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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enhancement cardiac magnetic resonance and 18fluorodeoxy glucose positron emission tomography (FDG-PET) imaging has superseded endomyocardial biopsy for the diagnosis of CS.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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2
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Chakrala T, Prakash RO, Jain A, Vautier RA, Prasada S, Al-Ani M, Ahmed MM. Severe cardiogenic shock and cardiac arrest due to fulminant cardiac sarcoidosis: a case report. BMC Cardiovasc Disord 2023; 23:225. [PMID: 37127559 PMCID: PMC10150484 DOI: 10.1186/s12872-023-03238-3] [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: 09/05/2022] [Accepted: 04/11/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Cardiac sarcoidosis is found to occur in approximately 5% of patients with sarcoidosis. Its presentation can typically range from complete heart block to ventricular arrhythmias. This condition can rarely present with severe heart failure and cardiogenic shock requiring aggressive and timely management strategies. Advanced imaging techniques are usually required to assist with its diagnosis. CASE PRESENTATION A 70-year-old woman with a history of pulmonary sarcoidosis presented with non-ST elevation myocardial infarction, congestive hepatopathy, and acute renal failure. Left heart catheterization showed evidence of non-obstructive coronary artery disease, and right heart catheterization revealed severely elevated filling pressures and depressed cardiac index. She underwent aggressive diuresis and placement of an intra-aortic balloon pump in addition to initiation of inotropic and vasopressor support. While in the cardiac intensive care unit, she experienced frequent episodes of ventricular tachycardia and went into cardiac arrest requiring cardiopulmonary resuscitation. High clinical suspicion for cardiac sarcoidosis was confirmed by cardiac magnetic resonance imaging findings. After starting immunosuppressive therapy for cardiac sarcoidosis, she demonstrated clinical improvement. CONCLUSION Patients with cardiac sarcoidosis may remain asymptomatic or present with conduction abnormalities and arrhythmias. They rarely present with severe biventricular heart failure and cardiogenic shock, and in such cases, they require timely initiation of pharmacologic and device therapies, along with implementation of mechanical circulatory support.
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Affiliation(s)
- Teja Chakrala
- Department of Medicine, University of Florida, 1600 SW Archer Road, Gainesville, FL, 32610, USA.
| | - Roshni O Prakash
- Department of Medicine, University of Florida, 1600 SW Archer Road, Gainesville, FL, 32610, USA
| | - Anshul Jain
- Department of Medicine, University of Florida, 1600 SW Archer Road, Gainesville, FL, 32610, USA
| | - R Ashton Vautier
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA
| | - Sahil Prasada
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA
| | - Mohammed Al-Ani
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA
| | - Mustafa M Ahmed
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA
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3
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Muacevic A, Adler JR, Drew PA, Moguillansky D. A 65-Year-Old Male With Classic Cardiac Sarcoidosis: Case Report and Review of the Literature. Cureus 2022; 14:e31705. [PMID: 36561583 PMCID: PMC9767670 DOI: 10.7759/cureus.31705] [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: 11/19/2022] [Indexed: 11/21/2022] Open
Abstract
Sarcoidosis is a systemic disease characterized by the formation of non-necrotizing granulomas, primarily involving the lungs and other organs such as the heart. The diagnosis of cardiac sarcoidosis can be difficult. The last set of diagnostic guidelines for diagnosis and treatment of cardiac sarcoidosis was published in 2019 by the Japanese Circulation Society (JCS). We describe a case of classic cardiac sarcoidosis and review the literature on clinical presentation, imaging, and management.
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Long-term, real world experience of ventricular tachycardia and granulomatous cardiomyopathy. Indian Pacing Electrophysiol J 2022; 22:169-178. [PMID: 35398517 PMCID: PMC9264019 DOI: 10.1016/j.ipej.2022.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 03/31/2022] [Accepted: 04/04/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Granulomatous cardiomyopathy(GCM) is relatively uncommon in patients presenting with ventricular tachycardia(VT). Sarcoidosis and tuberculosis are the most common causes of GCM with VT. The aim of study was to evaluate their clinical characteristics and the long-term outcomes. METHODS We retrospectively analyzed patients from March 2004 to January 2020, presenting with VT and subsequently diagnosed to have GCM. Patients were divided into three groups (sarcoid, tuberculosis and indeterminate) based on serologic tests, imaging and histopathology. The response to anti-arrhythmic and disease specific therapy on long-term follow-up were analysed. RESULTS There were 52 patients, comprising 27 males and 25 females, age 40 ± 10 years. The follow-up period was 5.9 ± 3.9 years. Sarcoidosis was diagnosed in 20(38%); tuberculosis(TB) in 15(29%) and 17(33%) patients were indeterminate. Left ventricular ejection fraction(LVEF) of the entire cohort was 0.45 ± 0.14. Erythrocyte Sedimentation Rate(ESR) was found to be significantly higher in TB(43.6 ± 18.4) patients vs sarcoid(18.9 ± 6.7)p < 0.0001, but not the indeterminate group(36.2 ± 21.1), p = 0.3. Implantable Cardioverter Defibrillator(ICD) implantation was performed in 12/20(60%) patients in the sarcoid group, in 4/15(27%) patients in the TB group and in 10/17(59%) patients in the indeterminate group. At a mean follow-up of six years, VT recurrences were noted in 6, 2, and 7 patients in the sarcoid, TB and indeterminate groups respectively. CONCLUSION Despite the advances in diagnostic modalities for tuberculosis and sarcoidosis, in real-world practice, almost one-third of the patients with VT and GCM have uncertain etiology. Long term outcomes of patients presenting with GCM and VT with mild left ventricle dysfunction treated appropriately seems favorable.
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5
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McGoldrick MT, Giuliano K, Etchill EW, Barbur I, Yenokyan G, Whitman G, Kilic A. Long-term survival after heart transplantation for cardiac sarcoidosis. J Card Surg 2021; 36:4247-4255. [PMID: 34176168 DOI: 10.1111/jocs.15783] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/07/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cardiac sarcoidosis is an increasingly common indication for a heart transplant, but there is a paucity of knowledge with regard to long-term outcomes following transplant. METHODS We utilized the Organ Procurement and Transplantation Network database to retrospectively analyze adult patients undergoing first-time, single-organ heart transplant between January 1999 and March 2020. RESULTS Of the 41,447 patients that underwent heart transplant during the study period, 289 (0.7%) were transplanted for a primary diagnosis of restrictive cardiomyopathy due to cardiac sarcoidosis (RCM-Sarcoidosis). RCM-Sarcoidosis was associated with 33% reduced risk of mortality over 10 years compared to non-RCM indications in a multivariable Cox proportional hazards model (p = .03). Ten-year survival functions were improved among RCM-Sarcoidosis compared to this reference group (73.4% [64.2%-80.6%] vs. 59.5% [58.8%-60.1%], p = .002). Among patients transplanted after 1999 who had at least 10 years of follow-up (n = 19,489), median survival of RCM-Sarcoidosis patients was 11.9 [8.3-14.6] years while that of non-RCM patients was 9.9 [4.0-13.1] years. RCM-Sarcoidosis was not associated with an increased risk of secondary outcomes such as graft failure, rejection, or infection. The incidence of retransplant was comparable between RCM-Sarcoidosis and non-RCM patients (1.38% vs. 1.50%, p = .93). CONCLUSIONS These data suggest that long-term outcomes following transplant for cardiac sarcoidosis are favorable compared to heart transplant for other indications.
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Affiliation(s)
- Matthew T McGoldrick
- Department of Surgery, Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Katherine Giuliano
- Department of Surgery, Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Eric W Etchill
- Department of Surgery, Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Iulia Barbur
- Department of Surgery, Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Gayane Yenokyan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Glenn Whitman
- Department of Surgery, Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Ahmet Kilic
- Department of Surgery, Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Rao Kulkarni RJ, Phadke AY, Prabhudesai PP, Balkundi KA. An Unusual Case of Atrial Wall Cardiac Sarcoidosis Detected on Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography Scan. Indian J Nucl Med 2021; 36:46-49. [PMID: 34040296 PMCID: PMC8130687 DOI: 10.4103/ijnm.ijnm_178_20] [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: 08/03/2020] [Revised: 08/13/2020] [Accepted: 08/13/2020] [Indexed: 11/04/2022] Open
Abstract
Isolated cardiac sarcoidosis (ICS) accounts for 5%-10% of patients with sarcoidosis. It can involve atrioventricular node causing heart block, as well as the basal septum, papillary muscles, focal regions in the free wall, and the myocardium being more commonly involved. The diagnosis is achieved on magnetic resonance imaging (MRI) and endomyocardial biopsy. Recently, Fluorine-18 fluorodeoxyglucose positron emission tomography and computed tomography (F-18 FDG PET) has been incorporated in the diagnosis as well as management algorithm. We describe an interesting case of ICS detected on F-18 FDG PET and MRI and discuss its role in the management of this rare presentation.
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Affiliation(s)
| | - Aniruddha Y Phadke
- Department of Gastroenterology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Pralhad P Prabhudesai
- Department of Respiratory Medicine, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Krishna A Balkundi
- Department of Nuclear Medicine, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
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7
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Lui JK, Mesfin N, Tugal D, Klings ES, Govender P, Berman JS. Critical Care of Patients With Cardiopulmonary Complications of Sarcoidosis. J Intensive Care Med 2021; 37:441-458. [PMID: 33611981 DOI: 10.1177/0885066621993041] [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: 11/16/2022]
Abstract
Sarcoidosis is a systemic inflammatory disease defined by the presence of aberrant granulomas affecting various organs. Due to its multisystem involvement, care of patients with established sarcoidosis becomes challenging, especially in the intensive care setting. While the lungs are typically involved, extrapulmonary manifestations also occur either concurrently or exclusively within a significant proportion of patients, complicating diagnostic and management decisions. The scope of this review is to focus on what considerations are necessary in the evaluation and management of patients with known sarcoidosis and their associated complications within a cardiopulmonary and critical care perspective.
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Affiliation(s)
- Justin K Lui
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA.,Section of Pulmonary, Allergy, Sleep & Critical Care Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Nathan Mesfin
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA.,Section of Pulmonary, Allergy, Sleep & Critical Care Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Derin Tugal
- Section of Cardiovascular Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Elizabeth S Klings
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA.,Section of Pulmonary, Allergy, Sleep & Critical Care Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Praveen Govender
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA.,Section of Pulmonary, Allergy, Sleep & Critical Care Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Jeffrey S Berman
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA.,Section of Pulmonary, Allergy, Sleep & Critical Care Medicine, Boston University School of Medicine, Boston, MA, USA
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8
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Sascău R, Anghel L, Clement A, Bostan M, Radu R, Stătescu C. The Importance of Multimodality Imaging in the Diagnosis and Management of Patients with Infiltrative Cardiomyopathies: An Update. Diagnostics (Basel) 2021; 11:diagnostics11020256. [PMID: 33562254 PMCID: PMC7915769 DOI: 10.3390/diagnostics11020256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 12/16/2022] Open
Abstract
Infiltrative cardiomyopathies (ICMs) comprise a broad spectrum of inherited and acquired conditions (mainly amyloidosis, sarcoidosis, and hemochromatosis), where the progressive buildup of abnormal substances within the myocardium results in left ventricular hypertrophy and manifests as restrictive physiology. Noninvasive multimodality imaging has gradually eliminated endomyocardial biopsy from the diagnostic workup of infiltrative cardiac deposition diseases. However, even with modern imaging techniques’ widespread availability, these pathologies persist in being largely under- or misdiagnosed. Considering the advent of novel, revolutionary pharmacotherapies for cardiac amyloidosis, the archetypal example of ICM, a standardized diagnostic approach is warranted. Therefore, this review aims to emphasize the importance of contemporary cardiac imaging in identifying specific ICM and improving outcomes via the prompt initiation of a targeted treatment.
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Affiliation(s)
- Radu Sascău
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania; (R.S.); (R.R.); (C.S.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M.Georgescu”, 700503 Iași, Romania
| | - Larisa Anghel
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania; (R.S.); (R.R.); (C.S.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M.Georgescu”, 700503 Iași, Romania
- Correspondence: (L.A.); (A.C.); (M.B.); Tel.: +40-0232-211834 (L.A.); +40-0232-211834 (A.C.); +40-0232-211834 (M.B.)
| | - Alexandra Clement
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M.Georgescu”, 700503 Iași, Romania
- Correspondence: (L.A.); (A.C.); (M.B.); Tel.: +40-0232-211834 (L.A.); +40-0232-211834 (A.C.); +40-0232-211834 (M.B.)
| | - Mădălina Bostan
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania; (R.S.); (R.R.); (C.S.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M.Georgescu”, 700503 Iași, Romania
- Correspondence: (L.A.); (A.C.); (M.B.); Tel.: +40-0232-211834 (L.A.); +40-0232-211834 (A.C.); +40-0232-211834 (M.B.)
| | - Rodica Radu
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania; (R.S.); (R.R.); (C.S.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M.Georgescu”, 700503 Iași, Romania
| | - Cristian Stătescu
- Internal Medicine Department, “Grigore T. Popa” University of Medicine and Pharmacy, 700503 Iași, Romania; (R.S.); (R.R.); (C.S.)
- Cardiology Department, Cardiovascular Diseases Institute “Prof. Dr. George I.M.Georgescu”, 700503 Iași, Romania
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Abstract
PURPOSE OF REVIEW In sarcoidosis, the appropriate management strategy remains challenging especially because of the lack of confident diagnosis, considerable variability in initial presentation, disease evolution, and outcome. Although asymptomatic patients with limited cardiac involvement have been described to have a benign outcome, cardiac sarcoidosis is associated with high morbidity and mortality and even sudden cardiac death in a significant proportion of patients. Higher morbidity and mortality can be related with both the disease activity and extent of fibrosis. RECENT FINDINGS Historical series suggested a 5-year mortality rate of 60% in patients with cardiac sarcoidosis. This has definitely improved with the appropriate use of anti-inflammatory medications as well as heart failure treatment, antiarrhythmic medication and device implantation. Timely recognition and vigorous initial approach is essential in avoiding life-threatening arrhythmias and sudden cardiac death. Advanced imaging modalities have proven to be helpful in the diagnostic approach and guiding treatment decisions. However, there is no optimal screening and risk stratification strategy available and further studies are required to determine, which patients would benefit from the available treatments. SUMMARY This review concentrates on the broad principles of management in cardiac sarcoidosis and the efficacy of sarcoidosis-specific medication and cardiac-specific therapies for cardiac dysfunction and rhythm disturbances.
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Affiliation(s)
| | | | - Rakesh Sharma
- Cardiology Department, Royal Brompton Hospital, London, UK
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10
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Peña-Garcia JI, Shaikh SJ, Villacis-Nunez DS, Gurram MK. Pericardial Effusion in Systemic Sarcoidosis: A Rare Manifestation of Cardiac Sarcoid. Heart Views 2019; 20:56-59. [PMID: 31462960 PMCID: PMC6686615 DOI: 10.4103/heartviews.heartviews_117_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a 65-year-old African American woman who was found to have pericardial effusion secondary to cardiac sarcoid. Pericardial effusion is a rare manifestation of cardiac sarcoid. All cases of sustemic sarcoid should be evaluated for cardiac involvement which can be difficult to detect.
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Affiliation(s)
| | - Sana Javeed Shaikh
- Department of Internal Medicine, SSM St. Mary's Hospital - St. Louis, MO, USA
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11
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Terasaki F, Fujita S, Miyamura M, Kuwabara H, Hirose Y, Torii I, Nakamura T, Hoshiga M. Atrial Arrhythmias and Atrial Involvement in Cardiac Sarcoidosis. Int Heart J 2019; 60:788-795. [PMID: 31353344 DOI: 10.1536/ihj.19-265] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Severe ventricular arrhythmias such as high-grade atrioventricular block and ventricular tachycardia may cause lethal conditions or sudden death in patients with cardiac sarcoidosis (CS). Physicians should examine patients carefully for these conditions and treat them appropriately. As arrhythmias are being better diagnosed and treated, physicians are increasingly aware of atrial arrhythmias, which have not been focused upon as CS-related conditions, in patients with CS. This article reports a case of atrial flutter in sarcoidosis, and discusses literature findings on atrial arrhythmias and atrial involvement of CS. It is highly likely that atrial arrhythmia and supraventricular conduction disorder associated with or caused by CS are more common than previously thought. Physicians should pay careful attention for these conditions in the diagnosis and treatment of CS.
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Affiliation(s)
- Fumio Terasaki
- Medical Education Center, Osaka Medical College.,Department of Cardiology, Osaka Medical College
| | | | | | | | | | - Ikuko Torii
- Division of Hospital Pathology, Hoshigaoka Medical Center
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12
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Jaimes CP, Arcos LC, Carrero NE, Gelves J, Sánchez L. Miocardiopatías infiltrativas. Aporte de la ecocardiografía. REVISTA COLOMBIANA DE CARDIOLOGÍA 2019. [DOI: 10.1016/j.rccar.2018.10.006] [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] Open
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13
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Trisvetova EL, Yudina OA, Smolensky AZ, Cherstvyi ED. [Diagnosis of isolated cardiac sarcoidosis]. Arkh Patol 2019; 81:57-64. [PMID: 30830107 DOI: 10.17116/patol20198101157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Heart involvement in sarcoidosis is diagnosed in vivo in 5-7%, at autopsy in 25% of cases as a manifestation of a systemic process and an isolated one. Difficulties in the diagnosis of isolated sarcoidosis are due to the absence of known causes of the disease and to the lack of specificity of clinical manifestations. The main symptoms include cardiac conduction and rhythm disturbances, cardiomyopathy with the development of heart failure, as well as pericardial involvement. Routine techniques (ECG, EchoCG, daily ECG monitoring) and imaging of the structures of the heart and its function evaluation (MRI, PET, and scintigraphy) are used in diagnosis. A set of clinical, instrumental, and histological data obtained at endomyocardial biopsy may suggest isolated cardiac sarcoidosis with the exception of other diseases.
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Affiliation(s)
- E L Trisvetova
- Belarusian State Medical University, Minsk, Republic of Belarus
| | - O A Yudina
- Belarusian State Medical University, Minsk, Republic of Belarus; City Clinical Pathological Anatomy Bureau, Minsk, Republic of Belarus
| | - A Z Smolensky
- City Clinical Pathological Anatomy Bureau, Minsk, Republic of Belarus
| | - E D Cherstvyi
- Belarusian State Medical University, Minsk, Republic of Belarus
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14
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Toma M, Birnie D. Heart Transplantation for End-Stage Cardiac Sarcoidosis: Increasingly Used With Excellent Results. Can J Cardiol 2018; 34:956-958. [DOI: 10.1016/j.cjca.2018.04.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 04/11/2018] [Accepted: 04/11/2018] [Indexed: 01/28/2023] Open
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15
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Aljizeeri A, Sulaiman A, Alhulaimi N, Alsaileek A, Al-Mallah MH. Cardiac magnetic resonance imaging in heart failure: where the alphabet begins! Heart Fail Rev 2018; 22:385-399. [PMID: 28432605 DOI: 10.1007/s10741-017-9609-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Cardiac Magnetic Resonance Imaging has become a cornerstone in the evaluation of heart failure. It provides a comprehensive evaluation by answering all the pertinent clinical questions across the full pathological spectrum of heart failure. Nowadays, CMR is considered the gold standard in evaluation of ventricular volumes, wall motion and systolic function. Through its unique ability of tissue characterization, it provides incremental diagnostic and prognostic information and thus has emerged as a comprehensive imaging modality in heart failure. This review outlines the role of main conventional CMR sequences in the evaluation of heart failure and their impact in the management and prognosis.
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Affiliation(s)
- Ahmed Aljizeeri
- Divsions of Cardiology and Advanced Cardiac Imaging, King Abdulaziz Cardiac Center, King Abdulaziz Medical City (Riyadh), Ministry of National Guard - Health Affairs, P.O. Box 22490, Riyadh, 11426. Mail Code: 1413, Kingdom of Saudi Arabia. .,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. .,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
| | - Abdulbaset Sulaiman
- Divsions of Cardiology and Advanced Cardiac Imaging, King Abdulaziz Cardiac Center, King Abdulaziz Medical City (Riyadh), Ministry of National Guard - Health Affairs, P.O. Box 22490, Riyadh, 11426. Mail Code: 1413, Kingdom of Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Naji Alhulaimi
- Mazankowski Alberta Heart Institute, University of Alberta Hospital, Edmonton, AB, Canada
| | - Ahmed Alsaileek
- Divsions of Cardiology and Advanced Cardiac Imaging, King Abdulaziz Cardiac Center, King Abdulaziz Medical City (Riyadh), Ministry of National Guard - Health Affairs, P.O. Box 22490, Riyadh, 11426. Mail Code: 1413, Kingdom of Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mouaz H Al-Mallah
- Divsions of Cardiology and Advanced Cardiac Imaging, King Abdulaziz Cardiac Center, King Abdulaziz Medical City (Riyadh), Ministry of National Guard - Health Affairs, P.O. Box 22490, Riyadh, 11426. Mail Code: 1413, Kingdom of Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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17
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Birnie DH, Nery PB, Ha AC, Beanlands RSB. Cardiac Sarcoidosis. J Am Coll Cardiol 2017; 68:411-21. [PMID: 27443438 DOI: 10.1016/j.jacc.2016.03.605] [Citation(s) in RCA: 342] [Impact Index Per Article: 48.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 03/01/2016] [Indexed: 11/30/2022]
Abstract
Clinically manifest cardiac involvement occurs in perhaps 5% of patients with sarcoidosis. The 3 principal manifestations of cardiac sarcoidosis (CS) are conduction abnormalities, ventricular arrhythmias, and heart failure. An estimated 20% to 25% of patients with pulmonary/systemic sarcoidosis have asymptomatic cardiac involvement (clinically silent disease). In 2014, the first international guideline for the diagnosis and management of CS was published. In patients with clinically manifest CS, the extent of left ventricular dysfunction seems to be the most important predictor of prognosis. There is controversy in published reports as to the outcome of patients with clinically silent CS. Despite a paucity of data, immunosuppression therapy (primarily with corticosteroids) has been advocated for the treatment of clinically manifest CS. Device therapy, primarily with implantable cardioverter-defibrillators, is often recommended for patients with clinically manifest disease.
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Affiliation(s)
- David H Birnie
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | - Pablo B Nery
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Andrew C Ha
- Peter Munk Cardiac Centre, University Health Network and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rob S B Beanlands
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Shelke AB, Aurangabadkar HU, Bradfield JS, Ali Z, Kumar KS, Narasimhan C. Serial FDG-PET scans help to identify steroid resistance in cardiac sarcoidosis. Int J Cardiol 2017; 228:717-722. [DOI: 10.1016/j.ijcard.2016.11.142] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 11/06/2016] [Indexed: 10/20/2022]
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IgG4-related systemic disease presenting with pleural effusion, ascites and dilated cardiomyopathy. TUMORI JOURNAL 2016; 102:5360919C-5C64-45EB-BBBE-59BF2953909F. [PMID: 27079904 DOI: 10.5301/tj.5000502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2016] [Indexed: 12/25/2022]
Abstract
PURPOSE We report the case of a patient with IgG4-related disease with multiple organ involvement, especially myocardium, that was successfully treated with prednisone. METHODS We performed several serological tests, electrocardiogram, echocardiography, computed tomography and inguinal lymph node biopsy. RESULTS We diagnosed the patient with IgG4-related disease by the elevated serum IgG4 level and histological lymph node findings. CONCLUSIONS This is the first reported case of IgG4-related disease with dilated cardiomyopathy.
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Clinical and radiological features of extra-pulmonary sarcoidosis: a pictorial essay. Insights Imaging 2016; 7:571-87. [PMID: 27222055 PMCID: PMC4956623 DOI: 10.1007/s13244-016-0495-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 04/07/2016] [Accepted: 04/22/2016] [Indexed: 12/19/2022] Open
Abstract
Abstract The aim of this manuscript is to describe radiological findings of extra-pulmonary sarcoidosis. Sarcoidosis is an immune-mediated systemic disease of unknown origin, characterized by non-caseating epitheliod granulomas. Ninety percent of patients show granulomas located in the lungs or in the related lymph nodes. However, lesions can affect any organ. Typical imaging features of liver and spleen sarcoidosis include visceromegaly, with multiple nodules hypodense on CT images and hypointense on T2-weighted MRI acquisitions. Main clinical and radiological manifestations of renal sarcoidosis are nephrolithiasis, nephrocalcinosis, and acute interstitial nephritis. Brain sarcoidosis shows multiple or solitary parenchymal nodules on MRI that enhance with a ring-like appearance after gadolinium. In spinal cord localization, MRI demonstrates enlargement and hyperintensity of spinal cord, with hypointense lesions on T2-weighted images. Skeletal involvement is mostly located in small bone, showing many lytic lesions; less frequently, bone lesions have a sclerotic appearance. Ocular involvement includes uveitis, conjunctivitis, optical nerve disease, chorioretinis. Erythema nodosum and lupus pernio represent the most common cutaneous manifestations encountered. Sarcoidosis in various organs can be very insidious for radiologists, showing different imaging features, often non-specific. Awareness of these imaging features helps radiologists to obtain the correct diagnosis. Teaching Points • Systemic sarcoidosis can exhibit abdominal, neural, skeletal, ocular, and cutaneous manifestations. • T2 signal intensity of hepatosplenic nodules may reflect the disease activity. • Heerfordt’s syndrome includes facial nerve palsy, fever, parotid swelling, and uveitis. • In the vertebrae, osteolytic and/or diffuse sclerotic lesions can be found. • Erythema nodosum and lupus pernio represent the most common cutaneous manifestations.
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A Diagnostic and Therapeutic Approach to Arrhythmias in Cardiac Sarcoidosis. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2016; 18:16. [PMID: 26874704 DOI: 10.1007/s11936-016-0439-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OPINION STATEMENT Cardiac sarcoidosis is a protean disease, capable of causing nearly any cardiac abnormality. Electrical abnormalities including heart block and ventricular tachyarrhythmias are some of the most feared manifestations of cardiac sarcoidosis. Despite increasing awareness, cardiac sarcoidosis remains underdiagnosed in clinical practice, and as a result, many patients do not receive potentially disease-altering immunosuppressant therapy. In this review, we discuss cardiac sarcoidosis and its management, focusing diagnostic and therapeutic approaches to arrhythmias in cardiac sarcoidosis.
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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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Abstract
Studies suggest clinically manifest cardiac involvement occurs in 5% of patients with pulmonary/systemic sarcoidosis. The principal manifestations of cardiac sarcoidosis (CS) are conduction abnormalities, ventricular arrhythmias, and heart failure. Data indicate that an 20% to 25% of patients with pulmonary/systemic sarcoidosis have asymptomatic (clinically silent) cardiac involvement. An international guideline for the diagnosis and management of CS recommends that patients be screened for cardiac involvement. Most studies suggest a benign prognosis for patients with clinically silent CS. Immunosuppression therapy is advocated for clinically manifest CS. Device therapy, with implantable cardioverter defibrillators, is recommended for some patients.
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Affiliation(s)
- David Birnie
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4 W7, Canada.
| | - Andrew C T Ha
- Department of Medicine, Peter Munk Cardiac Centre, University Health Network, University of Toronto, GW 3-558A, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada
| | - Lorne J Gula
- Division of Cardiology, London Health Sciences Centre, 339 Windermere Road, c6-110, London, Ontario N6A 5A5, Canada
| | - Santabhanu Chakrabarti
- Division of Cardiology, Department of Medicine, University of British Columbia, 211 1033, Davie Street, Vancouver, British Columbia V6E 1M7, Canada
| | - Rob S B Beanlands
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4 W7, Canada
| | - Pablo Nery
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4 W7, Canada
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Abstract
Cardiac sarcoidosis is a potentially life-threatening condition characterized by formation of granulomas in the heart, resulting in conduction disturbances, atrial and ventricular arrhythmias, and ventricular dysfunction. The presentation of cardiac sarcoidosis ranges from asymptomatic with an abnormal imaging scan, to palpitations, syncope, symptoms of congestive heart failure, and sudden cardiac death. Screening for cardiac sarcoidosis has not been standardized, but the presence of cardiac symptoms on medical history and physical examination, and an abnormal electrocardiogram (ECG), Holter monitoring, or echocardiogram has been shown to be highly sensitive for detecting cardiac sarcoidosis. A signal-averaged ECG might also have a role in screening for cardiac sarcoidosis in asymptomatic patients. Although endomyocardial biopsies are highly specific for the diagnosis of cardiac sarcoidosis, procedural yield is very low and appropriate findings on cardiac MRI or PET are, therefore, often used as diagnostic surrogates. Treatment for cardiac sarcoidosis usually involves immunosuppressive therapy, particularly corticosteroids. Additional therapy might be required, depending on the clinical presentation, including implantation of an internal defibrillator, antiarrhythmic agents, and catheter ablation.
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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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Golwala H, Dernaika T. Atrial fibrillation as the initial clinical manifestation of cardiac sarcoidosis. J Cardiovasc Med (Hagerstown) 2015; 16 Suppl 2:S104-12. [DOI: 10.2459/jcm.0b013e328343b589] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Houston BA, Mukherjee M. Cardiac sarcoidosis: clinical manifestations, imaging characteristics, and therapeutic approach. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2014; 8:31-7. [PMID: 25452702 PMCID: PMC4240214 DOI: 10.4137/cmc.s15713] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 10/12/2014] [Accepted: 10/21/2014] [Indexed: 12/26/2022]
Abstract
Sarcoidosis is a multi-system disease pathologically characterized by the accumulation of T-lymphocytes and mononuclear phagocytes into the sine qua non pathologic structure of the noncaseating granuloma. Cardiac involvement remains a key source of morbidity and mortality in sarcoidosis. Definitive diagnosis of cardiac sarcoidosis, particularly early enough in the disease course to provide maximal therapeutic impact, has proven a particularly difficult challenge. However, major advancements in imaging techniques have been made in the last decade. Advancements in imaging modalities including echocardiography, nuclear spectroscopy, positron emission tomography, and magnetic resonance imaging all have improved our ability to diagnose cardiac sarcoidosis, and in many cases to provide a more accurate prognosis and thus targeted therapy. Likewise, therapy for cardiac sarcoidosis is beginning to advance past a “steroids-only” approach, as novel immunosuppressant agents provide effective steroid-sparing options. The following focused review will provide a brief discussion of the epidemiology and clinical presentation of cardiac sarcoidosis followed by a discussion of up-to-date imaging modalities employed in its assessment and therapeutic approaches.
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Affiliation(s)
- Brian A Houston
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Monica Mukherjee
- Division of Cardiology, Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
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Birnie DH, Sauer WH, Bogun F, Cooper JM, Culver DA, Duvernoy CS, Judson MA, Kron J, Mehta D, Cosedis Nielsen J, Patel AR, Ohe T, Raatikainen P, Soejima K. HRS expert consensus statement on the diagnosis and management of arrhythmias associated with cardiac sarcoidosis. Heart Rhythm 2014; 11:1305-23. [PMID: 24819193 DOI: 10.1016/j.hrthm.2014.03.043] [Citation(s) in RCA: 881] [Impact Index Per Article: 88.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Indexed: 02/07/2023]
Affiliation(s)
- David H Birnie
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | | | | | | | | | - Claire S Duvernoy
- VA Ann Arbor Healthcare System and University of Michigan, Ann Arbor, Michigan
| | | | - Jordana Kron
- Virginia Commonwealth University, Richmond, Virginia
| | | | | | | | - Tohru Ohe
- Sakakibara Heart Institute of Okayama, Okayama, Japan
| | | | - Kyoko Soejima
- Kyorin University School of Medicine, Mitaka City, Japan
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NERY PABLOB, BEANLANDS ROBS, NAIR GIRISHM, GREEN MARTIN, YANG JIM, MCARDLE BRIANA, DAVIS DARRYL, OHIRA HIROSHI, GOLLOB MICHAELH, LEUNG EUGENE, HEALEY JEFFS, BIRNIE DAVIDH. Atrioventricular Block as the Initial Manifestation of Cardiac Sarcoidosis in Middle-Aged Adults. J Cardiovasc Electrophysiol 2014; 25:875-881. [DOI: 10.1111/jce.12401] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Revised: 02/16/2014] [Accepted: 02/27/2014] [Indexed: 11/29/2022]
Affiliation(s)
- PABLO B. NERY
- Division of Cardiology; Department of Medicine; University of Ottawa Heart Institute; Ottawa Canada
| | - ROB S. BEANLANDS
- Division of Cardiology; Department of Medicine; University of Ottawa Heart Institute; Ottawa Canada
| | - GIRISH M. NAIR
- Division of Cardiology; Department of Medicine; University of Ottawa Heart Institute; Ottawa Canada
| | - MARTIN GREEN
- Division of Cardiology; Department of Medicine; University of Ottawa Heart Institute; Ottawa Canada
| | - JIM YANG
- Division of Cardiology; Department of Medicine; University of Ottawa Heart Institute; Ottawa Canada
| | - BRIAN A. MCARDLE
- Division of Cardiology; Department of Medicine; University of Ottawa Heart Institute; Ottawa Canada
| | - DARRYL DAVIS
- Division of Cardiology; Department of Medicine; University of Ottawa Heart Institute; Ottawa Canada
| | - HIROSHI OHIRA
- Division of Cardiology; Department of Medicine; University of Ottawa Heart Institute; Ottawa Canada
| | - MICHAEL H. GOLLOB
- Division of Cardiology; Department of Medicine; University of Ottawa Heart Institute; Ottawa Canada
| | - EUGENE LEUNG
- Division of Nuclear Medicine; Department of Medicine; University of Ottawa and The Ottawa Hospital; Ottawa Canada
| | - JEFF S. HEALEY
- Population Health Research Institute; McMaster University; Hamilton Ontario Canada
| | - DAVID H. BIRNIE
- Division of Cardiology; Department of Medicine; University of Ottawa Heart Institute; Ottawa Canada
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Segura AM, Radovancevic R, Demirozu ZT, Frazier O, Buja LM. Granulomatous myocarditis in severe heart failure patients undergoing implantation of a left ventricular assist device. Cardiovasc Pathol 2014; 23:17-20. [DOI: 10.1016/j.carpath.2013.06.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 05/13/2013] [Accepted: 06/27/2013] [Indexed: 01/08/2023] Open
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Terasaki F, Ishizaka N. Deterioration of cardiac function during the progression of cardiac sarcoidosis: diagnosis and treatment. Intern Med 2014; 53:1595-605. [PMID: 25088870 DOI: 10.2169/internalmedicine.53.2784] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The cardiac involvement of sarcoidosis causes progressive heart failure symptoms and is a life-threatening condition; thus, an early and appropriate diagnosis of this condition is crucial. On the other hand, the decline in the cardiac function is rapid; therefore, patients usually have moderate-severe left ventricular dysfunction when diagnosed with cardiac sarcoidosis, which may decrease the effectiveness of therapies. We herein report three illustrative cases of heart failure due to cardiac sarcoidosis in patients who were or were not diagnosed with preceding systemic sarcoidosis. We also discuss the currently available diagnostic modalities and possible biomarkers for the diagnosis of cardiac sarcoidosis.
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Nery PB, Mc Ardle BA, Redpath CJ, Leung E, Lemery R, Dekemp R, Yang J, Keren A, Beanlands RS, Birnie DH. Prevalence of cardiac sarcoidosis in patients presenting with monomorphic ventricular tachycardia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 37:364-74. [PMID: 24102263 DOI: 10.1111/pace.12277] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Revised: 07/23/2013] [Accepted: 07/30/2013] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Sarcoidosis is a granulomatous disease of unknown etiology, which involves the heart in 5-25% of cases. Although ventricular tachycardia (VT) has been reported as the first presentation of sarcoidosis, its prevalence has not previously been investigated. In this prospective study, we sought to systematically investigate the prevalence of cardiac sarcoidosis (CS) in patients presenting with monomorphic VT (MMVT) and no previous history of sarcoidosis. METHODS Consecutive patients presenting with MMVT to a tertiary care center were screened for inclusion. Patients with idiopathic VT, VT secondary to coronary artery disease, or prior diagnosis of sarcoidosis were excluded. Included patients underwent F-18-fluorodeoxyglucose positron emission tomography (PET) scan. In subjects with PET scanning suggestive of active myocardial inflammation, histological diagnosis was confirmed through extracardiac or endomyocardial biopsy (EMB). RESULTS A total of 182 patients presented to our institution with VT between February 2010 and September 2012 and 14 subjects met inclusion criteria. Within this group, six of 14 (42%) patients had abnormal PET scans suggesting active myocardial inflammation. Four of the six patients had tissue biopsies that were diagnostic of sarcoidosis; the remaining two patients had guided EMB indicating nonspecific myocarditis. Atrioventricular block was observed in three of four (75%) patients with CS and none in 10 of the others (P = 0.022). Three of the four patients had pulmonary sarcoidosis and one patient had isolated CS. All four patients were treated with corticosteroids. CONCLUSION In this prospective study, four of 14 (28%) patients presenting with MMVT (without idiopathic VT, ischemic VT, or known sarcoidosis) had CS as the underlying etiology. Clinicians should consider screening for CS in patients with unexplained MMVT.
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Affiliation(s)
- Pablo B Nery
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
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Sadek MM, Yung D, Birnie DH, Beanlands RS, Nery PB. Corticosteroid Therapy for Cardiac Sarcoidosis: A Systematic Review. Can J Cardiol 2013; 29:1034-41. [DOI: 10.1016/j.cjca.2013.02.004] [Citation(s) in RCA: 179] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 02/08/2013] [Accepted: 02/09/2013] [Indexed: 11/12/2022] Open
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Heng WL, Seck T, Tay CP, Chua A, Song C, Lim CH, Lim YP. Homograft banking in Singapore: two years of cardiovascular tissue banking in Southeast Asia. Cell Tissue Bank 2013; 14:187-94. [PMID: 22538986 PMCID: PMC3663252 DOI: 10.1007/s10561-012-9310-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 03/26/2012] [Indexed: 11/30/2022]
Abstract
Established in 2008, the National Cardiovascular Homograft Bank (NCHB) has been instrumental in creating an available supply of cardiovascular tissues for implantation in Singapore. This article introduces its collaboration with Singapore General Hospital Skin Bank Unit. The procedure of homograft recovery, processing, cryopreservation and quality assurance are presented. Since its establishment, the NCHB has followed the guidelines set by the Ministry of Health Singapore and the American Association of Tissue Banks. A total of 57 homografts had been recovered and 40 homografts were determined to be suitable for clinical use. The most significant reasons for non-clinical use are positive microbiological culture or unsuitable graft condition. Crucial findings prompted reviews and implementation of new procedures to improve the safety of homograft recipients. These include (1) a change in antibiotic decontamination regime from penicillin and streptomycin to amikacin and vancomycin after a review and (2) mandating histopathogical examination since the discovery of cardiac sarcoidosis in a previously undiagnosed donor. Further, the NCHB also routinely performs dengue virus screening, for donors suspected of dengue infection. Cultural factors which affect the donation rate are also briefly explored. By 2010, 31 homografts had been implanted into recipients with congenital or acquired heart valve conditions. More than half of these recipients were children. Post-operative outcomes had been encouraging, with no report of adverse events attributed to implanted homografts.
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Affiliation(s)
- Wee Ling Heng
- National Cardiovascular Homograft Bank, Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore, Singapore.
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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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Mc Ardle BA, Leung E, Ohira H, Cocker MS, deKemp RA, DaSilva J, Birnie D, Beanlands RS, Nery PB. The role of F(18)-fluorodeoxyglucose positron emission tomography in guiding diagnosis and management in patients with known or suspected cardiac sarcoidosis. J Nucl Cardiol 2013; 20:297-306. [PMID: 23288545 DOI: 10.1007/s12350-012-9668-9] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 12/09/2012] [Indexed: 11/30/2022]
Abstract
Cardiac sarcoidosis (CS) has gained significant interest in recent years with the emergence of advanced imaging modalities such as MRI and F(18)-fluorodeoxyglucose-positron emission tomography (FDG-PET) as modalities to aid in the diagnosis of this condition. CS remains a difficult condition to diagnose, particularly in cases of isolated cardiac involvement and it can present with a broad spectrum of clinical syndromes. Furthermore, the appropriate management of these patients remains controversial. FDG-PET has a potential role not only in diagnosis of CS but also in directing further therapies, facilitating the decision to start immunosuppression and monitoring the response to it. In this article, we discuss when to consider FDG-PET, outline the current optimal patient preparation and scanning protocols and then, using case examples, discuss the use of FDG-PET in follow-up of patients with known or suspected CS. We also outline how PET can influence management decisions in these patients.
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Affiliation(s)
- B A Mc Ardle
- Division of Cardiology, Department of Medicine, Arrhythmia Service, University of Ottawa Heart Institute, Ottawa, ON, Canada
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Varzeshi N, Hansen M, Rezaee A, Dixon N, Duhig E, Slaughter R. Radiology and pathology correlation in common infiltrative cardiomyopathies. J Med Imaging Radiat Oncol 2012; 56:628-35. [PMID: 23210582 DOI: 10.1111/j.1754-9485.2012.02431.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Accepted: 12/08/2011] [Indexed: 12/01/2022]
Abstract
Infiltrative cardiomyopathies generally pose a diagnostic dilemma as current diagnostic tools are imprecise. Invasive endomyocardial biopsy is considered as the gold standard however it has some limitations. Recently cardiovascular magnetic resonance (CMR) is emerging as an excellent technique in diagnosing infiltrative cardiomyopathies and is increasingly being used. Characteristic pathologic and radiologic findings in most common infiltrative cardiomyopathies (amyloid, sarcoid and Fabry's) are discussed and correlated with relative CMR and histologic examples. There is fairly good correlation between the non-invasive radiologic and the invasive histologic findings in common infiltrative cardiomyopathies. Non-invasive CMR with its high sensitivity and specificity has an excellent role in establishing the diagnosis and improving the prognosis of common infiltrative cardiomyopathies.
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Affiliation(s)
- Neda Varzeshi
- Medical Imaging Department, The Prince Charles Hospital, Brisbane, Queensland, Australia
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Abstract
PURPOSE OF REVIEW Sarcoidosis is a granulomatous disease of unclear cause and variable presentation. Cardiac involvement can result in life-threatening conditions including heart block, ventricular tachycardia, sudden cardiac death, and heart failure. There is no consensus on the diagnosis and management of cardiac sarcoidosis and a practical update is needed to provide clinicians with guidance. RECENT FINDINGS Three recent studies have described cardiac manifestations as the first presentation of sarcoidosis. In one study, cardiac sarcoidosis was found to be the underlying cause in 19% of adults aged less than 55 years presenting with new onset unexplained atrioventricular block. Also, there are increasing reports of patients with isolated cardiac sarcoidosis (i.e., without sarcoid in other organs). Finally, advances in imaging have enhanced our ability to detect myocardial involvement and perhaps follow response to treatment. SUMMARY Cardiac sarcoidosis should be considered in patients aged less than 55 years presenting with unexplained atrioventricular block and in patients with idiopathic cardiomyopathy and sustained ventricular tachycardia. Much remains to be learned about the condition, including the role of steroids and devices in treatment, and the place of advanced imaging in following the response to treatment. Collaborative multicenter studies are required to answer these important clinical questions.
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Chapelon-Abric C. Cardiac sarcoidosis. Presse Med 2012; 41:e317-30. [DOI: 10.1016/j.lpm.2012.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Revised: 04/03/2012] [Accepted: 04/03/2012] [Indexed: 12/27/2022] Open
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Abstract
Sarcoidosis is a multisystem, granulomatous disease. In this article, the various clinical manifestations, approach to, and management of, pulmonary and extrapulmonary sarcoidosis are reviewed.
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Affiliation(s)
- Nabeel Hamzeh
- Division of Environmental and Occupational Health Sciences, National Jewish Health, Denver, CO 80206, USA.
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Bocoum AI, Daumas A, Cammilleri S, Bernard F, Rossi P, Bagneres D, Demoux AL, Aissi K, Dales JP, Berdah S, Chaumoitre K, Frances Y, Granel B. Péricardite récidivante révélant une sarcoïdose systémique. Rev Med Interne 2011; 32:575-9. [DOI: 10.1016/j.revmed.2011.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 01/17/2011] [Accepted: 03/10/2011] [Indexed: 10/17/2022]
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Affiliation(s)
- Jonathon White
- From the Department of Cardiology (J.W., T.S., A.K.), Middlemore Hospital, Auckland, New Zealand; and the University of Auckland (A.K.), Auckland, New Zealand
| | - Tim Sutton
- From the Department of Cardiology (J.W., T.S., A.K.), Middlemore Hospital, Auckland, New Zealand; and the University of Auckland (A.K.), Auckland, New Zealand
| | - Andrew Kerr
- From the Department of Cardiology (J.W., T.S., A.K.), Middlemore Hospital, Auckland, New Zealand; and the University of Auckland (A.K.), Auckland, New Zealand
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Current World Literature. Curr Opin Rheumatol 2010; 22:97-105. [DOI: 10.1097/bor.0b013e328334b3e8] [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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Affiliation(s)
- Reda E. Girgis
- Associate Professor, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
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