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Kurashima S, Kitai T, Xanthopoulos A, Skoularigis J, Triposkiadis F, Izumi C. Diagnosis of cardiac sarcoidosis: histological evidence vs. imaging. Expert Rev Cardiovasc Ther 2023; 21:693-702. [PMID: 37776232 DOI: 10.1080/14779072.2023.2266367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 09/29/2023] [Indexed: 10/02/2023]
Abstract
INTRODUCTION The prognosis for cardiac sarcoidosis (CS) remains unfavorable. Although early and accurate diagnosis is crucial, the low detection rate of endomyocardial biopsy makes accurate diagnosis challenging. AREAS COVERED The Heart Rhythm Society (HRS) consensus statement and the Japanese Circulation Society (JCS) guidelines are two major diagnostic criteria for the diagnosis of CS. While the requirement of positive histology for the diagnosis in the HRS criteria can result in overlooked cases, the JCS guidelines advocate for a group of 'clinical' diagnoses based on advanced imaging, including cardiovascular magnetic resonance and 18F-fluorodeoxyglucose positron emission tomography, which do not require histological evidence. Recent studies have supported the usefulness of clinical diagnosis of CS. However, other evidence suggests that clinical CS may sometimes be inaccurate. This article describes the advantages and disadvantages of the current diagnostic criteria for CS, and typical imaging and clinical courses. EXPERT OPINION The diagnosis of clinical CS has been made possible by recent developments in multimodality imaging. However, it is still crucial to look for histological signs of sarcoidosis in other organs in addition to the endomyocardium. Additionally, phenotyping based on clinical manifestations such as heart failure, conduction abnormality or ventricular arrhythmia, and extracardiac abnormalities is clinically significant.
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Affiliation(s)
- Shinichi Kurashima
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Andrew Xanthopoulos
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece
| | - John Skoularigis
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece
| | | | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
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Wiefels C, Lamai O, Kandolin R, Birnie D, Leung E, Mesquita CT, Beanlands R. The Role of 18F-FDG PET/CT in Cardiac Sarcoidosis. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2020. [DOI: 10.36660/ijcs.20200033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Terasaki F, Azuma A, Anzai T, Ishizaka N, Ishida Y, Isobe M, Inomata T, Ishibashi-Ueda H, Eishi Y, Kitakaze M, Kusano K, Sakata Y, Shijubo N, Tsuchida A, Tsutsui H, Nakajima T, Nakatani S, Horii T, Yazaki Y, Yamaguchi E, Yamaguchi T, Ide T, Okamura H, Kato Y, Goya M, Sakakibara M, Soejima K, Nagai T, Nakamura H, Noda T, Hasegawa T, Morita H, Ohe T, Kihara Y, Saito Y, Sugiyama Y, Morimoto SI, Yamashina A. JCS 2016 Guideline on Diagnosis and Treatment of Cardiac Sarcoidosis - Digest Version. Circ J 2019; 83:2329-2388. [PMID: 31597819 DOI: 10.1253/circj.cj-19-0508] [Citation(s) in RCA: 216] [Impact Index Per Article: 43.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Fumio Terasaki
- Medical Education Center / Department of Cardiology, Osaka Medical College
| | - Arata Azuma
- Department of Pulmonary Medicine, Nippon Medical School
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Nobukazu Ishizaka
- Department of Internal Medicine (III) / Department of Cardiology, Osaka Medical College
| | - Yoshio Ishida
- Department of Internal Medicine, Kaizuka City Hospital
| | - Mitsuaki Isobe
- Department of Cardiovascular Medicine, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University
| | - Takayuki Inomata
- Department of Cardiology, Kitasato University Kitasato Institute Hospital
| | | | - Yoshinobu Eishi
- Department of Human Pathology, Graduate School of Medical and Dental Science, Tokyo Medical and Dental University
| | - Masafumi Kitakaze
- Department of Clinical Medicine and Development, National Cerebral and Cardiovascular Center
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | | | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Takatomo Nakajima
- Division of Cardiology, Saitama Cardiovascular and Respiratory Center
| | - Satoshi Nakatani
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School of Medicine
| | - Taiko Horii
- Department of Cardiovascular Surgery, Kagawa University School of Medicine
| | | | - Etsuro Yamaguchi
- Department of Respiratory Medicine and Allergology, Aichi Medical University School of Medicine
| | | | - Tomomi Ide
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
| | - Hideo Okamura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Masahiko Goya
- Department of Cardiology, Tokyo Medical and Dental University
| | - Mamoru Sakakibara
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Kyoko Soejima
- Department of Cardiology, Kyorin University Faculty of Medicine
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takuya Hasegawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Tohru Ohe
- Department of Cardiology, Sakakibara Heart Institute of Okayama
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | - Yoshihiko Saito
- Department of Cardiorenal Medicine and Metabolic Disease, Nara Medical University
| | - Yukihiko Sugiyama
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University
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Kandolin R, Ekström K, Simard T, Hibbert B, Nery P, Lehtonen J, Kupari M, Birnie D. Spontaneous coronary artery dissection in cardiac sarcoidosis. Oxf Med Case Reports 2019; 2019:omz033. [PMID: 31198569 PMCID: PMC6544419 DOI: 10.1093/omcr/omz033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 02/26/2019] [Accepted: 03/11/2019] [Indexed: 11/17/2022] Open
Abstract
Cardiac sarcoidosis (CS) is increasingly recognized as a cause of diverse cardiac manifestations. Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome especially among young females. The prevalence of sarcoidosis in the causal spectrum of SCAD has not been described before but sarcoidosis is cited as a potential yet rare cause of SCAD. We aimed to examine the frequency and characteristics of SCAD in CS. Searching two prospective CS registries with 481 CS patients, we found only one case of manifest SCAD. She is a 61-year-old female previously diagnosed with endomyocardial biopsy confirmed CS. She presented with chest pain and elevated troponin. Coronary angiogram revealed two-vessel SCAD. Fluorodeoxyglucose positron emission tomography scan showed likely reactivation of CS. The patient was treated with dual antiplatelet therapy and immunosuppression. Repeat angiogram showed complete resolution of the coronary lesions.
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Affiliation(s)
- Riina Kandolin
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Kaj Ekström
- Division of Cardiology, Heart and Lung Center, Helsinki University Hospital, HUS, Finland
| | - Trevor Simard
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Benjamin Hibbert
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Pablo Nery
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Jukka Lehtonen
- Division of Cardiology, Heart and Lung Center, Helsinki University Hospital, HUS, Finland
| | - Markku Kupari
- Division of Cardiology, Heart and Lung Center, Helsinki University Hospital, HUS, Finland
| | - David Birnie
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
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Ramirez R, Trivieri M, Fayad ZA, Ahmadi A, Narula J, Argulian E. Advanced Imaging in Cardiac Sarcoidosis. J Nucl Med 2019; 60:892-898. [PMID: 31171594 DOI: 10.2967/jnumed.119.228130] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 06/03/2019] [Indexed: 12/14/2022] Open
Abstract
Sarcoidosis is a chronic disease of unknown etiology characterized by the presence of noncaseating granulomas. Cardiac involvement in sarcoidosis may lead to adverse outcomes such as advanced heart block, arrhythmias, cardiomyopathy, or death. Cardiac sarcoidosis can occur in patients with established sarcoidosis, or it can be the sole manifestation of the disease. Traditional diagnostic techniques, including echocardiography, have poor sensitivity for diagnosing cardiac sarcoidosis. The accumulating evidence supports the essential role of advanced cardiac imaging modalities such as MRI and PET in diagnosis, risk stratification, and management of patients with cardiac sarcoidosis. The current review highlights important theoretic and practical aspects of using cardiac imaging tools in the evaluation of patients with suspected or established cardiac sarcoidosis.
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Affiliation(s)
- Roberto Ramirez
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Maria Trivieri
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Zahi A Fayad
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Amir Ahmadi
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jagat Narula
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Edgar Argulian
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
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Abstract
The increasing implementation of advanced cardiovascular imaging in the form of cardiac PET/CT has had a significant impact on the management of cardiac sarcoidosis, which continues to evolve. This review summarizes the role of PET/CT imaging in sarcoidosis with a specific focus on (1) indications, (2) patient preparation, (3) test performance, (4) study interpretation, (5) clinical relevance of findings, (6) comparison to alternative imaging modalities, and finally (7) introduction of areas of anticipated development and research.
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7
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Perez IE, Garcia MJ, Taub CC. Multimodality Imaging in Cardiac Sarcoidosis: Is There a Winner? Curr Cardiol Rev 2016; 12:3-11. [PMID: 25784137 PMCID: PMC4807716 DOI: 10.2174/1573403x11666150318110406] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 03/10/2015] [Indexed: 11/22/2022] Open
Abstract
Sarcoidosis is a multisystem granulomatous disease of unknown cause that can affect the heart. Cardiac sarcoidosis may be present in as many as 25% of patients with systemic sarcoidosis, and it is frequently underdiagnosed. The early and accurate diagnosis of myocardial involvement is challenging. Advanced imaging techniques play important roles in the diagnosis and management of patients with cardiac sarcoidosis.
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Affiliation(s)
- Irving E Perez
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY. 1825 Eastchester Road Bronx, NY, 10461, USA.
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8
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Bois JP, Chareonthaitawee P. Radionuclide Imaging in Congestive Heart Failure: Assessment of Viability, Sarcoidosis, and Amyloidosis. Cardiol Clin 2015; 34:119-32. [PMID: 26590784 DOI: 10.1016/j.ccl.2015.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Radionuclide imaging provides both established and emerging diagnostic and prognostic tools to assist clinicians in the management of patients with ischemic cardiomyopathy, cardiac sarcoidosis, and cardiac amyloidosis. This review highlights the underlying pathophysiology of each entity and associated diagnostic and clinical challenges, and describes the available radionuclide imaging techniques. Specific protocols, advantages and disadvantages, comparison with other noninvasive imaging modalities, and discussion of the evolving role of hybrid imaging are also included.
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Affiliation(s)
- John P Bois
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
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Lambert J, Lim SP, Dwivedi G, Beanlands R, Chih S. Cardiac Imaging of Infiltrative Cardiomyopathies. CURRENT CARDIOVASCULAR IMAGING REPORTS 2015. [DOI: 10.1007/s12410-015-9330-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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10
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Ayoub C, Pena E, Ohira H, Dick A, Leung E, Nery PB, Birnie D, Beanlands RSB. Advanced Imaging of Cardiac Sarcoidosis. Curr Cardiol Rep 2015; 17:17. [DOI: 10.1007/s11886-015-0572-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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11
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Konsensuspapier der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin (DGP) und der Deutschen Gesellschaft für Kardiologie – Herz und Kreislaufforschung (DGK) zur Diagnostik und Therapie der kardialen Sarkoidose. KARDIOLOGE 2014. [DOI: 10.1007/s12181-013-0550-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Abstract
Sarcoidosis is a systemic granulomatous disease of unknown etiology. Cardiac involvement may occur, leading to an adverse outcome. Although early treatment to improve morbidity and mortality is desirable, sensitive and accurate detection of cardiac sarcoidosis remains a challenge. Accordingly, interest in the use of advanced imaging such as cardiac MR and PET with (18)F-FDG is increasing in order to refine the clinical workup. Although the field is still facing challenges and uncertainties, this article presents a summary of clinical background and the current state of diagnostic modalities and treatment of cardiac sarcoidosis.
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Affiliation(s)
- Imke Schatka
- Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany
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13
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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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14
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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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Diagnosis of Cardiac Sarcoidosis Through Mismatched Defects Seen on N-13 NH3/F-18 FDG Cardiac PET. Clin Nucl Med 2011; 36:1156-7. [DOI: 10.1097/rlu.0b013e3182336113] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Cardiac sarcoidosis is an underdiagnosed disease that may be present in as many as 25% of patients with systemic sarcoidosis. Although most commonly recognized in patients with other manifestations of sarcoidosis, it may occur in isolation and its presence is often not appreciated. Cardiac sarcoidosis may present as asymptomatic left ventricular dysfunction, congestive heart failure, atrioventricular block, atrial or ventricular arrhythmia and sudden death. Although untested in clinical trials, early use of high-dose steroid therapy may halt or reverse cardiac damage. This article reviews the clinical manifestations, diagnosis and treatment of sarcoidosis, with an emphasis on new imaging techniques and therapies.
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Abstract
PURPOSE OF REVIEW The clinical role of emerging imaging technologies for diagnosing cardiac sarcoidosis and other cardiomyopathies is evolving. An up-to-date review of the role of various imaging modalities in the evaluation of cardiac sarcoidosis and other cardiomyopathies is presented. RECENT FINDINGS No study prospectively established the accuracy of each of the various techniques for diagnosing myocardial involvement in patients with suspected cardiac sarcoidosis. Cardiac magnetic resonance imaging (CMR) is demonstrated to have a sensitivity of 100% and specificity of approximately 80%, and positive predictive value of approximately 55% in diagnosing cardiac sarcoidosis. Recent studies have shown that 18F-2-fluoro-2-deoxyglucose positron emission tomography (FDG-PET) has 100% sensitivity of detecting earlier stages of sarcoidosis. Both the FDG-PET and CMR may provide complementary information for the diagnosis and assessment of efficacy of therapy in patients with cardiac involvement from sarcoidosis. SUMMARY Clinical and subclinical cardiac involvement is common among patients with sarcoidosis. A structured clinical assessment incorporating advanced cardiac imaging with CMR and FDG-PET scanning is more sensitive than the established clinical criteria. CMR is an established imaging modality in the diagnosis of various other cardiomyopathies. Well designed prospective clinical trials are awaited to define the exact role of these imaging studies in the diagnosis and guidance of therapy.
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O'Hanlon R, Pennell DJ. Cardiovascular Magnetic Resonance in the Evaluation of Hypertrophic and Infiltrative Cardiomyopathies. Heart Fail Clin 2009; 5:369-87, vi. [DOI: 10.1016/j.hfc.2009.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Abstract
To this day the aetiology of sarcoidosis continues to elude definition. Partially as a consequence of this, little in the way of new therapies has evolved. The enigma of this condition is that, unusually for a disease with the potential for devastating consequences, many patients show spontaneous resolution and recover. Cardiac involvement can affect individuals of any age, gender or race and has a predilection for the conduction system of the heart. Heart involvement can also cause a dilated cardiomyopathy with consequent progressive heart failure. The most common presentation of this systemic disease is with pulmonary infiltration, but many cases will be asymptomatic and are detected on routine chest radiography revealing lymphadenopathy. Current advances lie in the newer methods of imaging and diagnosing this unusual heart disease. This review describes the pathology and diagnosis of this condition and the newer imaging techniques that have developed for determining cardiac involvement.
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Affiliation(s)
- Simon W Dubrey
- Department of Cardiology, Hillingdon Hospital, Uxbridge, Middlesex, UK.
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Banba K, Kusano KF, Nakamura K, Morita H, Ogawa A, Ohtsuka F, Ogo KO, Nishii N, Watanabe A, Nagase S, Sakuragi S, Ohe T. Relationship between arrhythmogenesis and disease activity in cardiac sarcoidosis. Heart Rhythm 2007; 4:1292-9. [PMID: 17905334 DOI: 10.1016/j.hrthm.2007.06.006] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2007] [Accepted: 06/10/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND In patients with cardiac sarcoidosis, ventricular arrhythmias and/or conduction disturbances are frequently observed and sometimes fatal. However, few reports on disease activity and arrhythmic events in cardiac sarcoidosis are available. OBJECTIVE The purpose of this study was to investigate the relationship between disease activity and arrhythmic events in cardiac sarcoidosis and the effect of corticosteroid therapy. METHODS The study population consisted of 15 cardiac sarcoidosis patients with new-onset symptomatic arrhythmia, including eight patients admitted once for complete atrioventricular block (CAVB), five patients admitted once for sustained ventricular tachycardia (VT), and two patients admitted twice for two arrhythmic events (one for CAVB and the other for sustained VT). Disease activity was evaluated by gallium-67 citrate (Ga) scintigraphy. All patients with positive Ga uptake were treated with corticosteroids, and arrhythmic events were evaluated by repeat Holter recordings. RESULTS Positive uptake of Ga was observed in 8 (80%) of the 10 CAVB events and in 1 (14%) of the 7 sustained VT events (80% vs 14%, P = .02). Corticosteroids abolished myocardial Ga uptake in all nine patients with positive Ga uptake. After corticosteroid therapy was started, AV conduction improved in 5 of 9 CAVB patients (including 8 patients with new-onset CAVB and one patient with history of CAVB). However, ventricular arrhythmias were not improved after corticosteroid therapy. CONCLUSION In cardiac sarcoidosis patients, CAVB develops mainly during the active phase of the disease. Early treatment with corticosteroids might improve AV conduction disturbance. However, sustained VT is not closely linked with disease activity and frequently develops in the advanced stage of disease.
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Affiliation(s)
- Kimikazu Banba
- Department of Cardiovascular Medicine, Graduate School of Medicine and Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Okayama 700-8558, Japan.
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Abstract
Viruses are the most common cause of myocarditis in economically advanced countries. Enteroviruses and adenoviruses are the most common etiologic agents. Viral myocarditis is a triphasic process. Phase 1 is the period of active viral replication in the myocardium during which the symptoms of myocardial damage range from none to cardiogenic shock. If the disease process continues, it enters phase 2, which is characterized by autoimmunity triggered by viral and myocardial proteins. Heart failure often appears for the first time in phase 2. Phase 3, dilated cardiomyopathy, is the end result in some patients. Diagnostic procedures and treatment should be tailored to the phase of disease. Viral myocarditis is a significant cause of dilated cardiomyopathy, as proved by the frequent presence of viral genomic material in the myocardium, and by improvement in ventricular function by immunomodulatory therapy. Myocarditis of any etiology usually presents with heart failure, but the second most common presentation is ventricular arrhythmia. As a result, myocarditis is one of the most common causes of sudden death in young people and others without preexisting structural heart disease. Myocarditis can be definitively diagnosed by endomyocardial biopsy. However, it is clear that existing criteria for the histologic diagnosis need to be refined, and that a variety of molecular markers in the myocardium and the circulation can be used to establish the diagnosis. Treatment of myocarditis has been generally disappointing. Accurate staging of the disease will undoubtedly improve treatment in the future. It is clear that immunosuppression and immunomodulation are effective in some patients, especially during phase 2, but may not be as useful in phases 1 and 3. Since myocarditis is often selflimited, bridging and recovery therapy with circulatory assistance may be effective. Prevention by immunization or receptor blocking strategies is under development. Giant cell myocarditis is an unusually fulminant form of the disease that progresses rapidly to heart failure or sudden death. Rapid onset of disease in young people, especially those with other autoimmune manifestations, accompanied by heart failure or ventricular arrhythmias, suggests giant cell myocarditis. Peripartum cardiomyopathy in economically developed countries is usually the result of myocarditis.
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Affiliation(s)
- James T. Willerson
- The University of Texas Health Science Center in Houston, Houston, ,Texas Heart Institute, Houston, TX USA
| | - Hein J. J. Wellens
- Department of Cardiology, University of Maastricht, Masstricht, The Netherlands
| | - Jay N. Cohn
- Rasmussen Center for Cardiovascular Disease Prevention Cardiovascular Division, University of Minnesota, Minneapolis, MN USA
| | - David R. Holmes
- Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, MN USA
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Rodado Marina S, Poblete García VM, García Vicente AM, Ruiz Solís S, Talavera Rubio MP, Cortés Romera M, Soriano Castrejón A. [Myocardial perfusion SPECT with 99mTc-tetrofosmin and thoracic SPECT with Gallium-67 SPECT in a patient with chest pain and a history of sarcoidosis]. REVISTA ESPANOLA DE MEDICINA NUCLEAR 2006; 25:35-9. [PMID: 16540010 DOI: 10.1157/13083348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
We present the case of a 54-year-old male patient, with history of diagnosed sarcoidosis some years ago and myocardial involvement, who being asymptomatic, shows chest pain because of which he goes to the emergency room of the hospital. During the first hours of his admission the pain relieves with nonsteroidal antiinflammatory medication, an electrocardiogram demonstrates changes of early repolarisation with pericardial involvement, the enzymes don't rise and the echocardiogram reveals a slight pericardial effusion. The differential diagnosis is between a chest pain due to ischemia, and the secondary to myopericarditis in the clinical context of a sarcoidosis. Myocardial perfusion rest SPECT is required which is compatible with lateral acute myocardial infarction (AMI) with extension to inferior wall. A coronary angiography was carried out and showed two vessels disease (RCA and Cx), PTCA and stent were carried out successfully. During the admission a thoracic scintigraphy and SPECT with gallium -67 showed an uptake in lateral wall of left ventricle (LV). Nothing about active sarcoidosis was found.
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Affiliation(s)
- S Rodado Marina
- Servicio de Medicina Nuclear, Hospital General de Ciudad Real, Ciudad Real.
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Chiu CZ, Nakatani S, Zhang G, Tachibana T, Ohmori F, Yamagishi M, Kitakaze M, Tomoike H, Miyatake K. Prevention of left ventricular remodeling by long-term corticosteroid therapy in patients with cardiac sarcoidosis. Am J Cardiol 2005; 95:143-6. [PMID: 15619415 DOI: 10.1016/j.amjcard.2004.08.083] [Citation(s) in RCA: 195] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2004] [Revised: 08/26/2004] [Accepted: 08/26/2004] [Indexed: 11/24/2022]
Abstract
Forty-three patients with cardiac sarcoidosis were studied echocardiographically before and after (mean follow-up 88 months) steroid therapy to determine the effectiveness of corticosteroids to prevent left ventricular (LV) remodeling and improve LV contractility. In patients with initial LV ejection fractions (LVEFs) >or=55%, long-term steroid therapy showed preventive effects for LV remodeling and LV function. Patients with LVEF <54% showed significant reductions of LV volumes and LVEF improvement. However, in patients with LVEFs <30%, steroid therapy resulted in neither LV volume reductions nor improved LVEFs. In the early or middle stage of the disease, steroid therapy may be protective or therapeutic in preventing LV remodeling and preserving LV function. However, it may not be as effective in the late stage.
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Affiliation(s)
- Chiung-Zuan Chiu
- Department of Cardiology, National Cardiovascular Center, Suita, Osaka, Japan
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Chapelon-Abric C, de Zuttere D, Duhaut P, Veyssier P, Wechsler B, Huong DLT, de Gennes C, Papo T, Blétry O, Godeau P, Piette JC. Cardiac sarcoidosis: a retrospective study of 41 cases. Medicine (Baltimore) 2004; 83:315-334. [PMID: 15525844 DOI: 10.1097/01.md.0000145367.17934.75] [Citation(s) in RCA: 200] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This retrospective study concerned 18 female and 23 male patients with cardiac sarcoidosis (CS). The average age at CS diagnosis was 38 years. CS was observed in white (73% of cases) and in black or Caribbean patients (27% of cases). All patients had extracardiac histologic proof of sarcoid tissue. In 63% of cases, the CS arose during the follow-up of systemic sarcoidosis. Systemic sarcoidosis was not specific except for a high frequency of neurosarcoidosis. Revealing cardiac signs were clinical in 63% of cases and electrical in 22%. In most patients these signs were associated with an abnormal echocardiography (77%) and/or a defect on thallium-201 or sestamibi imaging (75%). Thirty-nine patients received steroid therapy (initial dose mostly equal to 1 mg/kg per day), associated in 13 cases with another immunosuppressive treatment. In 26% of cases the immunosuppressive treatment was associated with a specific cardiac treatment. In the long-term follow-up (average follow-up, 58 mo), 87% of the cases showed an improvement, and 54% were cured from a clinical and laboratory point of view (electrocardiogram, 24-hour monitoring, echocardiography, radionuclide imaging). There was no sudden death. Two patients worsened, which can be explained in 1 case by very late treatment and in the other case by lack of treatment, except for a pacemaker. Our experience leads us to treat CS with corticosteroids as soon as possible and to use another immunosuppressive treatment where there is an insufficient therapeutic response or where there are contraindications to corticosteroids.
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Affiliation(s)
- Catherine Chapelon-Abric
- From Service de Médecine Interne (CC-A, PD, BW, DLTH, CdG, TP, PG, JCP), Hôpital de la Pitié, Paris; Service de Physiologie-Explorations Fonctionnelles (DdZ), Hôpital Bichât, Paris; Service de Médecine Interne (PV), Centre Hospitalier de Compiegne, Compiegne; and Service de Médecine Interne (OB), Hôpital Foch, Suresnes, France
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27
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Lee K, O'Sullivan R. Cardiac sarcoidosis: An elusive diagnosis. Heart Lung Circ 2003; 12:112. [PMID: 16352118 DOI: 10.1046/j.1444-2892.2003.00204.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Kenneth Lee
- Epworth Hospital MRI, Melbourne, Victoria, Australia
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Imai E, Kaminaga T, Takada K, Kutomi K, Furui S. Radioactive defect on I-123 MIBG myocardial SPECT imaging in a patient with cardiac sarcoidosis. Clin Nucl Med 2002; 27:729-30. [PMID: 12352118 DOI: 10.1097/00003072-200210000-00011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Erika Imai
- Department of Radiology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan
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29
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Abstract
MRI has become of great importance in the study of several aspects of sarcoidosis. The main development has taken place in the assessment of neurosarcoidosis, but MRI may be also useful in the evaluation of sarcoidosis of the bone, muscle, heart, and intrathoracic. Nuclear imaging in sarcoidosis acquired a great expansion with the introduction of (67)gallium scanning as a marker of activity. Although its current use has decreased, it is still very helpful in particular situations of the disease. Other more recently introduced nuclear imaging techniques may have a role in the evaluation of cardiac sarcoidosis and in the assessment of the extension of the disease.
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Affiliation(s)
- Juan Mañá
- University of Barcelona, Department of Internal Medicine, Bellvitge Hospital, Barcelona, Spain.
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30
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Chiu CZ, Cheng JJ, Nakatani S, Yamagishi M, Miyatake K. Echocardiographic Manifestations in Patients with Cardiac Sarcoidosis. J Med Ultrasound 2002. [DOI: 10.1016/s0929-6441(09)60031-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Hourigan LA, Burstow DJ, Pohlner P, Clarke BE, Donnelly JE. Transesophageal echocardiographic abnormalities in a case of cardiac sarcoidosis. J Am Soc Echocardiogr 2001; 14:399-402. [PMID: 11337687 DOI: 10.1067/mje.2001.110785] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Sarcoidosis is a granulomatous disease that may involve multiple organ systems, including the heart. Manifestations include atrial and ventricular arrhythmias, conduction abnormalities, congestive cardiac failure, pericarditis, and sudden death. Whereas cardiac involvement is a relatively common finding at autopsy, antemortem diagnosis is often missed because the clinical manifestations are nonspecific, and the sensitivity and specificity of investigations are low. We report a case of a 62-year-old woman who had clinically significant cardiac sarcoidosis associated with echocardiographic abnormalities that had not been reported previously in association with this condition.
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Affiliation(s)
- L A Hourigan
- Department of Cardiology, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, Australia.
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Keesling CA, Frush DP, O'Hara SM, Fordham LA. Clinical and imaging manifestations of pediatric sarcoidosis. Acad Radiol 1998; 5:122-32. [PMID: 9484547 DOI: 10.1016/s1076-6332(98)80134-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- C A Keesling
- Department of Radiology, Duke University Medical Center, Durham, NC
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Mañá J. Nuclear imaging. 67Gallium, 201thallium, 18F-labeled fluoro-2-deoxy-D-glucose positron emission tomography. Clin Chest Med 1997; 18:799-811. [PMID: 9413659 DOI: 10.1016/s0272-5231(05)70419-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
67Gallium scan has been used for years in sarcoidosis as a marker of activity, a determiner of the extent and distribution of the disease, a diagnostic support, and an aid in therapeutic management. Because of its limited sensitivity and specificity for sarcoidosis, however, it is currently used mainly to assist in diagnosis in difficult cases, particularly in those with isolated extrathoracic sarcoidosis. The finding of the typical lambda or panda patterns supports the diagnosis and reinforces the indication to perform an appropriate biopsy or Kveim-Siltzbach test. In addition, the detection of clinically silent extrathoracic uptake may provide sites for biopsy. 67Gallium scans' routine use in the follow-up of pulmonary sarcoidosis under treatment has decreased because that is best accomplished by means of serial chest radiographs and PFT. 201Thallium scintigraphy studies the myocardial perfusion and is complementary to echocardiography and 24-hour electrocardiographic monitoring in the assessment of sarcoid cardiac involvement. It typically shows segmental areas of decreased uptake in the ventricular myocardium that disappear or decrease in size during stress or after intravenous administration of dipyridamole. That reverse distribution is not specific for cardiac sarcoidosis, however, because it may also occur in other cardiomyopathies. PET is based on the increase of glucose metabolism in inflamed tissues. It may have great potential to assess sarcoidosis activity, but it is still largely experimental and is not routinely employed.
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Affiliation(s)
- J Mañá
- Department of Internal Medicine, Hospital de Bellvitge, University of Barcelona, Spain
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Abstract
In patients with sarcoidosis, myocardial involvement is common and may be fatal. With extensive disease, the primary manifestations may include conduction abnormalities and arrhythmias, which may lead to sudden death. Myocardial perfusion scintigraphy may be the most accurate method to assess extent of myocardial involvement and response to therapy.
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Affiliation(s)
- B B Chin
- Department of Radiology and Nuclear Medicine, Johns Hopkins Medical Institutes, Baltimore, Maryland 21287, USA
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Affiliation(s)
- L S Newman
- Department of Medicine, National Jewish Medical and Research Center, Denver, CO 80206, USA
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Lip GY, Gupta J, Gill JS, Singh SP. Sarcoid heart disease: a rare cause of chest pain and malignant cardiac arrhythmia in a young Asian man. A case report. Angiology 1996; 47:905-10. [PMID: 8810658 DOI: 10.1177/000331979604700910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Cardiac sarcoidosis is a disease of young adults. In most cases, it presents with sudden death, arrhythmia, conduction disorders, heart failure, or cardiomyopathy. The authors describe a young Indo-Asian man with cardiac sarcoidosis who presented acutely with chest pain and malignant cardiac arrhythmias. The diagnosis of cardiac sarcoidosis should be considered in all young patients with unexplained arrhythmias or heart failure or in cases of sudden death.
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Affiliation(s)
- G Y Lip
- Department of Cardiology, City Hospital, Birmingham
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Abstract
Cardiac uptake of Ga-67 in myocarditis has been described in association with a number of disease entities. However, there are no reports in the current literature describing Ga-67 uptake in myocarditis due to systemic lupus erythematosus, a disease that often involves the heart. The authors present the case of a patient with a long history of systemic lupus erythematosus in whom new ECG changes and left ventricular wall motion abnormality developed, and who demonstrated significant global myocardial uptake on Ga-67 scintigraphy. Other etiologies including myocardial infarction, epicardial coronary disease, pericarditis, endocarditis, dilated cardiomyopathy, and viral infection were excluded during extensive work-up.
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Affiliation(s)
- P R Jolles
- Department of Radiology, Medical College of Virginia Hospitals, Richmond 23298-0001, USA
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38
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Balingit AG, Slack MC, Allen S, Caravalho J, Rivera JE, Rodriguez AA. Right ventricular 201T1 uptake on myocardial perfusion single photon emission computed tomography imaging. Semin Nucl Med 1995; 25:348-51. [PMID: 8545639 DOI: 10.1016/s0001-2998(95)80008-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- A G Balingit
- Nuclear Medicine Service, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA
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