4
|
Okada DR, Bravo PE, Vita T, Agarwal V, Osborne MT, Taqueti VR, Skali H, Chareonthaitawee P, Dorbala S, Stewart G, Di Carli M, Blankstein R. Isolated cardiac sarcoidosis: A focused review of an under-recognized entity. J Nucl Cardiol 2018; 25:1136-1146. [PMID: 27613395 PMCID: PMC5540795 DOI: 10.1007/s12350-016-0658-1] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 08/10/2016] [Indexed: 02/07/2023]
Abstract
There is accumulating evidence for the existence of a phenotype of isolated cardiac sarcoidosis (ICS), or sarcoidosis that only involves the heart. In the absence of biopsy-confirmed cardiac sarcoidosis (CS), existing diagnostic criteria require the presence of extra-cardiac sarcoidosis as an inclusion criterion for the diagnosis of CS. Consequently, in the absence of a positive endomyocardial biopsy, ICS is not diagnosable by current guidelines. Therefore, there is uncertainty regarding the epidemiology, pathobiology, clinical characteristics, prognosis, and optimal treatment of ICS. This review will summarize the available data related to the prevalence and prognosis of ICS and will discuss challenges surrounding the diagnosis and management of this under-recognized entity.
Collapse
Affiliation(s)
- David R Okada
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Paco E Bravo
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Tomas Vita
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Vikram Agarwal
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael T Osborne
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Viviany R Taqueti
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Hicham Skali
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | | | - Sharmila Dorbala
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Garrick Stewart
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Marcelo Di Carli
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Ron Blankstein
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.
| |
Collapse
|
6
|
Kandolin R, Lehtonen J, Airaksinen J, Vihinen T, Miettinen H, Ylitalo K, Kaikkonen K, Tuohinen S, Haataja P, Kerola T, Kokkonen J, Pelkonen M, Pietilä-Effati P, Utrianen S, Kupari M. Cardiac sarcoidosis: epidemiology, characteristics, and outcome over 25 years in a nationwide study. Circulation 2014; 131:624-32. [PMID: 25527698 DOI: 10.1161/circulationaha.114.011522] [Citation(s) in RCA: 379] [Impact Index Per Article: 37.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study was designed to assess the epidemiology, characteristics, and outcome of cardiac sarcoidosis (CS) in Finland. METHODS AND RESULTS We identified in retrospect all adult (>18 years of age) patients diagnosed with histologically confirmed CS in Finland between 1988 and 2012. A total of 110 patients (71 women) 51±9 years of age (mean±SD) were found and followed up for outcome events to the end of 2013. The annual detection rate of CS increased >20-fold during the 25-year period, reaching 0.31 in 1×10(5) adults between 2008 and 2012. The 2012 prevalence of CS was 2.2 in 1×10(5). Nearly two thirds of patients had clinically isolated CS. Altogether, 102 of the 110 patients received immunosuppressive therapy, and 56 received an intracardiac defibrillator. Left ventricular function was impaired (ejection fraction <50%) in 65 patients (59%) at diagnosis and showed no overall change over 12 months of steroid therapy. During follow-up (median, 6.6 years), 10 patients died of a cardiac cause, 11 patients underwent transplantation, and another 11 patients suffered an aborted sudden cardiac death. The Kaplan-Meier estimates for 1-, 5-, and 10-year transplantation-free cardiac survival were 97%, 90%, and 83%, respectively. Heart failure at presentation predicted poor outcome (log-rank P=0.0001) with a 10-year transplantation-free cardiac survival of only 53%. CONCLUSIONS The detection rate of CS has increased markedly in Finland over the last 25 years. With current therapy, the prognosis of CS appears better than generally considered, but patients presenting with heart failure still have poor long-term outcome.
Collapse
Affiliation(s)
- Riina Kandolin
- From the Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland (R.K., J.L., M.K.); Heart Center, Turku University Hospital, Turku, Finland (J.A., T.V.); Heart Center, Kuopio University Hospital, Kuopio, Finland (H.M.); Medical Research Center Oulu, University and University Hospital of Oulu, Oulu, Finland (K.Y., K.K.); Heart Hospital, Tampere University Hospital, Tampere, Finland (S.T., P.H.); Päijät-Häme Central Hospital, Lahti, Finland (T.K.); Central Finland Central Hospital, Jyväskylä, Finland (J.K.); South Ostrobothnia Central Hospital, Seinäjoki, Finland (M.P.); Vaasa Central Hospital, Vaasa, Finland (P.P.-E.); and South Karelia Central Hospital, Lappeenranta, Finland (S.U.)
| | - Jukka Lehtonen
- From the Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland (R.K., J.L., M.K.); Heart Center, Turku University Hospital, Turku, Finland (J.A., T.V.); Heart Center, Kuopio University Hospital, Kuopio, Finland (H.M.); Medical Research Center Oulu, University and University Hospital of Oulu, Oulu, Finland (K.Y., K.K.); Heart Hospital, Tampere University Hospital, Tampere, Finland (S.T., P.H.); Päijät-Häme Central Hospital, Lahti, Finland (T.K.); Central Finland Central Hospital, Jyväskylä, Finland (J.K.); South Ostrobothnia Central Hospital, Seinäjoki, Finland (M.P.); Vaasa Central Hospital, Vaasa, Finland (P.P.-E.); and South Karelia Central Hospital, Lappeenranta, Finland (S.U.)
| | - Juhani Airaksinen
- From the Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland (R.K., J.L., M.K.); Heart Center, Turku University Hospital, Turku, Finland (J.A., T.V.); Heart Center, Kuopio University Hospital, Kuopio, Finland (H.M.); Medical Research Center Oulu, University and University Hospital of Oulu, Oulu, Finland (K.Y., K.K.); Heart Hospital, Tampere University Hospital, Tampere, Finland (S.T., P.H.); Päijät-Häme Central Hospital, Lahti, Finland (T.K.); Central Finland Central Hospital, Jyväskylä, Finland (J.K.); South Ostrobothnia Central Hospital, Seinäjoki, Finland (M.P.); Vaasa Central Hospital, Vaasa, Finland (P.P.-E.); and South Karelia Central Hospital, Lappeenranta, Finland (S.U.)
| | - Tapani Vihinen
- From the Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland (R.K., J.L., M.K.); Heart Center, Turku University Hospital, Turku, Finland (J.A., T.V.); Heart Center, Kuopio University Hospital, Kuopio, Finland (H.M.); Medical Research Center Oulu, University and University Hospital of Oulu, Oulu, Finland (K.Y., K.K.); Heart Hospital, Tampere University Hospital, Tampere, Finland (S.T., P.H.); Päijät-Häme Central Hospital, Lahti, Finland (T.K.); Central Finland Central Hospital, Jyväskylä, Finland (J.K.); South Ostrobothnia Central Hospital, Seinäjoki, Finland (M.P.); Vaasa Central Hospital, Vaasa, Finland (P.P.-E.); and South Karelia Central Hospital, Lappeenranta, Finland (S.U.)
| | - Heikki Miettinen
- From the Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland (R.K., J.L., M.K.); Heart Center, Turku University Hospital, Turku, Finland (J.A., T.V.); Heart Center, Kuopio University Hospital, Kuopio, Finland (H.M.); Medical Research Center Oulu, University and University Hospital of Oulu, Oulu, Finland (K.Y., K.K.); Heart Hospital, Tampere University Hospital, Tampere, Finland (S.T., P.H.); Päijät-Häme Central Hospital, Lahti, Finland (T.K.); Central Finland Central Hospital, Jyväskylä, Finland (J.K.); South Ostrobothnia Central Hospital, Seinäjoki, Finland (M.P.); Vaasa Central Hospital, Vaasa, Finland (P.P.-E.); and South Karelia Central Hospital, Lappeenranta, Finland (S.U.)
| | - Kari Ylitalo
- From the Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland (R.K., J.L., M.K.); Heart Center, Turku University Hospital, Turku, Finland (J.A., T.V.); Heart Center, Kuopio University Hospital, Kuopio, Finland (H.M.); Medical Research Center Oulu, University and University Hospital of Oulu, Oulu, Finland (K.Y., K.K.); Heart Hospital, Tampere University Hospital, Tampere, Finland (S.T., P.H.); Päijät-Häme Central Hospital, Lahti, Finland (T.K.); Central Finland Central Hospital, Jyväskylä, Finland (J.K.); South Ostrobothnia Central Hospital, Seinäjoki, Finland (M.P.); Vaasa Central Hospital, Vaasa, Finland (P.P.-E.); and South Karelia Central Hospital, Lappeenranta, Finland (S.U.)
| | - Kari Kaikkonen
- From the Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland (R.K., J.L., M.K.); Heart Center, Turku University Hospital, Turku, Finland (J.A., T.V.); Heart Center, Kuopio University Hospital, Kuopio, Finland (H.M.); Medical Research Center Oulu, University and University Hospital of Oulu, Oulu, Finland (K.Y., K.K.); Heart Hospital, Tampere University Hospital, Tampere, Finland (S.T., P.H.); Päijät-Häme Central Hospital, Lahti, Finland (T.K.); Central Finland Central Hospital, Jyväskylä, Finland (J.K.); South Ostrobothnia Central Hospital, Seinäjoki, Finland (M.P.); Vaasa Central Hospital, Vaasa, Finland (P.P.-E.); and South Karelia Central Hospital, Lappeenranta, Finland (S.U.)
| | - Suvi Tuohinen
- From the Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland (R.K., J.L., M.K.); Heart Center, Turku University Hospital, Turku, Finland (J.A., T.V.); Heart Center, Kuopio University Hospital, Kuopio, Finland (H.M.); Medical Research Center Oulu, University and University Hospital of Oulu, Oulu, Finland (K.Y., K.K.); Heart Hospital, Tampere University Hospital, Tampere, Finland (S.T., P.H.); Päijät-Häme Central Hospital, Lahti, Finland (T.K.); Central Finland Central Hospital, Jyväskylä, Finland (J.K.); South Ostrobothnia Central Hospital, Seinäjoki, Finland (M.P.); Vaasa Central Hospital, Vaasa, Finland (P.P.-E.); and South Karelia Central Hospital, Lappeenranta, Finland (S.U.)
| | - Petri Haataja
- From the Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland (R.K., J.L., M.K.); Heart Center, Turku University Hospital, Turku, Finland (J.A., T.V.); Heart Center, Kuopio University Hospital, Kuopio, Finland (H.M.); Medical Research Center Oulu, University and University Hospital of Oulu, Oulu, Finland (K.Y., K.K.); Heart Hospital, Tampere University Hospital, Tampere, Finland (S.T., P.H.); Päijät-Häme Central Hospital, Lahti, Finland (T.K.); Central Finland Central Hospital, Jyväskylä, Finland (J.K.); South Ostrobothnia Central Hospital, Seinäjoki, Finland (M.P.); Vaasa Central Hospital, Vaasa, Finland (P.P.-E.); and South Karelia Central Hospital, Lappeenranta, Finland (S.U.)
| | - Tuomas Kerola
- From the Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland (R.K., J.L., M.K.); Heart Center, Turku University Hospital, Turku, Finland (J.A., T.V.); Heart Center, Kuopio University Hospital, Kuopio, Finland (H.M.); Medical Research Center Oulu, University and University Hospital of Oulu, Oulu, Finland (K.Y., K.K.); Heart Hospital, Tampere University Hospital, Tampere, Finland (S.T., P.H.); Päijät-Häme Central Hospital, Lahti, Finland (T.K.); Central Finland Central Hospital, Jyväskylä, Finland (J.K.); South Ostrobothnia Central Hospital, Seinäjoki, Finland (M.P.); Vaasa Central Hospital, Vaasa, Finland (P.P.-E.); and South Karelia Central Hospital, Lappeenranta, Finland (S.U.)
| | - Jorma Kokkonen
- From the Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland (R.K., J.L., M.K.); Heart Center, Turku University Hospital, Turku, Finland (J.A., T.V.); Heart Center, Kuopio University Hospital, Kuopio, Finland (H.M.); Medical Research Center Oulu, University and University Hospital of Oulu, Oulu, Finland (K.Y., K.K.); Heart Hospital, Tampere University Hospital, Tampere, Finland (S.T., P.H.); Päijät-Häme Central Hospital, Lahti, Finland (T.K.); Central Finland Central Hospital, Jyväskylä, Finland (J.K.); South Ostrobothnia Central Hospital, Seinäjoki, Finland (M.P.); Vaasa Central Hospital, Vaasa, Finland (P.P.-E.); and South Karelia Central Hospital, Lappeenranta, Finland (S.U.)
| | - Markus Pelkonen
- From the Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland (R.K., J.L., M.K.); Heart Center, Turku University Hospital, Turku, Finland (J.A., T.V.); Heart Center, Kuopio University Hospital, Kuopio, Finland (H.M.); Medical Research Center Oulu, University and University Hospital of Oulu, Oulu, Finland (K.Y., K.K.); Heart Hospital, Tampere University Hospital, Tampere, Finland (S.T., P.H.); Päijät-Häme Central Hospital, Lahti, Finland (T.K.); Central Finland Central Hospital, Jyväskylä, Finland (J.K.); South Ostrobothnia Central Hospital, Seinäjoki, Finland (M.P.); Vaasa Central Hospital, Vaasa, Finland (P.P.-E.); and South Karelia Central Hospital, Lappeenranta, Finland (S.U.)
| | - Päivi Pietilä-Effati
- From the Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland (R.K., J.L., M.K.); Heart Center, Turku University Hospital, Turku, Finland (J.A., T.V.); Heart Center, Kuopio University Hospital, Kuopio, Finland (H.M.); Medical Research Center Oulu, University and University Hospital of Oulu, Oulu, Finland (K.Y., K.K.); Heart Hospital, Tampere University Hospital, Tampere, Finland (S.T., P.H.); Päijät-Häme Central Hospital, Lahti, Finland (T.K.); Central Finland Central Hospital, Jyväskylä, Finland (J.K.); South Ostrobothnia Central Hospital, Seinäjoki, Finland (M.P.); Vaasa Central Hospital, Vaasa, Finland (P.P.-E.); and South Karelia Central Hospital, Lappeenranta, Finland (S.U.)
| | - Seppo Utrianen
- From the Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland (R.K., J.L., M.K.); Heart Center, Turku University Hospital, Turku, Finland (J.A., T.V.); Heart Center, Kuopio University Hospital, Kuopio, Finland (H.M.); Medical Research Center Oulu, University and University Hospital of Oulu, Oulu, Finland (K.Y., K.K.); Heart Hospital, Tampere University Hospital, Tampere, Finland (S.T., P.H.); Päijät-Häme Central Hospital, Lahti, Finland (T.K.); Central Finland Central Hospital, Jyväskylä, Finland (J.K.); South Ostrobothnia Central Hospital, Seinäjoki, Finland (M.P.); Vaasa Central Hospital, Vaasa, Finland (P.P.-E.); and South Karelia Central Hospital, Lappeenranta, Finland (S.U.)
| | - Markku Kupari
- From the Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland (R.K., J.L., M.K.); Heart Center, Turku University Hospital, Turku, Finland (J.A., T.V.); Heart Center, Kuopio University Hospital, Kuopio, Finland (H.M.); Medical Research Center Oulu, University and University Hospital of Oulu, Oulu, Finland (K.Y., K.K.); Heart Hospital, Tampere University Hospital, Tampere, Finland (S.T., P.H.); Päijät-Häme Central Hospital, Lahti, Finland (T.K.); Central Finland Central Hospital, Jyväskylä, Finland (J.K.); South Ostrobothnia Central Hospital, Seinäjoki, Finland (M.P.); Vaasa Central Hospital, Vaasa, Finland (P.P.-E.); and South Karelia Central Hospital, Lappeenranta, Finland (S.U.).
| |
Collapse
|