1
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Hahn RT, Lerakis S, Delgado V, Addetia K, Burkhoff D, Muraru D, Pinney S, Friedberg MK. Multimodality Imaging of Right Heart Function: JACC Scientific Statement. J Am Coll Cardiol 2023; 81:1954-1973. [PMID: 37164529 DOI: 10.1016/j.jacc.2023.03.392] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 05/12/2023]
Abstract
Right ventricular (RV) size and function assessed by multimodality imaging are associated with outcomes in a variety of cardiovascular diseases. Understanding RV anatomy and physiology is essential in appreciating the strengths and weaknesses of current imaging methods and gives these measurements greater context. The adaptation of the right ventricle to different types and severity of stress, particularly over time, is specific to the cardiovascular disease process. Multimodality imaging parameters, which determine outcomes, reflect the ability to image the initial and longitudinal RV response to stress. This paper will review the standard and novel imaging methods for assessing RV function and the impact of these parameters on outcomes in specific disease states.
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Affiliation(s)
- Rebecca T Hahn
- Department of Medicine, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA.
| | | | - Victoria Delgado
- Hospital University Germans Trias i Pujol Hospital, Badalona, Barcelona, Spain
| | - Karima Addetia
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | | | - Denisa Muraru
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Sean Pinney
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
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2
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Akamatsu K, Ito T, Terasaki F, Hoshiga M. Myocardial findings evaluated by echocardiography in cardiac sarcoidosis: A report of seven cases. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:940-946. [PMID: 34431526 DOI: 10.1002/jcu.23058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/13/2021] [Accepted: 08/13/2021] [Indexed: 06/13/2023]
Abstract
Sarcoidosis is a multisystem granulomatous disease of unknown cause. With cardiac sarcoidosis (CS), patients represent a wide range of cardiac manifestations from subtle to overt morphological and functional abnormalities. The advent of ultrasound technologies has enabled to identify not only typical findings to CS such as basal thinning of the ventricular septum, but also subclinical myocardial alterations. Based on our recent experiences, we currently introduce a variety of myocardial manifestations evaluated by echocardiography on seven CS patients being selected. Most of the patients exhibited typical cardiac involvement and the remaining fairly unusual.
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Affiliation(s)
- Kanako Akamatsu
- Department of Cardiology, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Takahide Ito
- Department of Cardiology, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Fumio Terasaki
- Department of Cardiology, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Masaaki Hoshiga
- Department of Cardiology, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
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3
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Mathijssen H, Huitema MP, Bakker ALM, Akdim F, van Es HW, Grutters JC, Post MC. Value of echocardiography using knowledge-based reconstruction in determining right ventricular volumes in pulmonary sarcoidosis: comparison with cardiac magnetic resonance imaging. Int J Cardiovasc Imaging 2021; 38:309-316. [PMID: 34586530 DOI: 10.1007/s10554-021-02405-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
Right ventricular (RV) dysfunction in sarcoidosis is associated with adverse outcomes. Assessment of RV function by conventional transthoracic echocardiography (TTE) is challenging due to the complex RV geometry. Knowledge-based reconstruction (KBR) combines TTE measurements with three-dimensional coordinates to determine RV volumes. The aim of this study was to investigate the accuracy of TTE-KBR compared to the gold standard cardiac magnetic resonance imaging (CMR) in determining RV dimensions in pulmonary sarcoidosis. Pulmonary sarcoidosis patients prospectively received same-day TTE and TTE-KBR. If performed, CMR within 90 days after TTE-KBR was used as reference standard. Outcome parameters included RV end-diastolic volume (RVEDV), end-systolic volume (RVESV), stroke volume (RVSV) and ejection fraction (RVEF). 281 patients underwent same day TTE and TTE-KBR. In total, 122 patients received a CMR within 90 days of TTE and were included. TTE-KBR measured RVEDV and RVESV showed strong correlation with CMR measurements (R = 0.73, R = 0.76), while RVSV and RVEF correlated weakly (R = 0.46, R = 0.46). Bland-Altman analyses (mean bias ± 95% limits of agreement), showed good agreement for RVEDV (ΔRVEDVKBR-CMR, 5.67 ± 55.4 mL), while RVESV, RVSV and RVEF showed poor agreement (ΔRVESVKBR-CMR, 21.6 ± 34.1 mL; ΔRVSVKBR-CMR, - 16.1 ± 42.9 mL; ΔRVEFKBR-CMR, - 12.9 ± 16.4%). The image quality and time between CMR and TTE-KBR showed no impact on intermodality differences and there was no sign of a possible learning curve. TTE-KBR is convenient and shows good agreement with CMR for RVEDV. However, there is poor agreement for RVESV, RVSV and RVEF. The use of TTE-KBR does not seem to provide additional value in the determination of RV dimensions in pulmonary sarcoidosis patients.
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Affiliation(s)
- Harold Mathijssen
- Department of Cardiology, St. Antonius Hospital Nieuwegein/Utrecht, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands.
| | - Marloes P Huitema
- Department of Cardiology, St. Antonius Hospital Nieuwegein/Utrecht, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands
| | - Annelies L M Bakker
- Department of Cardiology, St. Antonius Hospital Nieuwegein/Utrecht, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands
| | - Fatima Akdim
- Department of Cardiology, St. Antonius Hospital Nieuwegein/Utrecht, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands
| | - Hendrik W van Es
- Department of Radiology, St. Antonius Hospital Nieuwegein/Utrecht, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands
| | - Jan C Grutters
- Department of Pulmonology, St. Antonius Hospital Nieuwegein/Utrecht, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands.,Department of Pulmonology, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Marco C Post
- Department of Cardiology, St. Antonius Hospital Nieuwegein/Utrecht, Koekoekslaan 1, 3435 CM, Nieuwegein, The Netherlands.,Department of Cardiology, University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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4
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Bobbio E, Björkenstam M, Nwaru BI, Giallauria F, Hessman E, Bergh N, Polte CL, Lehtonen J, Karason K, Bollano E. Short- and long-term outcomes after heart transplantation in cardiac sarcoidosis and giant-cell myocarditis: a systematic review and meta-analysis. Clin Res Cardiol 2021; 111:125-140. [PMID: 34402927 PMCID: PMC8816313 DOI: 10.1007/s00392-021-01920-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/11/2021] [Indexed: 12/14/2022]
Abstract
Heart transplantation (HTx) is a valid therapeutic option for end-stage heart failure secondary to cardiac sarcoidosis (CS) or giant-cell myocarditis (GCM). However, post-HTx outcomes in patients with inflammatory cardiomyopathy (ICM) have been poorly investigated. We searched PubMed, Scopus, Science Citation Index, EMBASE, and Google Scholar, screened the gray literature, and contacted experts in the field. We included studies comparing post-HTx survival, acute cellular rejection, and disease recurrence in patients with and without ICM. Data were synthesized by a random‐effects meta‐analysis. We screened 11,933 articles, of which 14 were considered eligible. In a pooled analysis, post-HTx survival was higher in CS than non-CS patients after 1 year (risk ratio [RR] 0.88, 95% confidence interval [CI] 0.60–1.17; I2 = 0%) and 5 years (RR 0.72, 95% CI 0.52–0.91; I2 = 0%), but statistically significant only after 5 years. During the first-year post-HTx, the risk of acute cellular rejection was similar for patients with and without CS, but after 5 years, it was lower in those with CS (RR 0.38, 95% CI 0.03–0.72; I2 = 0%). No difference in post-HTx survival was observed between patients with and without GCM after 1 year (RR 1.16, 95% CI 0.05–2.28; I2 = 0%) or 5 years (RR 0.98, 95% CI 0.42–1.54; I2 = 0%). During post-HTx follow-up, recurrence of CS and GCM occurred in 5% and 8% of patients, respectively. Post-HTx outcomes in patients with CS and GCM are comparable with cardiac recipients with other heart failure etiologies. Patients with ICM should not be disqualified from HTx.
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Affiliation(s)
- Emanuele Bobbio
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Medicine At Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marie Björkenstam
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Medicine At Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bright I Nwaru
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Francesco Giallauria
- Department of Translational Medical Sciences, 'Federico II' University of Naples, Naples, Italy
| | - Eva Hessman
- Biomedical Library, Gothenburg University Library, University of Gothenburg, Gothenburg, Sweden
| | - Niklas Bergh
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Medicine At Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christian L Polte
- Institute of Medicine At Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Departments of Clinical Physiology and Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jukka Lehtonen
- Heart and Lung Centre, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Kristjan Karason
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Medicine At Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Entela Bollano
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden. .,Institute of Medicine At Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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5
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Benmelouka AY, Abdelaal A, Mohamed ASE, Shamseldin LS, Zaki MM, Elsaeidy KS, Abdelmageed Mahmoud M, El-Qushayri AE, Ghozy S, Shariful Islam SM. Association between sarcoidosis and diabetes mellitus: a systematic review and meta-analysis. Expert Rev Respir Med 2021; 15:1589-1595. [PMID: 34018900 DOI: 10.1080/17476348.2021.1932471] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background: Sarcoidosis is multisystem inflammatory granulomatosis that can potentially affect any organ of the human body. We aimed to estimate the prevalence of diabetes mellitus (DM) in sarcoidosis patients and determine the association between sarcoidosis and DM.Method: All relevant articles reporting the prevalence of DM in sarcoidosis published until September 19th, 2020, were retrieved from ten electronic databases. We used the random effect model to perform the meta-analysis.Results: After screening 2,122 records, we included 19 studies (n = 18,686,162). The prevalence of DM in sarcoidosis patients was 12.7% (95% CI 10-16.1). The prevalence was highest in North America with 21.3% (13.5-31.8), followed by Europe 10.4 (7.9-13.7) and Asia 10% (1.8-39.7). Sarcoidosis patients had higher rates of DM compared to controls (OR 1.75; 95% CI 1.49-2.05). Sensitivity analysis, after removing the largest weighted study, did not reveal any effect on the significance of the results (OR 1.73; 95% CI 1.33-2.25).Conclusion: The prevalence of DM in sarcoidosis is considerably high, with increased odds of DM in sarcoidosis compared to healthy controls. Further research with a wide range of confounders is required to confirm the association of sarcoidosis with DM.
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Affiliation(s)
- Amira Yasmine Benmelouka
- Faculty of Medicine, University of Algiers, Algiers, Algeria.,Global Medical Research Initiative, Egypt
| | | | | | - Laila Salah Shamseldin
- Global Medical Research Initiative, Egypt.,Faculty of Medicine, Zagazig University, Zagazig, El-Sharkia, Egypt
| | - Mahmoud Mohamed Zaki
- Global Medical Research Initiative, Egypt.,Faculty of Medicine, Zagazig University, Zagazig, El-Sharkia, Egypt
| | - Khaled Saad Elsaeidy
- Global Medical Research Initiative, Egypt.,Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | | | - Sherief Ghozy
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
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6
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Gao C, Zeng W, Li X, Zheng Y, Liu W. Clinical Assistant Analysis of Color Doppler Ultrasound in Diagnosis Parameters of Chronic Heart Failure. JOURNAL OF MEDICAL IMAGING AND HEALTH INFORMATICS 2021. [DOI: 10.1166/jmihi.2021.3689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Chronic heart failure (CHF) is a group of clinical syndromes caused by changes in myocardial structure and function caused by any reason, leading to ventricular filling and ejection disorders. It is the final stage of the development of various cardiovascular diseases. It is a progressive
disease. Once it starts, even if there is no new myocardial damage, the clinic is still in a stable stage, and it can still continue to develop on its own. This article uses the comprehensive parameters of echocardiography to evaluate the overall heart function of patients with chronic heart
failure, and evaluates the treatment effect of patients with chronic heart failure. A total of 160 patients with chronic heart failure were studied, including 80 cases in the follow-up group, 40 cases in the non-follow-up group, and 40 cases in the normal control group. The heart failure ultrasound
index composed of the comprehensive parameters of echocardiography was used to measure brain natriureric pepride (BNP), and the heart function was graded. The results showed that when the heart failure ultrasound index value >3, the diagnosis of symptomatic chronic heart failure had a sensitivity
of 94.7%, a specificity of 94.6%, a positive predictive value of 97.8%, and a negative predictive value of 80.6%. The heart failure ultrasound index was positively correlated with plasma BNP and NYHA heart function (respectively 0.68, 0.73). After 6 months of observation, the ultrasound index
of heart failure in the follow-up group decreased significantly before and after treatment. The experimental results show that the heart failure ultrasound index can be used to guide the treatment of patients with chronic heart failure, evaluate the treatment effect, and evaluate the prognosis.
Appropriate health education and standardized medication can improve the treatment effect of chronic heart failure and improve the quality of life of patients.
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Affiliation(s)
- Chenwei Gao
- Department of Ultrasound Medicine, The First Affiliated Hospital of Hebei North University, Hebei Zhangjiakou, 075000, China
| | - Wei Zeng
- Department of Cardiology and Nephrology, The 81st Group Army Hospital of the Chinese People’s Liberation Army, Hebei Zhangjiakou, 075000, China
| | - Xueyong Li
- Department of Cardiology and Nephrology, The 81st Group Army Hospital of the Chinese People’s Liberation Army, Hebei Zhangjiakou, 075000, China
| | - Yingjuan Zheng
- Department of Ultrasound Medicine, The First Affiliated Hospital of Hebei North University, Hebei Zhangjiakou, 075000, China
| | - Weiliang Liu
- Department of Ultrasound Medicine, The First Affiliated Hospital of Hebei North University, Hebei Zhangjiakou, 075000, China
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7
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Mandoli GE, De Carli G, Pastore MC, Cameli P, Contorni F, D'Alessandro M, Bargagli E, Mondillo S, Cameli M. Right cardiac involvement in lung diseases: a multimodality approach from diagnosis to prognostication. J Intern Med 2021; 289:440-449. [PMID: 32996153 DOI: 10.1111/joim.13179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/12/2020] [Accepted: 09/17/2020] [Indexed: 02/04/2023]
Abstract
Lung diseases are amongst the main healthcare issues in the general population, having a high burden of morbidity and mortality. The cardiovascular system has a key role in patients affected by respiratory disorders. More specifically, the right ventricle (RV) enables the impaired lung function to be overcome in an initial stage of disease process, reducing the severity of dyspnoea. In addition, two of the main causes of death in this setting are RV failure and sudden cardiac death (SCD). Echocardiography is regarded as a useful and easily available tool in assessing RV function. Several noninvasive echocardiographic parameters of elevated pulmonary pressures and RV function have been proposed. The combination of different parameters and imaging methods is paramount and researches regarding RV impairment using these indices has been specifically addressed in relation to the chronic obstructive and restrictive lung disease in order to guide the clinicians in the management of these patients. Cardiac involvement in lung diseases is often observed, and RV changes are reported also in early stages of pulmonary diseases. The role of right ventricle in chronic respiratory disease patients has to be evaluated in detail to describe the response to therapy and the degree of disease progression through multimodality and advanced imaging techniques. The aim of this review is to describe the different pathophysiological mechanisms of cardiac impairment in primary lung disease (such as chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF) and sarcoidosis) and to summarize the role of cardiac multimodality imaging in the diagnosis and the prognosis of these diseases.
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Affiliation(s)
- G E Mandoli
- From the, Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - G De Carli
- From the, Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - M C Pastore
- From the, Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - P Cameli
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences & Neurosciences, Siena University Hospital, Siena, Italy
| | - F Contorni
- From the, Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - M D'Alessandro
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences & Neurosciences, Siena University Hospital, Siena, Italy
| | - E Bargagli
- Respiratory Diseases Unit, Department of Medical and Surgical Sciences & Neurosciences, Siena University Hospital, Siena, Italy
| | - S Mondillo
- From the, Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - M Cameli
- From the, Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
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8
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Masri SC, Bellumkonda L. Sarcoid Heart Disease: an Update on Diagnosis and Management. Curr Cardiol Rep 2020; 22:177. [PMID: 33119794 DOI: 10.1007/s11886-020-01429-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an update on cardiac sarcoidosis (CS) and to discuss the current recommendations and progress in diagnosis and management of this disease. Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Cardiac involvement is seen in at least 25% and is associated with poor prognosis. Manifestations of cardiac sarcoidosis (CS) can vary from presence of silent myocardial granulomas, which may lead to sudden death, to symptomatic conduction abnormalities, ventricular arrhythmias, and heart failure. RECENT FINDINGS We discuss newer imaging modalities such as cardiac magnetic resonance imaging and positron emission tomography in conjunction with clinical criteria increasingly used for diagnosing and prognosticating patients with CS. Immunosuppression (primarily corticosteroids) is recommended for treatment of CS; however, its efficacy has never been proven in prospective randomized studies. The role of imaging to guide the use of immunotherapy is unknown. Cardiac sarcoidosis continues to challenge clinicians due to its protean presentations, lack of diagnostic standards, and data for risk stratification and treatment. There is a need for prospective, randomized controlled trials to understand how best to diagnose and treat cardiac sarcoidosis.
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Affiliation(s)
- Sofia Carolina Masri
- Division of Cardiology, Department of Medicine, University of Wisconsin, Madison, WI, USA.
| | - Lavanya Bellumkonda
- Division of Cardiology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
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9
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Cavigli L, Focardi M, Cameli M, Mandoli GE, Mondillo S, D'Ascenzi F. The right ventricle in “Left-sided” cardiomyopathies: The dark side of the moon. Trends Cardiovasc Med 2020; 31:476-484. [DOI: 10.1016/j.tcm.2020.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/26/2020] [Accepted: 10/09/2020] [Indexed: 02/07/2023]
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10
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Crouser ED, Maier LA, Wilson KC, Bonham CA, Morgenthau AS, Patterson KC, Abston E, Bernstein RC, Blankstein R, Chen ES, Culver DA, Drake W, Drent M, Gerke AK, Ghobrial M, Govender P, Hamzeh N, James WE, Judson MA, Kellermeyer L, Knight S, Koth LL, Poletti V, Raman SV, Tukey MH, Westney GE. Diagnosis and Detection of Sarcoidosis. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2020; 201:e26-e51. [PMID: 32293205 PMCID: PMC7159433 DOI: 10.1164/rccm.202002-0251st] [Citation(s) in RCA: 484] [Impact Index Per Article: 121.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: The diagnosis of sarcoidosis is not standardized but is based on three major criteria: a compatible clinical presentation, finding nonnecrotizing granulomatous inflammation in one or more tissue samples, and the exclusion of alternative causes of granulomatous disease. There are no universally accepted measures to determine if each diagnostic criterion has been satisfied; therefore, the diagnosis of sarcoidosis is never fully secure. Methods: Systematic reviews and, when appropriate, meta-analyses were performed to summarize the best available evidence. The evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation approach and then discussed by a multidisciplinary panel. Recommendations for or against various diagnostic tests were formulated and graded after the expert panel weighed desirable and undesirable consequences, certainty of estimates, feasibility, and acceptability. Results: The clinical presentation, histopathology, and exclusion of alternative diagnoses were summarized. On the basis of the available evidence, the expert committee made 1 strong recommendation for baseline serum calcium testing, 13 conditional recommendations, and 1 best practice statement. All evidence was very low quality. Conclusions: The panel used systematic reviews of the evidence to inform clinical recommendations in favor of or against various diagnostic tests in patients with suspected or known sarcoidosis. The evidence and recommendations should be revisited as new evidence becomes available.
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11
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Velangi PS, Chen KHA, Kazmirczak F, Okasha O, von Wald L, Roukoz H, Farzaneh-Far A, Markowitz J, Nijjar PS, Bhargava M, Perlman D, Akçakaya M, Shenoy C. Right Ventricular Abnormalities on Cardiovascular Magnetic Resonance Imaging in Patients With Sarcoidosis. JACC Cardiovasc Imaging 2020; 13:1395-1405. [PMID: 31954639 PMCID: PMC9303493 DOI: 10.1016/j.jcmg.2019.12.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/04/2019] [Accepted: 12/09/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study aimed to determine the prevalence on cardiac magnetic resonance (CMR) of right ventricular (RV) systolic dysfunction and RV late gadolinium enhancement (LGE), their determinants, and their influences on long-term adverse outcomes in patients with sarcoidosis. BACKGROUND In patients with sarcoidosis, RV abnormalities have been described on many imaging modalities. On CMR, RV abnormalities include RV systolic dysfunction quantified as an abnormal right ventricular ejection fraction (RVEF), and RV LGE. METHODS Consecutive patients with biopsy-proven sarcoidosis who underwent CMR for suspected cardiac involvement were studied. They were followed for 2 endpoints: all-cause death, and a composite arrhythmic endpoint of sudden cardiac death or significant ventricular arrhythmia. RESULTS Among 290 patients, RV systolic dysfunction (RVEF <40% in men and <45% in women) and RV LGE were present in 35 (12.1%) and 16 (5.5%), respectively. The median follow-up time was 3.2 years (interquartile range [IQR]: 1.6 to 5.7 years) for all-cause death and 3.0 years (IQR: 1.4 to 5.5 years) for the arrhythmic endpoint. On Cox proportional hazards regression multivariable analyses, only RVEF was independently associated with all-cause death (hazard ratio [HR]: 1.05 for every 1% decrease; 95% confidence interval [CI]: 1.01 to 1.09; p = 0.022) after adjustment for left ventricular EF, left ventricular LGE extent, and the presence of RV LGE. RVEF was not associated with the arrhythmic endpoint (HR: 1.01; 95% CI: 0.96 to 1.06; p = 0.67). Conversely, RV LGE was not associated with all-cause death (HR: 2.78; 95% CI: 0.36 to 21.66; p = 0.33), while it was independently associated with the arrhythmic endpoint (HR: 5.43; 95% CI: 1.25 to 23.47; p = 0.024). CONCLUSIONS In this study of patients with sarcoidosis, RV systolic dysfunction and RV LGE had distinct prognostic associations; RV systolic dysfunction but not RV LGE was independently associated with all-cause death, whereas RV LGE but not RV systolic dysfunction was independently associated with sudden cardiac death or significant ventricular arrhythmia. These findings may indicate distinct implications for the management of RV abnormalities in sarcoidosis.
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MESH Headings
- Adult
- Aged
- Arrhythmias, Cardiac/etiology
- Arrhythmias, Cardiac/mortality
- Arrhythmias, Cardiac/physiopathology
- Death, Sudden, Cardiac/etiology
- Female
- Heart Ventricles/diagnostic imaging
- Heart Ventricles/physiopathology
- Humans
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Predictive Value of Tests
- Prevalence
- Prognosis
- Retrospective Studies
- Risk Assessment
- Risk Factors
- Sarcoidosis/complications
- Sarcoidosis/diagnostic imaging
- Sarcoidosis/mortality
- Sarcoidosis/physiopathology
- Stroke Volume
- Systole
- Time Factors
- Ventricular Dysfunction, Right/diagnostic imaging
- Ventricular Dysfunction, Right/etiology
- Ventricular Dysfunction, Right/mortality
- Ventricular Dysfunction, Right/physiopathology
- Ventricular Function, Right
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Affiliation(s)
- Pratik S Velangi
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Ko-Hsuan Amy Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Felipe Kazmirczak
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Osama Okasha
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Lisa von Wald
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Henri Roukoz
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Afshin Farzaneh-Far
- Section of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Jeremy Markowitz
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Prabhjot S Nijjar
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Maneesh Bhargava
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - David Perlman
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Mehmet Akçakaya
- Department of Electrical and Computer Engineering, Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, Minnesota
| | - Chetan Shenoy
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.
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12
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Smedema JP, Ainslie G, Crijns HJGM. Review: Contrast-enhanced magnetic resonance in the diagnosis and management of cardiac sarcoidosis. Prog Cardiovasc Dis 2020; 63:271-307. [PMID: 32330463 DOI: 10.1016/j.pcad.2020.03.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 03/22/2020] [Indexed: 01/14/2023]
Abstract
Sarcoidosis is a relatively rare inflammatory condition which potentially carries high morbidity and substantial mortality. Due to the fact that it does not subject patients to ionizing radiation, has high temporal, spatial and contrast resolutions, cardiovascular magnetic resonance imaging (CMR) has become an important diagnostic and prognostic modality in the evaluation for cardiac involvement in this condition. This review provides relevant clinical and pathophysiological background on cardiac sarcoidosis, whilst detailing the role of CMR imaging in the diagnosis, and management of this condition.
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Affiliation(s)
| | - Gillian Ainslie
- Respiratory Clinic, Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa.
| | - Harry J G M Crijns
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands.
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13
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Kaptan Ozen D, Mutlu B, Kocakaya D, Turan B, Sert Sekerci S, Ceyhan B, Kepez A, Erdogan O. The effect of global longitudinal strain on ımpaired six-minute walk test performance in patients with sarcoidosis. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2020; 37:66-73. [PMID: 33093770 PMCID: PMC7569543 DOI: 10.36141/svdld.v37i1.8802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/21/2020] [Indexed: 12/13/2022]
Abstract
Background: Sarcoidosis is a multisystem and granulomatous disease associated with impaired functional capacity as a result of pulmonary and cardiac involvement. Factors adversely effecting functional capacity in patients with sarcoidosis have not been systematically assessed including myocardial strain imaging on echocardiography which enable to diagnose subclinical cardiac dysfunction. We aimed to evaluate the effect of left and right ventricular global longitudinal strain (GLS) on submaximal exercise capacity in patients with sarcoidosis who do not have clinically manifest cardiac involvement. Methods: Extracardiac biopsy proven 56 patients with sarcoidosis and 26 controls were included consecutively. Submaximal exercise capacity of the subjects was assessed with six-minute walk test (6 MWT). Pulmonary function tests and standard transthoracic and two-dimensional speckle tracking echocardiography were performed to the all subjects. Linear regression analysis was performed to find independent predictors of 6 MWT. Results: Fifty-six patients (18% male) with a mean age of 52.5 ± 10.7 years were included. Patients with sarcoidosis had low 6 MWT performance and higher New York Heart Association classes and NT-proBNP levels. There were no significant differences between controls and patients with sarcoidosis in parameters of pulmonary function test. Biventricular GLS levels and biatrial reservoir and conduit function values were lower and systolic pulmonary artery pressure (SPAP) was significantly higher in patients with sarcoidosis as compared with controls. Older age and higher SPAP were found as independent predictors of poor 6 MWT performance. Conclusion: Although biventricular GLS levels were lower in the patients with sarcoidosis, only age and SPAP elevations were independent predictors of the submaximal exercise capacity. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (1): 63-73)
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Affiliation(s)
- Deniz Kaptan Ozen
- Department of Cardiology, Derince Training and Research Hospital, Kocaeli, Turkey
| | - Bulent Mutlu
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Derya Kocakaya
- Department of Pneomalogy, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Burak Turan
- Department of Cardiology, Derince Training and Research Hospital, Kocaeli, Turkey
| | - Sena Sert Sekerci
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Berrin Ceyhan
- Department of Pneomalogy, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Alper Kepez
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Okan Erdogan
- Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey
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14
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Jose A, Delio J, Gwizdala J, Goulart H, Ahari JE. Predictive value of pulmonary function testing in the evaluation of pulmonary hypertension in sarcoidosis. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2020; 35:308-316. [PMID: 32476918 PMCID: PMC7170124 DOI: 10.36141/svdld.v35i4.6855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 04/17/2018] [Indexed: 11/06/2022]
Abstract
Background: In sarcoidosis patients, pulmonary hypertension (PH) is associated with significant morbidity and mortality. Early identification of sarcoidosis-associated pulmonary hypertension (SAPH) has substantial clinical implications. While a number of pulmonary function testing (PFT) variables have been associated with SAPH, the optimal use of PFT’s in screening for SAPH is unknown. Objectives: To examine the predictive value of PFT’s for echocardiographic PH in a cohort of sarcoidosis patients. Methods: We conducted a retrospective cohort study of patients with sarcoidosis from a single center over a period of five years. All consecutive adult patients with a diagnosis of biopsy-proven sarcoidosis (determined by review of the medical chart) who underwent PFT and echocardiographic testing were included. Echocardiographic risk of PH (either intermediate or high) was determined by the presence of echocardiographic PH signs and tricuspid regurgitant jet velocity. Data analysis was performed using multivariate logistic regression analysis with least absolute shrinkage and selection operator. Results: Of the 156 patients included in the study, 42 (27%) met the criteria for echocardiographic PH. Roughly equal proportions met the criteria for intermediate risk (45%) as did for high risk of PH (55%). The percent predicted of diffusion capacity for carbon monoxide (%DLCO) and forced vital capacity (%FVC) were predictive of echocardiographic PH. No other PFT variables outperformed these two markers, and the incorporation of additional PFT variables failed to significantly enhance the model. Conclusions: The %FVC and %DLCO emerged as being predictive of echocardiographic PH in this cohort of biopsy-proven sarcoidosis patients. Potentially reflecting the multifactorial pathogenesis of PH in sarcoidosis, incorporation of other PFT variables failed to enhance screening for PH in this population. (Sarcoidosis Vasc Diffuse Lung Dis 2018; 35: 308-316)
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Affiliation(s)
- Arun Jose
- Pulmonary, Critical Care, and Sleep Medicine Division and
| | - Joseph Delio
- Internal Medicine Division, The George Washington University MFA, Washington D.C
| | - Jonathan Gwizdala
- Internal Medicine Division, The George Washington University MFA, Washington D.C
| | - Hannah Goulart
- The School of Medicine, George Washington University, Washington D.C
| | - Jalil E Ahari
- Pulmonary, Critical Care, and Sleep Medicine Division and
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15
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Bobbio E, Lingbrant M, Nwaru BI, Hessman E, Lehtonen J, Karason K, Bollano E. Inflammatory cardiomyopathies: short- and long-term outcomes after heart transplantation-a protocol for a systematic review and meta-analysis. Heart Fail Rev 2020; 25:481-485. [PMID: 31932994 PMCID: PMC7181433 DOI: 10.1007/s10741-020-09919-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Heart transplantation (HTx) for patients with "giant cell myocarditis" (GCM) or "cardiac sarcoidosis" (CS) is still controversial. However, no single center has accumulated enough experience to investigate post-HTx outcome. The primary aim of this systematic review is to identify, appraise, and synthesize existing literature investigating whether patients who have undergone HTx because of GCM or CS have worse outcomes as compared with patients transplanted because of other etiologies. A systematic and comprehensive search will be performed using PubMed, Scopus, Web of Science, EMBASE, and Google Scholar, for studies published up to December 2019. Observational and interventional population-based studies will be eligible for inclusion. The quality of observational studies will be assessed using the Newcastle-Ottawa scale, while the interventional studies will be assessed using the Cochrane Effective Practice Organization of Care tool. The collected evidence will be narratively synthesized; in addition, we will perform a meta-analysis to pool estimates from studies considered to be homogenous. Reporting of the systematic review and meta-analysis will be in accordance with the Meta-analysis of Observational Studies in Epidemiology Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines. To our knowledge, this will be the first synthesis of outcomes, including survival, acute cellular rejection, and disease recurrence, in patients with either GCM or CS treated with HTx. Reviewing the suitability of HTx in this population and highlighting areas for further research will benefit both patients and healthcare providers. Trial registration: CRD42019140574.
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Affiliation(s)
- Emanuele Bobbio
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden. .,Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Marie Lingbrant
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bright I Nwaru
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Eva Hessman
- University Library, University of Gothenburg, Gothenburg, Sweden
| | - Jukka Lehtonen
- Heart and Lung Center, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Kristjan Karason
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.,Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Entela Bollano
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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16
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Abstract
Sarcoidosis is a highly variable granulomatous multisystem syndrome. It affects individuals in the prime years of life; both the frequency and severity of sarcoidosis are greater in economically disadvantaged populations. The diagnosis, assessment, and management of pulmonary sarcoidosis have evolved as new technologies and therapies have been adopted. Transbronchial needle aspiration guided by endobronchial ultrasound has replaced mediastinoscopy in many centers. Advanced imaging modalities, such as fluorodeoxyglucose positron emission tomography scanning, and the widespread availability of magnetic resonance imaging have led to more sensitive assessment of organ involvement and disease activity. Although several new insights about the pathogenesis of sarcoidosis exist, no new therapies have been specifically developed for use in the disease. The current or proposed use of immunosuppressive medications for sarcoidosis has been extrapolated from other disease states; various novel pathways are currently under investigation as therapeutic targets. Coupled with the growing recognition of corticosteroid toxicities for managing sarcoidosis, the use of corticosteroid sparing anti-sarcoidosis medications is likely to increase. Besides treatment of granulomatous inflammation, recognition and management of the non-granulomatous complications of pulmonary sarcoidosis are needed for optimal outcomes in patients with advanced disease.
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Affiliation(s)
- Daniel A Culver
- Department of Pulmonary Medicine, Respiratory Institute, Department of Inflammation and Immunity, Lerner Research Institute Cleveland Clinic, Cleveland, OH, USA
| | - Marc A Judson
- Division of Pulmonary and Critical Care Medicine, Albany Medical College, Albany, NY, USA
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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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18
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Cardiac sarcoidosis: Case presentation and Review of the literature. ACTA ACUST UNITED AC 2019; 57:7-13. [PMID: 30375351 DOI: 10.2478/rjim-2018-0030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Indexed: 11/20/2022]
Abstract
Cardiac sarcoidosis usually occurs in the context of systemic disease; however, isolated cardiac involvement can occur in up to 25% of cases and tends to be clinically silent. When symptoms are present, they are often nonspecific and occasionally fatal, representing a diagnostic challenge. A high index of clinical suspicion and the integration of appropriate imaging, laboratory, and pathologic findings is always required. Treatment aims to control the systemic inflammatory condition while preventing further cardiac damage. However, even with adequate diagnosis and treatment strategies, prognosis remains poor. We describe the case of a patient who presented with cardiac symptoms, whose initial examination was unrevealing. Diagnosis was made retrospectively based on later systemic manifestations that revealed characteristic sarcoidosis findings.
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Abstract
PURPOSE OF REVIEW Cardiac sarcoidosis (CS) is associated with significant morbidity and mortality. The diagnosis of CS is challenging and typically one that is only entertained after many other conditions have been ruled out. A high index of suspicion is necessary in order to correctly determine appropriate testing for the disease. Transthoracic echocardiography is the most readily available imaging modality available to help establish a diagnosis in a potential patient. However, no one echocardiographic feature is pathognomonic. RECENT FINDINGS On echocardiography, unusual wall motion abnormalities, which do not fit a classic coronary distribution, along with diastolic dysfunction may alert one to the presence of cardiac sarcoid, particularly in the right clinical context. Myocardial strain imaging on echocardiography may increase the sensitivity of identifying cardiac sarcoidosis. Alternative imaging with cardiac magnetic resonance imaging or positron emission tomography have become more frequently utilized to establish a diagnosis of CS. Cardiac sarcoidosis remains a difficult condition to diagnose. However early diagnosis is critical to decrease the associated high mortality. Endomyocardial biopsy is highly specific but lacks sensitivity due to the patchy nature of the granulomatous deposition. Thus, imaging plays a role in diagnosis as well as for follow-up. Echocardiography remains an hallmark during the workup for CS. Decreased sensitivity of echocardiography has facilitated the use of other techniques to establish the presence of CS.
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Invasive Hemodynamics and Rejection Rates in Patients With Cardiac Sarcoidosis After Heart Transplantation. Can J Cardiol 2018; 34:978-982. [PMID: 30049365 DOI: 10.1016/j.cjca.2018.03.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/21/2018] [Accepted: 03/21/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Orthotopic heart transplant (OHT) is increasingly used for end-stage heart failure due to cardiac sarcoidosis (CS). However, concern regarding long-term outcomes in patients with CS after OHT persists because of multiorgan involvement. METHODS Baseline demographics and invasive hemodynamics were measured in 12 patients with CS and 28 patients with nonischemic cardiomyopathy requiring OHT at the time of transplantation, 1 week after OHT, and in routine follow-up. Primary endpoints included changes in pulmonary artery pressure, right ventricular stroke work index, and pulmonary compliance. Secondary endpoints included degree of allograft rejection and death. RESULTS During a mean follow-up of 73.8 months, no differences in pulmonary artery pressures, right ventricular stroke work index, or cardiac index were observed in patient with CS (n = 12) compared with those without CS (n = 28) between 1 week after OHT and the most recent follow-up. Long-term follow-up showed that pulmonary hemodynamics remained normal in the CS group. International Society for Heart and Lung Transplantation (ISHLT) 1990 grade ≥ 1a rejection occurred less frequently in the CS group (17% vs 68%, P = 0.006), and 0 of 12 patients in the CS group experienced histologic or clinical recurrence of sarcoidosis or ≥2 rejection. Patients with CS had excellent survival after OHT, with 0 deaths or significant rejection. CONCLUSIONS Patients with CS have similar post-transplant hemodynamics as patients without CS, without evidence of right ventricular dysfunction or pulmonary hypertension. Neither significant rejection nor recurrence of sarcoid in the allograft was observed in this cohort of patients with CS. Survival is similar between patients with CS and those without CS. Heart transplant is a viable strategy in selected patients with CS with excellent outcomes.
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Tadic M, Zlatanovic M, Cuspidi C, Stevanovic A, Celic V, Damjanov N, Kocijancic V. Systemic sclerosis impacts right heart and cardiac autonomic nervous system. JOURNAL OF CLINICAL ULTRASOUND : JCU 2018; 46:188-194. [PMID: 29064088 DOI: 10.1002/jcu.22552] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 09/22/2017] [Accepted: 09/30/2017] [Indexed: 06/07/2023]
Abstract
AIM To evaluate the influence of systemic sclerosis (SSc) on right ventricular (RV) remodeling by two- and three-dimensional echocardiography (2DE and 3DE) and heart rate variability (HRV). METHODS Forty-five SSc patients and 35 age- and gender-matched healthy controls underwent clinical examination, 24-h Holter monitoring, and comprehensive 2DE and 3DE. RESULTS 2DE RV global and RV free wall longitudinal strains, as well as 2DE RV endocardial, mid-myocardial, and epicardial longitudinal strains were lower in SSc subjects, who exhibited greater 3DE RV volumes but lower 3DE RV ejection fraction than controls. HRV indices were impaired in SSc subjects. These differences in RV global and free wall longitudinal strain, layer-specific strains, and ejection fraction, were associated with HRV indices independently of demographic, clinical, and echocardiographic parameters. Modified Rodnan Skin Score, clinical indicator of skin involvement in SSc, was associated with HRV parameters, RV layer-specific mechanics, and RV ejection fraction. CONCLUSION SSc affects RV function and mechanics of all myocardial layers, as well as cardiac autonomic nervous function. HRV indices are significantly associated with RV function, RV deformation, and skin involvement in SSc patients.
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Affiliation(s)
- Marijana Tadic
- Cardiology Department, University Clinical Hospital Center "Dr. Dragisa Misovic-Dedinje,", Heroja Milana Tepica 1, Belgrade 11000, Serbia
| | - Maja Zlatanovic
- Institute for Rheumatology, Resavska 69, Belgrade 11000, Serbia
| | - Cesare Cuspidi
- Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, Viale della Resistenza 23, Meda 20036, Italy
| | - Ana Stevanovic
- Cardiology Department, University Clinical Hospital Center "Dr. Dragisa Misovic-Dedinje,", Heroja Milana Tepica 1, Belgrade 11000, Serbia
| | - Vera Celic
- Cardiology Department, University Clinical Hospital Center "Dr. Dragisa Misovic-Dedinje,", Heroja Milana Tepica 1, Belgrade 11000, Serbia
| | | | - Vesna Kocijancic
- Cardiology Department, University Clinical Hospital Center "Dr. Dragisa Misovic-Dedinje,", Heroja Milana Tepica 1, Belgrade 11000, Serbia
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Abstract
Clinicians in pulmonary medicine frequently confront the challenge of screening, diagnosis and management of pulmonary hypertension (PH) in sarcoidosis patients who present with unexplained dyspnea. Sarcoidosis associated pulmonary hypertension (SAPH) is most prevalent in patients with pulmonary fibrosis, though it can be independent of airflow obstruction or restriction. SAPH independently associates with significantly increased mortality and decreased functional capacity, outcomes which can be mitigated by early detection and focused treatment. In this review, we discuss the pathophysiology of SAPH, which may resemble pulmonary arterial hypertension as well as secondary causes of PH. We offer a screening algorithm for SAPH, and advocate for detailed assessment of the cause of PH in each patient prior to choice of an individualized treatment plan. We note that treatment of sarcoidosis via immune suppression is typically insufficient to adequately treat SAPH. We discuss secondary causes of SAPH such as left heart disease, sleep disordered breathing, and thromboembolic disease, and the evidence for use of PH-specific therapy in select cases of SAPH. Management of SAPH by clinicians experienced in PH, with early referral to transplantation in refractory cases is advised.
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