.89, 95% CI -6.14, -1.64, P < .001. GCS was significantly lower in the extra-cardiac sarcoidosis group as compared with controls, SMD: -3.33, 95% CI -4.71, -1.95, P < .001. CONCLUSION LVGLS and GCS were significantly lower in extra-cardiac sarcoidosis patients despite not exhibiting any cardiac symptoms. LVGLS correlates with MCEs in CS. Further studies are required to investigate the role of STE in the early screening of CS.
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Affiliation(s)
- Kirolos Barssoum
- Department of Internal Medicine, Unity Hospital, Rochester Regional Health System, Rochester, NY, USA
| | - Ahmed M Altibi
- Department of Internal Medicine, Henry Ford Allegiance Health, Jackson, MI, USA
| | - Devesh Rai
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Ashish Kumar
- Department of Critical Care, St. John's Medical College, Bangalore, India
| | - Adnan Kharsa
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Medhat Chowdhury
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | | | - Sara Shahid
- Department of Internal Medicine, Unity Hospital, Rochester Regional Health System, Rochester, NY, USA
| | | | - Ahmed Sami Abuzaid
- Department of Cardiology, Alaska and Vascular Institute LLC, Anchorage, AK, USA
| | - Bipul Baibhav
- Department of Cardiology, Sands Constellation Heart Institute, Rochester Regional Health, Rochester, NY, USA
| | - Vishal Parikh
- Department of Cardiology, Sands Constellation Heart Institute, Rochester Regional Health, Rochester, NY, USA
| | - Scott C Feitell
- Department of Cardiology, Sands Constellation Heart Institute, Rochester Regional Health, Rochester, NY, USA
| | - Mallory Balmer-Swain
- Department of Cardiology, Sands Constellation Heart Institute, Rochester Regional Health, Rochester, NY, USA
| | - Mohan Rao
- Department of Cardiology, Sands Constellation Heart Institute, Rochester Regional Health, Rochester, NY, USA
| | - Myriam Amsallem
- Department of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Navin C Nanda
- Division of Cardiovascular Disease, University of Alabama, Birmingham, AL, USA
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10
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Lu C, Chen J, Suksaranjit P, Menda Y, Adhaduk M, Jayanna MB, Scalzetti E, Ji J, Wei T, Feiglin D, Liu K. Regional Myocardial Remodeling Characteristics Correlates With Cardiac Events in Sarcoidosis. J Magn Reson Imaging 2020; 52:499-509. [PMID: 31950573 DOI: 10.1002/jmri.27057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/30/2019] [Accepted: 12/30/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The poor prognosis of cardiac sarcoidosis (CS) underscores the need for risk stratification. PURPOSE To investigate the prognostic significance of ventricular/myocardial remodeling features in sarcoidosis. STUDY TYPE Retrospective. POPULATION In all, 132 biopsy-proven sarcoidosis patients imaged from 2008 to 2018. The primary endpoint was a composite of cardiac mortality, new onset arrhythmias, hospitalization for heart failure, and device implantation. FIELD STRENGTH/SEQUENCE No field strength or sequence restrictions. ASSESSMENT Global and regional ventricular/myocardial remodeling features were assessed by standard volumetric measurements and automated function imaging postprocessing analysis. STATISTICAL TESTS Student's t-test or Mann-Whitney test (chi2 test or Fisher's exact test for categorical variables) were used for comparisons. Cox-proportional hazards regression model, univariate /multivariate analyses, and receiver operating characteristic were performed to relate clinical/lab data, imaging parameters to the endpoints. RESULTS Over a median follow-up of 40.7 (interquartile range 18.8-60.5) months, 41 (31.1%) patients developed adverse cardiac events. Abnormal left ventricular (LV) geometric remodeling alterations (measured by LV mass index and relative wall thickness) occurred 3.66-fold more frequently in patients with endpoints than patients without. The ratio of patients with endpoints increased as ventricular remodeling phenotype progressed. In patients with endpoints, regional myocardial wall thickness (RMWT) was significantly (P = 0.022) increased in six clustered LV segments located in the middle interventricular septum and basal/middle anterolateral walls. In all of the abnormal ventricular remodeling stages, patients with endpoints constantly had higher mean RMWT than those without. Among clinical, electrocardiographic, and imaging parameters, LV mass index (hazard ratio [HR] 1.010 95% confidence interval [CI] 1.002-1.018, P = 0.017) and mean RMWT (HR 3.482 95% CI 1.679-7.223, P = 0.001) were independently associated with endpoints. Sarcoidosis patients without this RMWT distribution pattern were significantly (P < 0.001) more likely to be free of the occurrence of subsequent cardiac events. DATA CONCLUSION Regional myocardial remodeling characteristics are associated with subsequent adverse cardiac events in sarcoidosis. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY STAGE: 2 J. Magn. Reson. Imaging 2020;52:499-509.
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Affiliation(s)
- Chenying Lu
- Department of Medicine and Radiology, State University of New York, Upstate Medical University Hospital, Syracuse, New York, USA.,Key Laboratory of Imaging Diagnosis and Minimally Invasive and Intervention Research, Lishui Hospital, Zhejiang University School of Medicine, Lishui, China
| | - Jian Chen
- Department of Medicine and Radiology, State University of New York, Upstate Medical University Hospital, Syracuse, New York, USA.,Department of Interventional Cardiovascular Medicine, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, China
| | - Promporn Suksaranjit
- Division of Cardiology, Department of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Yusuf Menda
- Department of Radiology, University of Iowa, Iowa City, Iowa, USA
| | - Mehul Adhaduk
- Division of Cardiology, Department of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Manju B Jayanna
- Division of Cardiology, Department of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Ernest Scalzetti
- Department of Medicine and Radiology, State University of New York, Upstate Medical University Hospital, Syracuse, New York, USA
| | - Jiansong Ji
- Key Laboratory of Imaging Diagnosis and Minimally Invasive and Intervention Research, Lishui Hospital, Zhejiang University School of Medicine, Lishui, China
| | - Tiemin Wei
- Key Laboratory of Imaging Diagnosis and Minimally Invasive and Intervention Research, Lishui Hospital, Zhejiang University School of Medicine, Lishui, China
| | - David Feiglin
- Department of Medicine and Radiology, State University of New York, Upstate Medical University Hospital, Syracuse, New York, USA
| | - Kan Liu
- Department of Medicine and Radiology, State University of New York, Upstate Medical University Hospital, Syracuse, New York, USA.,Division of Cardiology, Department of Medicine, University of Iowa, Iowa City, Iowa, USA
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11
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Singh A, Voss WB, Lentz RW, Thomas JD, Akhter N. The Diagnostic and Prognostic Value of Echocardiographic Strain. JAMA Cardiol 2019; 4:580-588. [DOI: 10.1001/jamacardio.2019.1152] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Arushi Singh
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Robert W. Lentz
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - James D. Thomas
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nausheen Akhter
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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12
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Perry R, Selvanayagam JB. Echocardiography in Infiltrative Cardiomyopathy. Heart Lung Circ 2019; 28:1365-1375. [PMID: 31109889 DOI: 10.1016/j.hlc.2019.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/14/2019] [Accepted: 04/11/2019] [Indexed: 01/18/2023]
Abstract
Left ventricular (LV) wall thickening can occur due to both physiological and pathological processes. Some LV wall thickening is caused by infiltrative cardiac deposition diseases - rare disorders from both inherited and acquired conditions, with varying systemic manifestations. They portend a poor prognosis and are generally not reversible except in rare circumstances when early diagnosis and treatment may alter the outcome (e.g., Fabry disease). Cardiac involvement is variable and depends on the degree of infiltration and type of infiltrate. These changes often lead to the development of abnormalities in both the relaxation and contractile function of the heart ultimately resulting in heart failure. Echocardiography is generally the first investigation of choice as it is easily available and gives valuable information about the thickness of the ventricular walls as well as systolic and diastolic function. It is also able to identify unique, characteristic features of the disease as well as detecting any haemodynamic sequelae. This review looks at the role of echocardiography in the diagnosis and prognosis of infiltrative cardiac deposition diseases.
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Affiliation(s)
- Rebecca Perry
- College of Medicine, Flinders University, Adelaide, SA, Australia; Department of Cardiovascular Medicine, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, SA, Australia; Cardiac Imaging Research, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Joseph B Selvanayagam
- College of Medicine, Flinders University, Adelaide, SA, Australia; Department of Cardiovascular Medicine, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, SA, Australia; Cardiac Imaging Research, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
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13
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Tan JL, Fong HK, Birati EY, Han Y. Cardiac Sarcoidosis. Am J Cardiol 2019; 123:513-522. [PMID: 30503798 DOI: 10.1016/j.amjcard.2018.10.021] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 10/27/2018] [Accepted: 10/31/2018] [Indexed: 12/13/2022]
Abstract
Clinical and subclinical cardiac sarcoidosis (CS) remains diagnostically challenging as the sensitivity and specificity of the diagnostic modalities are limited. The Japanese Ministry of Health and Welfare criteria and the Heart Rhythm Society expert consensus statement on CS are the most common guidelines used to diagnose CS. However, they are mostly based on expert opinions and lack clinical trial validation. The emergence and increase use of newer imaging modalities such as cardiac magnetic resonance and positron emission tomography may give valuable information for accurate diagnosis and assessment of treatment response in CS patient. Although immunosuppressive therapies, particularly corticosteroids, have been proposed as the mainstay of treatment in CS, there is paucity of data on the optimal initiation, duration, and dosage of immunosuppressive therapies. Recommendations are mostly based on small observational studies. Further studies are warranted to better characterize the use of immunosuppressive therapies in this patient population. Device therapies such as implantable cardioverter-defibrillators are usually recommended for patient with clinical CS. In conclusion, this article synthesizes the current best evidence of utilizing various imaging modalities to diagnose CS and summarizing the main therapeutic approaches to manage and treat CS.
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Affiliation(s)
- Jian Liang Tan
- Department of Internal Medicine, Crozer-Chester Medical Center, Upland, Pennsylvania.
| | - Hee Kong Fong
- Department of Internal Medicine, University of Missouri-Columbia, Columbia, Missouri
| | - Edo Y Birati
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yuchi Han
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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