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Sharma R, Kouranos V, Cooper LT, Metra M, Ristic A, Heidecker B, Baksi J, Wicks E, Merino JL, Klingel K, Imazio M, de Chillou C, Tschöpe C, Kuchynka P, Petersen SE, McDonagh T, Lüscher T, Filippatos G. Management of cardiac sarcoidosis. Eur Heart J 2024:ehae356. [PMID: 38923509 DOI: 10.1093/eurheartj/ehae356] [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: 03/20/2024] [Revised: 05/01/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024] Open
Abstract
Cardiac sarcoidosis (CS) is a form of inflammatory cardiomyopathy associated with significant clinical complications such as high-degree atrioventricular block, ventricular tachycardia, and heart failure as well as sudden cardiac death. It is therefore important to provide an expert consensus statement summarizing the role of different available diagnostic tools and emphasizing the importance of a multidisciplinary approach. By integrating clinical information and the results of diagnostic tests, an accurate, validated, and timely diagnosis can be made, while alternative diagnoses can be reasonably excluded. This clinical expert consensus statement reviews the evidence on the management of different CS manifestations and provides advice to practicing clinicians in the field on the role of immunosuppression and the treatment of cardiac complications based on limited published data and the experience of international CS experts. The monitoring and risk stratification of patients with CS is also covered, while controversies and future research needs are explored.
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Affiliation(s)
- Rakesh Sharma
- Department of Cardiology, Royal Brompton Hospital, part of Guy's and St Thomas's NHS Foundation Trust, London SW3 6NP, UK
- National Heart and Lung Institute, Imperial College London, UK
- King's College London, UK
| | - Vasileios Kouranos
- National Heart and Lung Institute, Imperial College London, UK
- Interstitial Lung Disease Unit, Royal Brompton Hospital, part of Guys and St. Thomas's Hospital, London, UK
| | - Leslie T Cooper
- Department of Cardiovascular Medicine, Mayo Clinic in Florida, 4500 San Pablo, Jacksonville, USA
| | - Marco Metra
- Cardiology Unit, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Arsen Ristic
- Department of Cardiology, University of Belgrade, Pasterova 2, Floor 9, 11000 Belgrade, Serbia
| | - Bettina Heidecker
- Department for Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Benjamin Franklin; Charité Universitätsmedizin Berlin, Berlin Institute of Health (BIH) at Charité, Berlin, Germany
| | - John Baksi
- National Heart and Lung Institute, Imperial College London, UK
- Cardiac MRI Unit, Royal Brompton Hospital, part of Guy's and St Thomas's NHS Foundation Trust, London, UK
| | - Eleanor Wicks
- Department of Cardiology, Oxford University Hospitals NHS Trust, Oxford, UK
- University College London, London, UK
| | - Jose L Merino
- La Paz University Hospital-IdiPaz, Universidad Autonoma, Madrid, Spain
| | | | - Massimo Imazio
- Department of Medicine, University of Udine, Udine, Italy
- Department of Cardiology, University Hospital Santa Maria della Misericordia, Udine, Italy
| | - Christian de Chillou
- Department of Cardiology, CHRU-Nancy, Université de Lorraine, Nancy, France
- Department of Cardiology, IADI, INSERM U1254, Université de Lorraine, Nancy, France
| | - Carsten Tschöpe
- Department of Cardiology, Deutsches Herzzentrum der Charité (DHZC), Angiology and Intensive Medicine (Campus Virchow) and German Centre for Cardiovascular Research (DZHK)- partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH) at Charité - Center for Regenerative Therapies, Universitätsmedizin Berlin, Berlin, Germany
| | - Petr Kuchynka
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Steffen E Petersen
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University London, Charterhouse Square, London, EC1M 6BQ, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, EC1A 7BE, London, UK
| | | | - Thomas Lüscher
- Royal Brompton Hospital, part of Guys and St Thomas's NHS Foundation Trust, Professor of Cardiology at Imperial College and Kings College, London, UK
| | - Gerasimos Filippatos
- Department of Cardiology, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
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Mactaggart S, Ahmed R. The role of ICDs in patients with sarcoidosis-A comprehensive review. Curr Probl Cardiol 2024; 49:102483. [PMID: 38401822 DOI: 10.1016/j.cpcardiol.2024.102483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 02/21/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Implantable cardioverter defibrillator (ICD) use in cardiac sarcoidosis (CS) to prevent sudden cardiac death (SCD) is a potentially life-saving intervention. However, the factors that determine outcome in this cohort remains largely unknown. This review analyses CS patients with an ICD and highlights determinants of poor outcome. OUTCOMES Analysis of studies which used the 2014 HRS Consensus, 2017 AHA/ACC/HRS Guideline and 2022 ESC Guidelines showed that those with class I recommendations have higher incidences of ventricular arrhythmia (VA) than those with class II recommendations. Additionally, even those with normal left ventricular ejection fraction (LVEF) and CS are at high risk of VA and SCD. SUMMARY Compounding research emphasises the importance of cardiac imaging in those with sarcoidosis, with evidence to suggest a possible need for revision of the guidelines. Other variables such as demographics and ventricular characteristics may prove useful in predicting those to benefit most from ICD insertion.
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Affiliation(s)
| | - Raheel Ahmed
- Royal Brompton Hospital, London, United Kingdom; National Heart and Lung Institute, Imperial College London, United Kingdom
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Tanabe S, Nakano Y, Ando H, Fujimoto M, Onishi T, Ohashi H, Kuno S, Naito K, Waseda K, Takahashi H, Suzuki Y, Fukuta M, Amano T. Utility of new FDG-PET/CT guidelines for diagnosing cardiac sarcoidosis in patients with implanted cardiac pacemakers for atrioventricular block. Sci Rep 2024; 14:7825. [PMID: 38570621 PMCID: PMC10991404 DOI: 10.1038/s41598-024-58475-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 03/29/2024] [Indexed: 04/05/2024] Open
Abstract
Diagnosing cardiac sarcoidosis (CS), especially in isolated cases, is challenging, particularly due to the limitations of endomyocardial biopsy, leading to potential undiagnosed cases in pacemaker-implanted patients. This study aims to provide real world findings to support new guideline for CS using 18F-fluoro-deoxyglucose positron-emission tomography computed tomography (FDG-PET/CT) which give a definite diagnosis of isolated CS (iCS) without histological findings. We examined consecutive patients with cardiac pacemakers for atrioventricular block (AV-b) attending our outpatient pacemaker clinic. The patients underwent periodical follow-up echocardiography and were divided into two groups according to echocardiographic findings: those with suspected CS and those without suspected CS. Patients suspected of having nonischemic cardiomyopathy underwent FDG-PET/CT for CS diagnosis. We investigated the utility of the new guideline for CS using FDG-PET/CT. Among the 272 patients enrolled, 97 patients were implanted with cardiac pacemakers for AV-b. Twenty-two patients were suspected of having CS during a median observation period of 5.4 years after pacemaker implantation. Of these, one did not consent, and nine of 21 cases (43%) were diagnosed with definite CS according to the new guidelines. Five of these nine patients were diagnosed with iCS using FDG-PET/CT. The number of patients diagnosed with definite CS using the new guidelines tended to be approximately 2.3 times that of the conventional criteria (p = 0.074). Three of the nine patients underwent steroid treatment. The composite outcome, comprising all-cause death, heart failure hospitalization, and a substantial reduction in left ventricular ejection fraction, were significantly lower in patients receiving steroid treatment compared to those without steroid treatment (p = 0.048). The utilization of FDG-PET/CT in accordance with the new guidelines facilitates the diagnosis of CS, including iCS, resulting in approximately 2.3 times as many diagnoses of CS compared to the conventional criteria. This guideline has the potential to support the early identification of iCS and may contribute to enhancing patient clinical outcomes.
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Affiliation(s)
- Subaru Tanabe
- Department of Cardiology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Yusuke Nakano
- Department of Cardiology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan.
| | - Hirohiko Ando
- Department of Cardiology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Masanobu Fujimoto
- Department of Cardiology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Tomohiro Onishi
- Department of Cardiology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Hirofumi Ohashi
- Department of Cardiology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Shimpei Kuno
- Department of Cardiology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Kazuhiro Naito
- Department of Cardiology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Katsuhisa Waseda
- Department of Cardiology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Hiroshi Takahashi
- Fujita Health University School of Medical Science, 1-98 Dengakukubo, Kutsukake, Toyoake, Aichi, Japan
| | - Yasushi Suzuki
- Department of Cardiology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
| | - Motoyuki Fukuta
- Department of Cardiology, Tajimi City Hospital, 3-43 Maehatacho, Tajimi, Gifu, Japan
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi, 480-1195, Japan
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Maizels L, Mansour M, Abu-Much A, Massalha E, Kalstein M, Beinart R, Sabbag A, Brodov Y, Goitein O, Chernomordik F, Berger M, Herscovici R, Kuperstein R, Arad M, Matetzky S, Beigel R. Prevalence of Cardiac Sarcoidosis in Middle-Aged Adults Diagnosed with High-Grade Atrioventricular Block. Am J Med 2024; 137:358-365. [PMID: 38113953 DOI: 10.1016/j.amjmed.2023.11.027] [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: 11/04/2023] [Revised: 11/28/2023] [Accepted: 11/28/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION Atrioventricular block may be idiopathic or a secondary manifestation of an underlying systemic disease. Cardiac sarcoidosis is a significant underlying cause of high-grade atrioventricular block, posing diagnostic challenges and significant clinical implications. This study aimed to assess the prevalence and clinical characteristics of cardiac sarcoidosis among younger patients presenting with unexplained high-grade atrioventricular block. METHODS We evaluated patients aged between 18 and 65 years presenting with unexplained high-grade atrioventricular block, who were systematically referred for cardiac magnetic resonance imaging, positron emission tomography-computed tomography, or both, prior to pacemaker implantation. Subjects with suspected cardiac sarcoidosis based on imaging findings were further referred for tissue biopsy. Cardiac sarcoidosis diagnosis was confirmed based on biopsy results. RESULTS Overall, 30 patients with high-grade atrioventricular block were included in the analysis. The median age was 56.5 years (interquartile range 53-61.75, years). In 37%, cardiac magnetic resonance imaging, positron emission tomography-computed tomography, or both, were suggestive of cardiac sarcoidosis, and in 33% cardiac sarcoidosis was confirmed by tissue biopsy. Compared with idiopathic high-grade atrioventricular block patients, all cardiac sarcoidosis patients were males (100% vs 60%, P = .029), were more likely to present with heart failure symptoms (50% vs 10%, P = .047), had thicker inter-ventricular septum on echocardiography (12.2 ± 2.7 mm vs 9.45 ± 1.6 mm, P = .002), and were more likely to present with right ventricular dysfunction (33% vs 10%, P = .047). CONCLUSIONS Cardiac sarcoidosis was confirmed in one-third of patients ≤ 65 years, who presented with unexplained high-grade atrioventricular block. Cardiac sarcoidosis should be highly suspected in such patients, particularly in males who present with heart failure symptoms or exhibit thicker inter-ventricular septum and right ventricular dysfunction on echocardiography.
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Affiliation(s)
- Leonid Maizels
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center, Ramat Gan, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel; Talpiot Sheba Medical Leadership Program, Sheba Medical Center, Ramat Gan, Israel
| | - Mahmoud Mansour
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center, Ramat Gan, Israel
| | - Arsalan Abu-Much
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center, Ramat Gan, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Eias Massalha
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center, Ramat Gan, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Maia Kalstein
- Internal Medicine Department C, Sheba Medical Center, Ramat Gan, Israel
| | - Roy Beinart
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center, Ramat Gan, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Avi Sabbag
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center, Ramat Gan, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Yafim Brodov
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center, Ramat Gan, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel; Division of Diagnostic Imaging, Sheba Medical Center; Ramat Gan, Israel
| | - Orly Goitein
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center, Ramat Gan, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel; Division of Diagnostic Imaging, Sheba Medical Center; Ramat Gan, Israel
| | - Fernando Chernomordik
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center, Ramat Gan, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Michael Berger
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center, Ramat Gan, Israel
| | - Romana Herscovici
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center, Ramat Gan, Israel
| | - Rafael Kuperstein
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center, Ramat Gan, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Michael Arad
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center, Ramat Gan, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Shlomi Matetzky
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center, Ramat Gan, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Roy Beigel
- Division of Cardiology, Leviev Center of Cardiovascular Medicine, Sheba Medical Center, Ramat Gan, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel.
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Aimo A, Milandri A, Barison A, Pezzato A, Morfino P, Vergaro G, Merlo M, Argirò A, Olivotto I, Emdin M, Finocchiaro G, Sinagra G, Elliott P, Rapezzi C. Electrocardiographic abnormalities in patients with cardiomyopathies. Heart Fail Rev 2024; 29:151-164. [PMID: 37848591 PMCID: PMC10904564 DOI: 10.1007/s10741-023-10358-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 10/19/2023]
Abstract
Abnormalities in impulse generation and transmission are among the first signs of cardiac remodeling in cardiomyopathies. Accordingly, 12-lead electrocardiogram (ECG) of patients with cardiomyopathies may show multiple abnormalities. Some findings are suggestive of specific disorders, such as the discrepancy between QRS voltages and left ventricular (LV) mass for cardiac amyloidosis or the inverted T waves in the right precordial leads for arrhythmogenic cardiomyopathy. Other findings are less sensitive and/or specific, but may orient toward a specific diagnosis in a patient with a specific phenotype, such as an increased LV wall thickness or a dilated LV. A "cardiomyopathy-oriented" mindset to ECG reading is important to detect the possible signs of an underlying cardiomyopathy and to interpret correctly the meaning of these alterations, which differs in patients with cardiomyopathies or other conditions.
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Affiliation(s)
- Alberto Aimo
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy.
| | | | - Andrea Barison
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Andrea Pezzato
- Center for Diagnosis and Management of Cardiomyopathies, Cardiothoracovascular Department Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | - Paolo Morfino
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Giuseppe Vergaro
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Marco Merlo
- Center for Diagnosis and Management of Cardiomyopathies, Cardiothoracovascular Department Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | | | - Iacopo Olivotto
- Department of Experimental and Clinical Medicine, University of Florence, Meyer Children Hospital Florence, Florence, Italy
| | - Michele Emdin
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Gherardo Finocchiaro
- Royal Brompton and Harefield Hospital, London, UK
- St George's University of London, London, UK
| | - Gianfranco Sinagra
- Center for Diagnosis and Management of Cardiomyopathies, Cardiothoracovascular Department Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | - Perry Elliott
- UCL Centre for Heart Muscle Disease and Lead of the Inherited Cardiovascular Disease Unit, Bart's Heart Centre, London, UK
- Cardiology Centre, University of Ferrara, Ferrara, Italy
| | - Claudio Rapezzi
- UCL Centre for Heart Muscle Disease and Lead of the Inherited Cardiovascular Disease Unit, Bart's Heart Centre, London, UK
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Lucinian YA, Martineau P, Poenaru R, Tremblay-Gravel M, Cadrin-Tourigny J, Harel F, Pelletier-Galarneau M. FDG-PET/CT and rest myocardial perfusion imaging to predict high-degree atrioventricular block recovery in cardiac sarcoidosis. J Nucl Cardiol 2023; 30:2490-2500. [PMID: 37258950 DOI: 10.1007/s12350-023-03306-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 05/06/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUNDS High-degree atrioventricular block (AVB) recovery in CS has been shown to be highly variable despite immunosuppressive treatment, with no reliable tool available to predict odds of reversibility. This study sought to evaluate the potential of combined fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) and resting myocardial perfusion imaging (rMPI) to predict reversibility of newly diagnosed high-grade AVB in cardiac sarcoidosis (CS). METHODS We performed a single-center, retrospective analysis of patients with CS presenting with high-grade AVB who underwent combined FDG-PET/CT and rMPI. The 2016 JCS and the 2014 HRS diagnostic criteria were used for the diagnosis of CS. Patients with a history of coronary artery disease or prior immunosuppressive treatment were excluded. Patients were divided into AVB recovery and non-recovery subgroups. CS disease staging was based on FDG-PET and rMPI findings: (Stage 0) normal FDG-PET and rMPI (Stage 1) positive FDG-PET and normal rMPI (Stage 2) positive FDG-PET with perfusion deficits on rMPI (Stage 3) normal FDG-PET with perfusion deficits on rMPI. RESULTS Twenty-seven patients, including 13 demonstrating AVB recovery, were identified. Eleven out of fourteen (78.6%) patients presenting with stage 1 CS demonstrated AVB recovery. Stage 1 CS was significantly more present in the recovery group compared to the non-recovery group (84.6% vs 21.4%, P = .002). Eleven presented with stage 2 CS, with only 2 (18.2%) recovering AV nodal conduction. Stage 2 CS presented more frequently in the non-recovery group (64.3% vs 15.4%, P = .020). CONCLUSIONS Combined FDG-PET and rMPI employed to stage CS disease presenting with high-degree AVB appears to have good performance for predicting likelihood of recovery.
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Affiliation(s)
- Yousif A Lucinian
- Department of Medical Imaging, Montreal Heart Institute, Montreal, QC, H1T1C8, Canada
| | | | - Raluca Poenaru
- Department of Medical Imaging, Montreal Heart Institute, Montreal, QC, H1T1C8, Canada
| | | | | | - Francois Harel
- Department of Medical Imaging, Montreal Heart Institute, Montreal, QC, H1T1C8, Canada
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Castro A, Gilles F, Marrakchi S, Wajchert T, Rouvier P, Cohen-Aubart F, Gibault-Genty G, Georges JL. [Cardiac sarcoidosis revealed by recurrent ventricular tachycardia]. Ann Cardiol Angeiol (Paris) 2023; 72:101644. [PMID: 37677913 DOI: 10.1016/j.ancard.2023.101644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/16/2023] [Indexed: 09/09/2023]
Abstract
Sarcoidosis is an inflammatory disease whose diagnosis is suggested by clinical and paraclinical signs and confirmed by histological evidence showing granulomatosis without caseous necrosis. The clinical presentation is sometimes misleading and the diagnosis difficult to confirm. We report here the case of a young woman with cardiac sarcoidosis of difficult diagnosis, revealed by a myocardial infarction with normal coronary angiography and recurrent ventricular tachycardia. Multimodal imaging, combined with left ventricular endomyocardial biopsies guided by electrophysiological analysis and endocavitary mapping, finally confirmed the diagnosis, and allowed effective medical treatment.
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Affiliation(s)
- Alois Castro
- Service de cardiologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay Rocquencourt, Paris, France
| | - Floriane Gilles
- Service de cardiologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay Rocquencourt, Paris, France
| | - Sonia Marrakchi
- Service de cardiologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay Rocquencourt, Paris, France; Service de rythmologie, Groupe Hospitalier Universitaire de la Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Thibaut Wajchert
- Service de cardiologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay Rocquencourt, Paris, France
| | - Philippe Rouvier
- Service d'anatomie et cytologie pathologiques, Groupe Hospitalier Universitaire de la Pitié Salpêtrière, Assistance Publique- Hôpitaux de Paris, Paris, France
| | - Fleur Cohen-Aubart
- Service de médecine interne, Groupe Hospitalier Universitaire de la Pitié Salpêtrière, Assistance Publique- Hôpitaux de Paris, Paris, France
| | - Géraldine Gibault-Genty
- Service de cardiologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay Rocquencourt, Paris, France
| | - Jean-Louis Georges
- Service de cardiologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay Rocquencourt, Paris, France.
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8
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Blankstein R, Achenbach S. [Imaging diagnostics of cardiac sarcoidosis]. Herz 2023; 48:366-371. [PMID: 37682338 DOI: 10.1007/s00059-023-05208-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/09/2023]
Abstract
Cardiac involvement is clinically apparent in approximately 5% of all patients with systemic sarcoidosis, whereas evidence of cardiac involvement by imaging studies can be found in approximately 20% of cases. Occasionally, isolated cardiac sarcoidosis is encountered and is the only sign of the disease. The most frequent cardiac manifestations of the multifocal granulomatous inflammation include atrioventricular (AV) blocks and other conduction disorders, ventricular arrhythmias, sudden cardiac death and left and right ventricular wall disorders. Accordingly, symptoms that should raise suspicion include palpitations, lightheadedness and syncope. The diagnostic approach to cardiac sarcoidosis is not straightforward. Typical echocardiographic findings include regional thinning and contraction abnormalities particularly in basal, septal and lateral locations. Infrequently, myocardial hypertrophy may be present; however, the sensitivity of echocardiography is low and cardiac sarcoidosis can be present even when an echocardiogram is unrevealing. Cardiac magnetic resonance imaging (MRI) frequently shows late gadolinium enhancement (LGE) in a multifocal pattern often involving the basal septum and lateral walls. The sensitivity and specificity of MRI for detecting cardiac sarcoidosis are high. Fluorodeoxyglucose positron emission tomography (FDG-PET) plays an important role in the diagnostic algorithm due to its ability to visualize focal inflammatory activity both in the myocardium and in extracardiac locations. This may help target the optimal location for biopsy in order to obtain histologic proof of sarcoidosis and can also be used to follow the response to anti-inflammatory treatment. Notably, the sensitivity of endomyocardial biopsy is poor due to the patchy nature of myocardial involvement. In clinical practice, either histologic evidence of noncaseating granulomas from the myocardium or evidence from extracardiac tissue in combination with typical cardiac imaging findings are required to establish the diagnosis.
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Affiliation(s)
- Ron Blankstein
- Department of Medicine (Cardiovascular Division), Brigham and Women's Hospital, Boston, MA, USA
- Department of Medicine (Cardiovascular Division), Harvard Medical School, Boston, MA, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
- Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Stephan Achenbach
- Medizinische Klinik 2, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Deutschland.
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9
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Joglar JA, Kapa S, Saarel EV, Dubin AM, Gorenek B, Hameed AB, Lara de Melo S, Leal MA, Mondésert B, Pacheco LD, Robinson MR, Sarkozy A, Silversides CK, Spears D, Srinivas SK, Strasburger JF, Tedrow UB, Wright JM, Zelop CM, Zentner D. 2023 HRS expert consensus statement on the management of arrhythmias during pregnancy. Heart Rhythm 2023; 20:e175-e264. [PMID: 37211147 DOI: 10.1016/j.hrthm.2023.05.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 05/12/2023] [Indexed: 05/23/2023]
Abstract
This international multidisciplinary expert consensus statement is intended to provide comprehensive guidance that can be referenced at the point of care to cardiac electrophysiologists, cardiologists, and other health care professionals, on the management of cardiac arrhythmias in pregnant patients and in fetuses. This document covers general concepts related to arrhythmias, including both brady- and tachyarrhythmias, in both the patient and the fetus during pregnancy. Recommendations are provided for optimal approaches to diagnosis and evaluation of arrhythmias; selection of invasive and noninvasive options for treatment of arrhythmias; and disease- and patient-specific considerations when risk stratifying, diagnosing, and treating arrhythmias in pregnant patients and fetuses. Gaps in knowledge and new directions for future research are also identified.
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Affiliation(s)
- José A Joglar
- The University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Elizabeth V Saarel
- St. Luke's Health System, Boise, Idaho, and Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, Ohio
| | | | | | | | | | | | | | - Luis D Pacheco
- The University of Texas Medical Branch at Galveston, Galveston, Texas
| | | | - Andrea Sarkozy
- University Hospital of Antwerp, University of Antwerp, Antwerp, Belgium
| | | | - Danna Spears
- University Health Network, Toronto, Ontario, Canada
| | - Sindhu K Srinivas
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | | | | | - Carolyn M Zelop
- The Valley Health System, Ridgewood, New Jersey; New York University Grossman School of Medicine, New York, New York
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10
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Patel R, Mistry AM, Mulukutla V, Prajapati K. Cardiac Sarcoidosis: A Literature Review of Current Recommendations on Diagnosis and Management. Cureus 2023; 15:e41451. [PMID: 37546036 PMCID: PMC10404059 DOI: 10.7759/cureus.41451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 08/08/2023] Open
Abstract
Cardiac sarcoidosis (CS) is a rare multisystem disorder characterized by granulomatous infiltration of the myocardium, which can lead to significant morbidity and mortality. Its clinical manifestations range from asymptomatic conduction abnormalities to severe heart failure (HF) and sudden cardiac death. This comprehensive review aims to provide an overview of the diagnosis, clinical features, and current medical management strategies for CS. Additionally, the role of implantable cardioverter-defibrillators (ICDs) and the potential use of positron emission tomography in guiding management decisions are explored. A comprehensive understanding of the medical management of CS is essential for improving patient outcomes and guiding future research endeavors.
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Affiliation(s)
- Rutul Patel
- Internal Medicine, Texas Tech University Health Sciences Center, El Paso, USA
| | - Anuja Mahesh Mistry
- Internal Medicine, Texas Tech University Health Sciences Center, El Paso, USA
| | | | - Krupal Prajapati
- Internal Medicine, Nathiba Hargovandas Lakhmichand (NHL) Municipal Medical College, Ahmedabad, IND
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11
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Cherrett C, Lee W, Bart N, Subbiah R. Management of the arrhythmic manifestations of cardiac sarcoidosis. Front Cardiovasc Med 2023; 10:1104947. [PMID: 37304969 PMCID: PMC10248162 DOI: 10.3389/fcvm.2023.1104947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Cardiac sarcoidosis (CS) is characterised by a high burden of arrhythmic manifestations and cardiac electrophysiologists play an important role in both the diagnosis and management of this challenging condition. CS is characterised by the formation of noncaseating granulomas within the myocardium, which can subsequently lead to fibrosis. Clinical presentations of CS are varied and depend on the location and extent of granulomas. Patients may present with atrioventricular block, ventricular arrhythmias, sudden cardiac death or heart failure. CS is being increasing diagnosed through use of advanced cardiac imaging, however endomyocardial biopsy is often still required to confirm the diagnosis. Due to the low sensitivity of fluoroscopy-guided right ventricular biopsies, three-dimensional electro-anatomical mapping and electrogram-guided biopsies are being investigated as a means to improve diagnostic yield. Cardiac implantable electronic devices are often required in the management of CS, either for pacing or for primary or secondary prevention of ventricular arrhythmias. Catheter ablation for ventricular arrythmias may also be required, although this is often associated with high recurrence rates due to the challenging nature of the arrhythmogenic substrate. This review will explore the underlying mechanisms of the arrhythmic manifestations of CS, provide an overview of current clinical practice guidelines, and examine the important role that cardiac electrophysiologists play in managing patients with CS.
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Affiliation(s)
- Callum Cherrett
- Cardiology Department, St Vincent’s Hospital Sydney, Sydney, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - William Lee
- Cardiology Department, St Vincent’s Hospital Sydney, Sydney, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | - Nicole Bart
- Cardiology Department, St Vincent’s Hospital Sydney, Sydney, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | - Rajesh Subbiah
- Cardiology Department, St Vincent’s Hospital Sydney, Sydney, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
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12
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Kaneta K, Takahama H, Tateishi E, Irie Y, Moriuchi K, Amano M, Okada A, Amaki M, Kiso K, Kanzaki H, Kusano K, Yasuda S, Izumi C. Clinical Outcomes of Radiologic Relapse in Patients With Cardiac Sarcoidosis Under Immunosuppressive Therapies. Am J Cardiol 2023; 188:24-29. [PMID: 36462271 DOI: 10.1016/j.amjcard.2022.10.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/12/2022] [Accepted: 10/24/2022] [Indexed: 12/02/2022]
Abstract
Although nuclear imaging can detect cardiac involvement of cardiac sarcoidosis (CS), including subclinical states, little is known about the prevalence and outcomes of radiologic relapse under prednisolone (PSL) therapy. This study aimed to investigate the clinical characteristics and outcomes in patients with radiologic relapse. A total of 80 consecutive patients with CS whose disease activity on nuclear imaging decreased at least once after initiation of immunosuppressive therapy were identified through a retrospective chart review. Radiologic relapse of CS was diagnosed using 18F-fluoro-2-deoxyglucose positron emission tomography or gallium-67 scintigraphy. Composite adverse events were defined as at least 1 of the following: all-cause death, hospitalization for heart failure, or lethal arrhythmia. During the follow-up period (median 2.9 years), radiologic relapse was observed in 31 patients (38.8% of overall patients) at 30 months (median) after immunosuppressive therapy initiation. After radiologic relapse was detected, all patients were treated with intensified immunosuppressive therapies (increasing PSL, n = 26 [83.9%], adding other immunosuppressive therapies to PSL, n = 5 [16.1%]). There were no differences in occurrences of composite adverse events in patients with and patients without radiologic relapse. Radiologic relapse under immunosuppressive therapy was observed in many patients with CS, but it was not associated with clinical outcomes under intensified immunosuppressive therapy.
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Affiliation(s)
- Kohei Kaneta
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiroyuki Takahama
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Emi Tateishi
- Department of Radiology and Nuclear Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yuki Irie
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kenji Moriuchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masashi Amano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Atsushi Okada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Makoto Amaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Keisuke Kiso
- Department of Radiology and Nuclear Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hideaki Kanzaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
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13
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Abstract
About 5% of sarcoidosis patients develop clinically manifest cardiac features. Cardiac sarcoidosis (CS) typically presents with conduction abnormalities, ventricular arrhythmias and heart failure. Its diagnosis is challenging and requires a substantial degree of clinical suspicion as well as expertise in advanced cardiac imaging. Adverse events, particularly malignant arrhythmias and development of heart failure, are common among CS patients. A timely diagnosis is paramount to ameliorating outcomes for these patients. Despite weak evidence, immunosuppression (primarily with corticosteroids) is generally recommended in the presence of active inflammation in the myocardium. The burden of malignant arrhythmias remains important regardless of treatment, thus leading to the recommended use of an implantable cardioverter defibrillator in most patients with clinically manifest CS.
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Affiliation(s)
- Alessandro De Bortoli
- Division of Cardiology, University of Ottawa Heart Institute.,Department of Cardiology, Vestfold Hospital Trust
| | - David H Birnie
- Division of Cardiology, University of Ottawa Heart Institute
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14
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Abstract
Sarcoidosis is a granulomatous disease with the potential of multiple organ system involvement and its etiology remains unknown. Cardiac involvement is associated with worse clinical outcome, and has been reported to be 20-30% in white and as high as 58% in Japanese populations with sarcoidosis. Clinical manifestations of cardiac sarcoidosis highly depend on the extent and location of granulomatous inflammation. The most frequent presentations include heart block, tachyarrhythmia, or heart failure. Endomyocardial biopsy is the most specific diagnostic test, but has poor sensitivity due to often patchy involvement. The diagnosis of cardiac sarcoidosis remains challenging due to nonspecific imaging findings. Both 18 F-fluorodeoxyglucose-positron emission tomography (FDG-PET) and cardiac magnetic resonance imaging can be used to evaluate cardiac sarcoidosis, but evaluate different stages of the disease process. FDG-PET detects metabolically active inflammatory cells while cardiac magnetic resonance imaging with late gadolinium enhancement reveals areas of myocardial necrosis and fibrosis. Aggressive therapy of symptomatic cardiac sarcoidosis is often sought due to the high risk of sudden death and/or progression to heart failure. Prednisone 20-40 mg a day is the recommended initial treatment. In refractory or severe cases, higher doses of prednisone, 1-1.5 mg/kg/d (or its equivalent) and addition of a steroid-sparing agent have been utilized. Methotrexate is added most commonly. Long-term improvement has been reported with the use of a combination of weekly methotrexate and prednisone versus prednisone alone. After initiation of treatment, a cardiac FDG-PET scan may be performed 2-3 months later to assess treatment response.
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Affiliation(s)
- Chengyue Jin
- From the Department of Medicine, Westchester Medical Center, Valhalla, NY
| | - Liliya Gandrabur
- Division of Rheumatology, Department of Medicine, Westchester Medical Center, Valhalla, NY
| | - Woo Young Kim
- From the Department of Medicine, Westchester Medical Center, Valhalla, NY
| | - Stephen Pan
- Department of Medicine and Cardiology, Westchester Medical Center, Valhalla, NY
| | - Julia Y Ash
- Division of Rheumatology, Department of Medicine, Westchester Medical Center, Valhalla, NY
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15
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Affiliation(s)
- Cristina Basso
- From the Cardiovascular Pathology Unit, Azienda Ospedaliera, Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padua, Padua, Italy
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16
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Paul A, Paul A, Subhash I, Yadav B, Jacob JR, Christopher DJ, Balamugesh T. Atrial depolarization abnormalities in pulmonary sarcoidosis. Egypt Heart J 2022; 74:74. [PMID: 36209309 PMCID: PMC9547766 DOI: 10.1186/s43044-022-00312-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 09/22/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cardiac sarcoidosis, often manifested as sudden death, can be the first manifestation of sarcoidosis. Since 12-lead electrocardiogram (ECG) is recommended as an initial screening tool for cardiac sarcoidosis, the recognition of subtle abnormalities assumes utmost significance. The objective of this study was to identify the electrocardiographic abnormalities in patients with pulmonary sarcoidosis. RESULTS A detailed analysis of 12-lead ECGs obtained from sixty patients with histopathologically proven pulmonary sarcoidosis and no overt cardiac involvement was done. The findings were compared with those of an age-matched control group. Varying degrees of intraventricular conduction defects were common in the study group [67%], as well as the control group [57%] [P = 0.23]. There was a higher prevalence of biphasic P wave [P = 0.003] and bifid P wave [P = 0.029] in lead III and rsr' in lead aVF [P = 0.03] in the study group as compared to the control group. CONCLUSIONS Our study demonstrates a greater prevalence of subtle ECG abnormalities in patients with pulmonary sarcoidosis as compared to patients with other forms of pulmonary disease. Atrial depolarization abnormalities were commoner in patients with pulmonary sarcoidosis.
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Affiliation(s)
- Amal Paul
- grid.11586.3b0000 0004 1767 8969Department of Cardiology, Christian Medical College and Hospital (CMCH), Vellore, India ,grid.416265.20000 0004 1767 487XMOSC Medical Mission Hospital, Aduputty Hills, Kunnamkulam, Thrissur, Kerala 680503 India
| | - Akhil Paul
- grid.11586.3b0000 0004 1767 8969Department of Pulmonary Medicine, Christian Medical College and Hospital (CMCH), Vellore, India
| | - Immanuel Subhash
- grid.11586.3b0000 0004 1767 8969Department of Pulmonary Medicine, Christian Medical College and Hospital (CMCH), Vellore, India
| | - Bijesh Yadav
- grid.11586.3b0000 0004 1767 8969Department of Biostatistics, Christian Medical College and Hospital (CMCH), Vellore, India
| | - John Roshan Jacob
- grid.11586.3b0000 0004 1767 8969Department of Cardiology and Cardiac Electrophysiology, Christian Medical College and Hospital (CMCH), Vellore, India
| | - D. J. Christopher
- grid.11586.3b0000 0004 1767 8969Department of Pulmonary Medicine, Christian Medical College and Hospital (CMCH), Vellore, India
| | - T. Balamugesh
- grid.11586.3b0000 0004 1767 8969Department of Pulmonary Medicine, Christian Medical College and Hospital (CMCH), Vellore, India
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17
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Jaiswal V, Ang SP, Sarfraz Z, Butey S, Khandait HV, Song D, Chia JE, Maroo D, Hanif M, Ghanim M, Chand R, Biswas M. RETRACTED: Association between sarcoidosis and cardiovascular Outcomes: A systematic review and Meta-analysis. IJC HEART & VASCULATURE 2022; 41:101073. [PMID: 35800042 PMCID: PMC9253999 DOI: 10.1016/j.ijcha.2022.101073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/14/2022] [Accepted: 06/19/2022] [Indexed: 11/10/2022]
Abstract
What is known? Previous studies showed the prevalence of cardiovascular diseases with sarcoidosis. However, there is limited data quantifying the future risks of these adverse outcomes in patients with a diagnosis of sarcoidosis. What is New? To the best of our knowledge, this is the first meta-analysis assessed the adverse cardiovascular outcomes in patients with sarcoidosis. Our study analyzed 22,539,096 patients and found that the incidence of Atrial Arrhythmia, Ventricular Tachycardia and Heart Failure were significantly higher in patients with sarcoidosis. All-cause mortality appeared to be approximately 2-fold higher in patients with sarcoidosis. What are the clinical implications? In sarcoidosis with cardiac involvement, clinicians should be aware of the increased risk of adverse cardiovascular events in these patients. Additional studies are warranted to study the optimal management approach towards patients with cardiac sarcoidosis.
Background Sarcoidosis is a chronic inflammatory disorder of unknown etiology associated with high morbidity and mortality. Its association with cardiovascular outcomes is under-documented. Aim The aim of this study was to assess the adverse cardiovascular outcomes in patients with sarcoidosis compared with that of non-sarcoidosis. Methodology Online databases including PubMed, Embase and Scopus were queried from inception until March 2022. The outcomes assessed included all-cause mortality (ACM) and incidence of ventricular tachycardia (VT), heart failure (HF) and atrial arrhythmias (AA). Result A total of 6 studies with 22,539,096 participants (42,763 Sarcoidosis, 22,496,354 Non-Sarcoidosis) were included in this analysis. The pooled prevalence of sarcoidosis was 13.1% (95% CI 1% to 70%). The overall mean age was 47 years. The most common comorbidities were hypertension (12.7% vs 12.5%), and diabetes mellitus (5.5% vs 4%) respectively. The pooled analysis of primary endpoints showed that all-cause mortality (RR, 2.08; 95% CI: 1.17 to 3.08; p = 0.01) was significantly increased in sarcoidosis patients. The pooled analysis of secondary endpoints showed that the incidence of VT (RR, 15.3; 95% CI: 5.39 to 43.42); p < 0.001), HF (RR, 4.96; 95% CI: 2.02 to 12.14; p < 0.001) and AA (RR, 2.55; 95% CI: 1.47 to 4.44); p = 0.01) were significantly higher with sarcoidosis respectively compared to non-sarcoidosis. Conclusion Incidence of VT, HF and AA was significantly higher in patients with CS. Clinicians should be aware of these adverse cardiovascular events associated with sarcoidosis.
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18
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Taha A, Assaf O, Champsi A, Nadarajah R, Patel PA. Outcomes after transvenous defibrillator implantation in cardiac sarcoidosis: A systematic review. J Arrhythm 2022; 38:710-722. [PMID: 36237869 PMCID: PMC9535799 DOI: 10.1002/joa3.12753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 06/23/2022] [Accepted: 06/25/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Sarcoidosis is a systemic inflammatory disorder associated with ventricular arrhythmias (VAs) and sudden death in the context of cardiac involvement. Guidelines advocate implantable cardioverter‐defibrillator (ICD) implantation in specific subcohorts, but there is a paucity of data on outcomes. Methods and Results A systematic review was performed to assess outcomes in patients with definite or probable cardiac sarcoidosis (CS) treated with ICD. Observational studies were identified from multiple databases from inception to 21st May 2021. Outcomes of interest included appropriate and inappropriate ICD therapies in addition to all‐cause mortality. Study quality was assessed individually using the Newcastle Ottawa Scale (NOS). Eight studies were identified comprising 530 patients, with follow‐up period of 24–66 months (weighted average 40 months). Mean age was 53.9 years with ejection fraction of 41.3%. Overall incidence of appropriate therapy was 38.1% during follow‐up. Left ventricular systolic dysfunction (LVSD) with ejection fraction <40% was a predictor of appropriate therapy in the majority of studies, as were sustained VAs during electrophysiological testing (EP) in one study. There was no interaction with device indication (i.e. primary or secondary). Where documented, inappropriate therapy was primarily driven by atrial arrhythmias. All‐cause mortality was 6.0% over a median follow‐up period of 42 months. Only three studies achieved good quality in the comparability domain of NOS. Conclusions Appropriate ICD therapy in patients with CS is commonly associated with LVSD, which can act as a surrogate for scar burden. The utility of EP testing in this setting remains unclear.
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Affiliation(s)
- Ahmed Taha
- Department of Cardiology, Leeds General Infirmary Leeds UK
| | - Omar Assaf
- Department of Cardiology Blackpool Victoria Hospital Blackpool UK
| | - Asgher Champsi
- Department of Cardiology New Cross Hospital Wolverhampton UK
| | | | - Peysh A. Patel
- Department of Cardiology Queen Elizabeth Hospital Birmingham UK
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19
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Sex Differences in Cardiomyopathy. CURRENT CARDIOVASCULAR RISK REPORTS 2022. [DOI: 10.1007/s12170-022-00700-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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von Wald L, Shenoy C. Managing Patients With Advanced Atrioventricular Block: The Essential Role of Cardiovascular Magnetic Resonance Imaging for Timely and Accurate Diagnosis. J Am Heart Assoc 2022; 11:e026199. [PMID: 35658512 PMCID: PMC9238691 DOI: 10.1161/jaha.122.026199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Lisa von Wald
- Cardiovascular Division Department of Medicine University of Minnesota Medical School Minneapolis MN
| | - Chetan Shenoy
- Cardiovascular Division Department of Medicine University of Minnesota Medical School Minneapolis MN
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21
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2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Translation of the document prepared by the Czech Society of Cardiology. COR ET VASA 2022. [DOI: 10.33678/cor.2022.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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22
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Resdal Dyssekilde J, Frederiksen TC, Christiansen MK, Hasle Sørensen R, Pedersen LN, Loof Møller P, Christensen LS, Larsen JM, Thomsen KK, Lindhardt TB, Böttcher M, Molsted S, Havndrup O, Fischer T, Møller DS, Henriksen FL, Johansen JB, Nielsen JC, Bundgaard H, Nygaard M, Jensen HK. Diagnostic Yield of Genetic Testing in Young Patients With Atrioventricular Block of Unknown Cause. J Am Heart Assoc 2022; 11:e025643. [PMID: 35470684 PMCID: PMC9238593 DOI: 10.1161/jaha.121.025643] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background The cause of atrioventricular block (AVB) remains unknown in approximately half of young patients with the diagnosis. Although variants in several genes associated with cardiac conduction diseases have been identified, the contribution of genetic variants in younger patients with AVB is unknown. Methods and Results Using the Danish Pacemaker and Implantable Cardioverter Defibrillator (ICD) Registry, we identified all patients younger than 50 years receiving a pacemaker because of AVB in Denmark in the period from January 1, 1996 to December 31, 2015. From medical records, we identified patients with unknown cause of AVB at time of pacemaker implantation. These patients were invited to a genetic screening using a panel of 102 genes associated with inherited cardiac diseases. We identified 471 living patients with AVB of unknown cause, of whom 226 (48%) accepted participation. Median age at the time of pacemaker implantation was 39 years (interquartile range, 32–45 years), and 123 (54%) were men. We found pathogenic or likely pathogenic variants in genes associated with or possibly associated with AVB in 12 patients (5%). Most variants were found in the LMNA gene (n=5). LMNA variant carriers all had a family history of either AVB and/or sudden cardiac death. Conclusions In young patients with AVB of unknown cause, we found a possible genetic cause in 1 out of 20 participating patients. Variants in the LMNA gene were most common and associated with a family history of AVB and/or sudden cardiac death, suggesting that genetic testing should be a part of the diagnostic workup in these patients to stratify risk and screen family members.
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Affiliation(s)
| | - Tanja Charlotte Frederiksen
- Department of Cardiology Aarhus University Hospital Aarhus Denmark.,Department of Clinical Medicine Health Aarhus University Aarhus Denmark
| | | | | | | | | | | | | | | | - Tommi Bo Lindhardt
- Department of Cardiology Copenhagen University HospitalHerlev and Gentofte Hospital Hellerup Denmark
| | - Morten Böttcher
- Department of Cardiology Regional Hospital Herning Herning Denmark
| | - Stig Molsted
- Department of Clinical Research North Zealand Hospital Hillerød Denmark
| | - Ole Havndrup
- Department of Cardiology Zealand University Hospital Roskilde Denmark
| | | | | | | | | | - Jens Cosedis Nielsen
- Department of Cardiology Aarhus University Hospital Aarhus Denmark.,Department of Clinical Medicine Health Aarhus University Aarhus Denmark
| | - Henning Bundgaard
- Department of Cardiology The Heart Center Rigshospitalet Copenhagen Denmark.,Department of Clinical Medicine University of Copenhagen Denmark
| | - Mette Nygaard
- Department of Biomedicine Health Aarhus University Aarhus Denmark.,Department of Health Science and Technology Aalborg Denmark
| | - Henrik Kjærulf Jensen
- Department of Cardiology Aarhus University Hospital Aarhus Denmark.,Department of Clinical Medicine Health Aarhus University Aarhus Denmark
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Long-term, real world experience of ventricular tachycardia and granulomatous cardiomyopathy. Indian Pacing Electrophysiol J 2022; 22:169-178. [PMID: 35398517 PMCID: PMC9264019 DOI: 10.1016/j.ipej.2022.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 03/31/2022] [Accepted: 04/04/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Granulomatous cardiomyopathy(GCM) is relatively uncommon in patients presenting with ventricular tachycardia(VT). Sarcoidosis and tuberculosis are the most common causes of GCM with VT. The aim of study was to evaluate their clinical characteristics and the long-term outcomes. METHODS We retrospectively analyzed patients from March 2004 to January 2020, presenting with VT and subsequently diagnosed to have GCM. Patients were divided into three groups (sarcoid, tuberculosis and indeterminate) based on serologic tests, imaging and histopathology. The response to anti-arrhythmic and disease specific therapy on long-term follow-up were analysed. RESULTS There were 52 patients, comprising 27 males and 25 females, age 40 ± 10 years. The follow-up period was 5.9 ± 3.9 years. Sarcoidosis was diagnosed in 20(38%); tuberculosis(TB) in 15(29%) and 17(33%) patients were indeterminate. Left ventricular ejection fraction(LVEF) of the entire cohort was 0.45 ± 0.14. Erythrocyte Sedimentation Rate(ESR) was found to be significantly higher in TB(43.6 ± 18.4) patients vs sarcoid(18.9 ± 6.7)p < 0.0001, but not the indeterminate group(36.2 ± 21.1), p = 0.3. Implantable Cardioverter Defibrillator(ICD) implantation was performed in 12/20(60%) patients in the sarcoid group, in 4/15(27%) patients in the TB group and in 10/17(59%) patients in the indeterminate group. At a mean follow-up of six years, VT recurrences were noted in 6, 2, and 7 patients in the sarcoid, TB and indeterminate groups respectively. CONCLUSION Despite the advances in diagnostic modalities for tuberculosis and sarcoidosis, in real-world practice, almost one-third of the patients with VT and GCM have uncertain etiology. Long term outcomes of patients presenting with GCM and VT with mild left ventricle dysfunction treated appropriately seems favorable.
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24
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DeFilippis EM, Beale A, Martin T, Agarwal A, Elkayam U, Lam CSP, Hsich E. Heart Failure Subtypes and Cardiomyopathies in Women. Circ Res 2022; 130:436-454. [PMID: 35175847 PMCID: PMC10361647 DOI: 10.1161/circresaha.121.319900] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Heart failure affects over 2.6 million women and 3.4 million men in the United States with known sex differences in epidemiology, management, response to treatment, and outcomes across a wide spectrum of cardiomyopathies that include peripartum cardiomyopathy, hypertrophic cardiomyopathy, stress cardiomyopathy, cardiac amyloidosis, and sarcoidosis. Some of these sex-specific considerations are driven by the cellular effects of sex hormones on the renin-angiotensin-aldosterone system, endothelial response to injury, vascular aging, and left ventricular remodeling. Other sex differences are perpetuated by implicit bias leading to undertreatment and underrepresentation in clinical trials. The goal of this narrative review is to comprehensively examine the existing literature over the last decade regarding sex differences in various heart failure syndromes from pathophysiological insights to clinical practice.
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Affiliation(s)
| | - Anna Beale
- Department of Cardiology, Alfred Hospital, Melbourne, Australia (A.B.)
| | - Trejeeve Martin
- Department of Cardiology, Cleveland Clinic, Ohio (T.M., E.H.)
| | - Anubha Agarwal
- Northwestern University Feinberg School of Medicine (A.A.)
| | - Uri Elkayam
- Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California (U.E.)
| | - Carolyn S P Lam
- National Heart Centre Singapore and Duke-National University of Singapore (C.S.P.L.)
| | - Eileen Hsich
- Department of Cardiology, Cleveland Clinic, Ohio (T.M., E.H.)
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25
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJ, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM. Grupo de trabajo sobre estimulación cardiaca y terapia de resincronización cardiaca de la Sociedad Europea de Cardiología (ESC). Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.10.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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26
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Taduru SS, Goyal A, Dalia T, Mastoris I, Rali AS, Acharya P, Weidling R, Sauer A, Haglund N, Shah Z. Inpatient Characteristics, Complications, and Outcomes of Patients with Cardiac Sarcoidosis: A Study from The National Inpatient Sample. Indian Heart J 2022; 74:148-150. [PMID: 35104459 PMCID: PMC9039686 DOI: 10.1016/j.ihj.2021.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 12/27/2021] [Accepted: 12/30/2021] [Indexed: 11/18/2022] Open
Abstract
Although seen in ∼5% of sarcoidosis patients, cardiac sarcoidosis (CS) accounts for nearly 25% of disease-related deaths. This study aimed to describe characteristics and outcomes among CS patients. Patients diagnosed with CS in 2016-2017 in the US National Inpatient Sample Database were evaluated to study patient characteristics, reasons ascribed to admission, in-hospital outcomes, and complications. A total of 2420 patients (median age 56 years) were included in the analysis. Most admissions occurred due to ventricular tachycardia (12.8%), followed by myocarditis (9.9%) with a mean length of stay of 7±7 days. The overall incidence of in-hospital mortality was 2.5%.
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Affiliation(s)
- Siva S Taduru
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Amandeep Goyal
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, KS, USA.
| | - Tarun Dalia
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Ioannis Mastoris
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Aniket S Rali
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Prakash Acharya
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Robert Weidling
- Department of Internal Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Andrew Sauer
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Nicholas Haglund
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, KS, USA
| | - Zubair Shah
- Department of Cardiovascular Medicine, The University of Kansas Health System, University of Kansas School of Medicine, Kansas City, KS, USA.
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27
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM, Leyva F, Linde C, Abdelhamid M, Aboyans V, Arbelo E, Asteggiano R, Barón-Esquivias G, Bauersachs J, Biffi M, Birgersdotter-Green U, Bongiorni MG, Borger MA, Čelutkienė J, Cikes M, Daubert JC, Drossart I, Ellenbogen K, Elliott PM, Fabritz L, Falk V, Fauchier L, Fernández-Avilés F, Foldager D, Gadler F, De Vinuesa PGG, Gorenek B, Guerra JM, Hermann Haugaa K, Hendriks J, Kahan T, Katus HA, Konradi A, Koskinas KC, Law H, Lewis BS, Linker NJ, Løchen ML, Lumens J, Mascherbauer J, Mullens W, Nagy KV, Prescott E, Raatikainen P, Rakisheva A, Reichlin T, Ricci RP, Shlyakhto E, Sitges M, Sousa-Uva M, Sutton R, Suwalski P, Svendsen JH, Touyz RM, Van Gelder IC, Vernooy K, Waltenberger J, Whinnett Z, Witte KK. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Europace 2022; 24:71-164. [PMID: 34455427 DOI: 10.1093/europace/euab232] [Citation(s) in RCA: 111] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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28
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Caobelli F, Popescu CE. PET imaging in cardiovascular inflammation: Cardiac sarcoidosis. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00001-6] [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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29
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Nakagama S, Candray K, Yamamoto T, Tsugeno Y, Nakagama Y, Kido Y, Nitahara Y, Maejima Y, Sasano T. Inflammatory cardiomyopathy of possibly overlapping aetiology: a case posing treatment dilemma and potential association. ESC Heart Fail 2021; 9:761-765. [PMID: 34964280 PMCID: PMC8788040 DOI: 10.1002/ehf2.13771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 11/26/2021] [Accepted: 12/02/2021] [Indexed: 11/09/2022] Open
Abstract
We report on a 52‐year‐old Brazilian immigrant woman with past histories of chronic kidney disease and uveitis, presenting with symptomatic atrioventricular block. Her country of origin being endemic for Trypanosoma cruzi infection, we suspected Chagas disease as the aetiology, diagnosis of which was confirmed by serological tests. Further systemic workup identified an emerging nodular lesion in the lung, which turned out to be a sarcoid epithelioid granuloma on biopsy. Involvement of the kidneys and eyes was suggestive of systemic extension of the lung sarcoidosis. Although imaging modalities did not detect inflammatory foci in the myocardium, the rare coexistence of histologically proven sarcoidosis raised the intriguing concept of cardiac manifestation having arisen from two possibly overlapping aetiologies: Chagas disease and cardiac sarcoidosis. The case highlights a treatment dilemma increasingly likely to be encountered in this globalized world, and also raises the potential, but intriguing, association of these two diseases.
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Affiliation(s)
- Shun Nakagama
- Department of Cardiovascular Medicine, Graduate School of Medical and Dental Sciences Tokyo Medical and Dental University Tokyo Japan
| | - Katherine Candray
- Department of Parasitology and Research Center for Infectious Disease Sciences Osaka City University Osaka Japan
- Centro Nacional de Investigaciones Científicas de El Salvador (CICES) San Salvador El Salvador
| | - Tasuku Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medical and Dental Sciences Tokyo Medical and Dental University Tokyo Japan
| | - Yuta Tsugeno
- Department of Comprehensive Pathology, Graduate School of Medical and Dental Sciences Tokyo Medical and Dental University Tokyo Japan
| | - Yu Nakagama
- Department of Parasitology and Research Center for Infectious Disease Sciences Osaka City University Osaka Japan
| | - Yasutoshi Kido
- Department of Parasitology and Research Center for Infectious Disease Sciences Osaka City University Osaka Japan
| | - Yuko Nitahara
- Department of Parasitology and Research Center for Infectious Disease Sciences Osaka City University Osaka Japan
| | - Yasuhiro Maejima
- Department of Cardiovascular Medicine, Graduate School of Medical and Dental Sciences Tokyo Medical and Dental University Tokyo Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Graduate School of Medical and Dental Sciences Tokyo Medical and Dental University Tokyo Japan
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30
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Haddad C, Herrera-Siklody C, Porretta AP, Carroz P, Pascale P, Pruvot E. From trivial to severe arrhythmias: the diagnostic role of multimodality imaging in inflammatory cardiomyopathy through a case series. Eur Heart J Case Rep 2021; 5:ytab418. [PMID: 34805739 PMCID: PMC8598124 DOI: 10.1093/ehjcr/ytab418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/03/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022]
Abstract
Abstract
Background
The diagnosis of inflammatory cardiomyopathy remains challenging in cases presenting with arrhythmia as sole manifestation. An early diagnosis is critical as it may prevent life-threatening complications such as sudden cardiac death and atrioventricular block (AVB). The diagnostic workup of suspected cases includes multimodality imaging that requires an adequate interpretation in order to limit the risk of overdiagnosis.
Case summary
Herein, we report three cases presenting with various new-onset arrhythmias. The first patient was admitted for a third-degree AVB. The second patient suffered from a supraventricular tachycardia which degenerated into ventricular fibrillation. The third case was investigated for symptomatic premature ventricular complexes. No apparent heart disease was observed on standard exams (clinical, biological examinations, and echocardiography). However, cardiac magnetic resonance imaging (MRI) and nuclear imaging (68Ga-DOTATOC and/or 18F-FDG PET/CT) suggested an inflammatory substrate that seemed to correlate with the arrhythmic phenotype. Cardiac inflammation disappeared on immunotherapy for the first case and spontaneously for the third case.
Discussion
These cases emphasize the incremental diagnostic yield of multimodality imaging to highlight myocardial inflammation. Nuclear imaging modalities may complement MRI by enabling the detection of active inflammation. The 18F-FDG PET/CT is well established for the diagnosis of cardiac sarcoidosis but its role remains to be clarified for the diagnosis of myocarditis. An alternative radiotracer, 68Ga-DOTATOC, appears promising by overcoming the main limitation of 18F-FDG but its specificity is not yet well established. The role of functional investigations is discussed as well as the benefit of immunosuppressive treatments.
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Affiliation(s)
- Christelle Haddad
- National Reference Center for Inherited Arrhythmias of Lyon, Arrhythmias Unit, Louis Pradel Cardiovascular Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France
- Arrhythmias Unit, Department of Cardiology, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Claudia Herrera-Siklody
- Arrhythmias Unit, Department of Cardiology, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Alessandra Pia Porretta
- Arrhythmias Unit, Department of Cardiology, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Patrice Carroz
- Arrhythmias Unit, Department of Cardiology, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Patrizio Pascale
- Arrhythmias Unit, Department of Cardiology, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Etienne Pruvot
- Arrhythmias Unit, Department of Cardiology, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
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31
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Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, Barrabés JA, Boriani G, Braunschweig F, Brignole M, Burri H, Coats AJS, Deharo JC, Delgado V, Diller GP, Israel CW, Keren A, Knops RE, Kotecha D, Leclercq C, Merkely B, Starck C, Thylén I, Tolosana JM. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J 2021; 42:3427-3520. [PMID: 34455430 DOI: 10.1093/eurheartj/ehab364] [Citation(s) in RCA: 807] [Impact Index Per Article: 269.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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32
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Nabeta T, Hara M, Naruke T, Maemura K, Oki T, Yazaki M, Fujita T, Ikeda Y, Ishii S, Koitabashi T, Ako J. Clinical valuables related to resolution of complete or advanced atrioventricular block after steroid therapy in patients with cardiac sarcoidosis. J Arrhythm 2021; 37:1093-1100. [PMID: 34386137 PMCID: PMC8339084 DOI: 10.1002/joa3.12583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/16/2021] [Accepted: 06/01/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Prediction of atrioventricular block (AVB) resolution after steroid therapy in patients with cardiac sarcoidosis (CS) is difficult. METHODS We identified 24 patients with CS and complete or advanced AVB receiving steroid therapy. AVB resolution was assessed by reviewing surface electrocardiogram and the percentage of ventricular pacing required on subsequent device interrogation reports. RESULTS AVB resolution was noted in eight (33%) patients 1 year after receiving steroid therapy. Univariate Cox regression analysis demonstrated that left ventricular ejection fraction (LVEF) (hazard ratio [HR] 1.07, 95% confidence interval [CI] 1.01-1.14, P = .016), interval from recognized AVB to start of steroid therapy (HR 0.98, 95% CI 0.95-0.99, P < .001), and lysozyme (HR 1.51, 95% CI 1.12-2.19, P = .013) were significantly associated with resolution of AVB. Combination of area under the curve (AUC) of each variable that was significantly related to resolution of AVB (AUC, 0.969; 95% CI 0.921-1.000, P < .001) was tended to be higher compared with each variable alone. CONCLUSIONS A shorter interval from recognition of AVB to start of steroid therapy, higher LVEF, and higher lysozyme levels were significantly associated with resolution of AVB after steroid therapy in patients with CS. The combination of each variable could be able to distinguish patients with resolution of AVB from those without.
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Affiliation(s)
- Takeru Nabeta
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaJapan
| | - Masahiko Hara
- Center for Community‐based Healthcare Research and EducationShimane UniversityMatsueJapan
| | - Takashi Naruke
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaJapan
| | - Kenji Maemura
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaJapan
| | - Takumi Oki
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaJapan
| | - Mayu Yazaki
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaJapan
| | - Teppei Fujita
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaJapan
| | - Yuki Ikeda
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaJapan
| | - Shunsuke Ishii
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaJapan
| | - Toshimi Koitabashi
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaJapan
| | - Junya Ako
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaJapan
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33
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Viwe M, Nery P, Birnie DH. Management of ventricular tachycardia in patients with cardiac sarcoidosis. Heart Rhythm O2 2021; 2:412-422. [PMID: 34430947 PMCID: PMC8369307 DOI: 10.1016/j.hroo.2021.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Sarcoidosis is a multisystem granulomatous disease with 2 different phases (inflammation and scar). In the current era of targeted use of implantable cardioverter-defibrillators and modern heart failure therapy, recent data indicate the prognosis of cardiac sarcoidosis (CS) is much improved, and hence more patients are presenting with recurrent ventricular tachycardia (VT). This review highlights our current understanding of the pathophysiology and management of ventricular arrhythmias in CS with the major focus on indications, techniques, and outcomes of ablation. It is likely macroreentry phenomena around areas of fibrosis is the most frequent mechanism of ventricular arrhythmia in CS. It is also possible that inflammation may play a role in initiating reentry with ventricular ectopy in CS patients, or by slowing conduction in diseased tissue. The best available data would suggest annual rates of VT of perhaps 1%-2% and 10%-15% in patients with initially clinically silent and clinically manifest disease, respectively. Current guidelines recommend a stepwise approach to VT management. The first suggested step is treatment with immunosuppression if there is evidence of active inflammation. Antiarrhythmic medications are often started at the same time, with catheter ablation considered if VT cannot be controlled. Activation and entrainment mapping and ablation are favored in the setting of hemodynamically tolerated VT. Substrate ablation targets areas of abnormal electrogram and favorable pace mapping using linear and/or cluster lesion sets with the goal of abolishing critical isthmuses and/or blocking VT exit sites. Epicardial mapping ablation is required in 20%-35% of cases. In general, more morphologies of VT are induced (often 3-4) and subsequent outcomes (recurrence rates 40%-50%) are less favorable than in other forms of nonischemic cardiomyopathy. The prognosis of CS is much improved and, as a result, more patients are developing VT during follow-up. Likely principally related to the complex disease substrate, VT ablation is technically challenging, with moderate outcomes, and much remains to be learned.
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Affiliation(s)
- Mtwesi Viwe
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Canada
- Division of Cardiology, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Pablo Nery
- Arrhythmia Service, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada
| | - David H. Birnie
- Arrhythmia Service, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Canada
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34
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Dideriksen JR, Christiansen MK, Johansen JB, Nielsen JC, Bundgaard H, Jensen HK. Long-term outcomes in young patients with atrioventricular block of unknown aetiology. Eur Heart J 2021; 42:2060-2068. [PMID: 33599276 PMCID: PMC8169155 DOI: 10.1093/eurheartj/ehab060] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 11/17/2020] [Accepted: 01/31/2021] [Indexed: 12/20/2022] Open
Abstract
Aims Atrioventricular block (AVB) of unknown aetiology is rare in the young, and outcome in these patients is unknown. We aimed to assess long-term morbidity and mortality in young patients with AVB of unknown aetiology. Methods and results We identified all Danish patients younger than 50 years receiving a first pacemaker due to AVB between January 1996 and December 2015. By reviewing medical records, we included patients with AVB of unknown aetiology. A matched control cohort was established. Follow-up was performed using national registries. The primary outcome was a composite endpoint consisting of death, heart failure hospitalization, ventricular tachyarrhythmia, and cardiac arrest with successful resuscitation. We included 517 patients, and 5170 controls. Median age at first pacemaker implantation was 41.3 years [interquartile range (IQR) 32.7–46.2 years]. After a median follow-up of 9.8 years (IQR 5.7–14.5 years), the primary endpoint had occurred in 14.9% of patients and 3.2% of controls [hazard ratio (HR) 3.8; 95% confidence interval (CI) 2.9–5.1; P < 0.001]. Patients with persistent AVB at time of diagnosis had a higher risk of the primary endpoint (HR 10.6; 95% CI 5.7–20.0; P < 0.001), and risk was highest early in the follow-up period (HR 6.8; 95% CI 4.6–10.0; P < 0.001, during 0–5 years of follow-up). Conclusion Atrioventricular block of unknown aetiology presenting before the age of 50 years and treated with pacemaker implantation was associated with a three- to four-fold higher rate of the composite endpoint of death or hospitalization for heart failure, ventricular tachyarrhythmia, or cardiac arrest with successful resuscitation. Patients with persistent AVB were at higher risk. These findings warrant improved follow-up strategies for young patients with AVB of unknown aetiology.
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Affiliation(s)
- Johnni Resdal Dideriksen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.,Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Morten K Christiansen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Jens B Johansen
- Department of Cardiology, Odense University Hospital, 5000 Odense C, Denmark
| | - Jens C Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.,Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Henning Bundgaard
- Department of Cardiology B2142, Unit for Inherited Cardiovascular Diseases, The Heart Centre, National University Hospital, 2100 Copenhagen, Denmark
| | - Henrik K Jensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.,Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
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35
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Seferović PM, Tsutsui H, McNamara DM, Ristić AD, Basso C, Bozkurt B, Cooper LT, Filippatos G, Ide T, Inomata T, Klingel K, Linhart A, Lyon AR, Mehra MR, Polovina M, Milinković I, Nakamura K, Anker SD, Veljić I, Ohtani T, Okumura T, Thum T, Tschöpe C, Rosano G, Coats AJS, Starling RC. Heart Failure Association of the ESC, Heart Failure Society of America and Japanese Heart Failure Society Position statement on endomyocardial biopsy. Eur J Heart Fail 2021; 23:854-871. [PMID: 34010472 DOI: 10.1002/ejhf.2190] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 03/23/2021] [Accepted: 04/08/2021] [Indexed: 12/17/2022] Open
Abstract
Endomyocardial biopsy (EMB) is an invasive procedure, globally most often used for the monitoring of heart transplant (HTx) rejection. In addition, EMB can have an important complementary role to the clinical assessment in establishing the diagnosis of diverse cardiac disorders, including myocarditis, cardiomyopathies, drug-related cardiotoxicity, amyloidosis, other infiltrative and storage disorders, and cardiac tumours. Improvements in EMB equipment and the development of new techniques for the analysis of EMB samples have significantly improved diagnostic precision of EMB. The present document is the result of the Trilateral Cooperation Project between the Heart Failure Association of the European Society of Cardiology, the Heart Failure Society of America, and the Japanese Heart Failure Society. It represents an expert consensus aiming to provide a comprehensive, up-to-date perspective on EMB, with a focus on the following main issues: (i) an overview of the practical approach to EMB, (ii) an update on indications for EMB, (iii) a revised plan for HTx rejection surveillance, (iv) the impact of multimodality imaging on EMB, and (v) the current clinical practice in the worldwide use of EMB.
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Affiliation(s)
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Dennis M McNamara
- Heart and Vascur Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Arsen D Ristić
- Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Cristina Basso
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Biykem Bozkurt
- Winters Center for Heart Failure, Cardiovascular Research Institute, Baylor College of Medicine, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Leslie T Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Gerasimos Filippatos
- Attikon University Hospital, Department of Cardiology, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Tomomi Ide
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takayuki Inomata
- Department of Cardiovascular Medicine, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Karin Klingel
- Cardiopathology, Institute for Pathology, University Hospital, Tuebingen, Germany
| | - Aleš Linhart
- Department of Cardiovascular Medicine, Charles University, Prague, Czech Republic
| | - Alexander R Lyon
- National Heart and Lung Institute, Imperial College and Royal Brompton Hospital, London, UK
| | - Mandeep R Mehra
- Heart and Vascular Center, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Marija Polovina
- Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivan Milinković
- Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Stefan D Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin, Berlin, Germany
| | - Ivana Veljić
- Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Tomohito Ohtani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies, Hannover Medical School, Hannover, Germany.,Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany
| | - Carsten Tschöpe
- Berlin Institute of Health (BIH) and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Department of Cardiology, Campus Virchow Klinikum, Charite University, Berlin, Germany
| | - Giuseppe Rosano
- Department of Medical Sciences, IRCCS San Raffaele, Rome, Italy.,Cardiology Clinical Academic Group, St George's Hospitals NHS Trust, London, UK
| | - Andrew J S Coats
- Monash University, Melbourne, Australia.,University of Warwick, Coventry, UK
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36
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Seferović PM, Tsutsui H, Mcnamara DM, Ristić AD, Basso C, Bozkurt B, Cooper LT, Filippatos G, Ide T, Inomata T, Klingel K, Linhart A, Lyon AR, Mehra MR, Polovina M, Milinković I, Nakamura K, Anker SD, Veljić I, Ohtani T, Okumura T, Thum T, Tschöpe C, Rosano G, Coats AJS, Starling RC. Heart Failure Association, Heart Failure Society of America, and Japanese Heart Failure Society Position Statement on Endomyocardial Biopsy. J Card Fail 2021; 27:727-743. [PMID: 34022400 DOI: 10.1016/j.cardfail.2021.04.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Endomyocardial biopsy (EMB) is an invasive procedure, globally most often used for the monitoring of heart transplant rejection. In addition, EMB can have an important complementary role to the clinical assessment in establishing the diagnosis of diverse cardiac disorders, including myocarditis, cardiomyopathies, drug-related cardiotoxicity, amyloidosis, other infiltrative and storage disorders, and cardiac tumors. Improvements in EMB equipment and the development of new techniques for the analysis of EMB samples has significantly improved the diagnostic precision of EMB. The present document is the result of the Trilateral Cooperation Project between the Heart Failure Association of the European Society of Cardiology, Heart Failure Society of America, and the Japanese Heart Failure Society. It represents an expert consensus aiming to provide a comprehensive, up-to-date perspective on EMB, with a focus on the following main issues: (1) an overview of the practical approach to EMB, (2) an update on indications for EMB, (3) a revised plan for heart transplant rejection surveillance, (4) the impact of multimodality imaging on EMB, and (5) the current clinical practice in the worldwide use of EMB.
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Affiliation(s)
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Dennis M Mcnamara
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Arsen D Ristić
- Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Cristina Basso
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Biykem Bozkurt
- Winters Center for Heart Failure, Cardiovascular Research Institute, Baylor College of Medicine, Michael E. DeBakey VA Medical Center, Houston, Texas
| | - Leslie T Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida
| | - Gerasimos Filippatos
- Attikon University Hospital, Department of Cardiology, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Tomomi Ide
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takayuki Inomata
- Department of Cardiovascular Medicine, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Karin Klingel
- Cardiopathology, Institute for Pathology, University Hospital, Tuebingen, Germany
| | - Aleš Linhart
- Department of Cardiovascular Medicine, Charles University, Prague, Czech Republic
| | - Alexander R Lyon
- National Heart and Lung Institute, Imperial College and Royal Brompton Hospital, London, UK
| | - Mandeep R Mehra
- Heart and Vascular Center, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Marija Polovina
- Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivan Milinković
- Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Stefan D Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin Berlin, Germany
| | - Ivana Veljić
- Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Tomohito Ohtani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies, Hannover Medical School, Hannover, Germany; Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany
| | - Carsten Tschöpe
- Berlin Institute of Health (BIH) and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Department of Cardiology, Campus Virchow Klinikum, Charite University, Berlin, Germany
| | - Giuseppe Rosano
- Department of Medical Sciences, IRCCS San Raffaele, Rome, Italy, and Cardiology Clinical Academic Group, St George's Hospitals NHS Trust
| | - Andrew J S Coats
- Monash University, Australia, and University of Warwick, Coventry, UK
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Abstract
Cardiac sarcoidosis (CS) is a complex disease that can manifest as a diverse array of arrhythmias. CS patients may be at higher risk for sudden cardiac death (SCD), and, in some cases, SCD may be the first presenting symptom of the underlying disease. As such, identification, risk stratification, and management of CS-related arrhythmia are crucial in the care of these patients. Left untreated, CS carries significant arrhythmogenic morbidity and mortality. Cardiac manifestations of CS are a consequence of an inflammatory process resulting in the myocardial deposition of noncaseating granulomas. Endomyocardial biopsy remains the gold standard for diagnosis; however, biopsy yield is limited by the patchy distribution of the granulomas. As such, recent guidelines have improved clinical diagnostic pathways relying on advanced cardiac imaging to help in the diagnosis of CS. To date, corticosteroids are the best studied agent to treat CS but are associated with significant risks and limited benefits. Implantable cardioverter-defibrillators have an important role in SCD risk reduction. Catheter ablation in conjunction with antiarrhythmics seems to reduce ventricular arrhythmia burden. However, the appropriate selection of these patients is crucial as ablation is likely more helpful in the setting of a myocardial scar substrate versus arrhythmia driven by active inflammation. Further studies investigating CS pathophysiology, the pathway to diagnosis, arrhythmogenic manifestations, and SCD risk stratification will be crucial to reduce the high morbidity and mortality of this disease.
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Affiliation(s)
| | - Michael I Gurin
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Tana C, Mantini C, Donatiello I, Mucci L, Tana M, Ricci F, Cipollone F, Giamberardino MA. Clinical Features and Diagnosis of Cardiac Sarcoidosis. J Clin Med 2021; 10:1941. [PMID: 34062709 PMCID: PMC8124502 DOI: 10.3390/jcm10091941] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 12/12/2022] Open
Abstract
Cardiac sarcoidosis (CS) is an unusual, but potentially harmful, manifestation of systemic sarcoidosis (SA), a chronic disease characterized by organ involvement from noncaseating and nonnecrotizing granulomas. Lungs and intrathoracic lymph nodes are usually the sites that are most frequently affected, but no organ is spared and CS can affect a variable portion of SA patients, up to 25% from post-mortem studies. The cardiovascular involvement is usually associated with a bad prognosis and is responsible for the major cause of death and complications, particularly in African American patients. Furthermore, the diagnosis is often complicated by the occurrence of non-specific clinical manifestations, which can mimic the effect of more common heart disorders, and imaging and biopsies are the most valid approach to avoid misdiagnosis. This narrative review summarizes the main clinical features of CS and imaging findings, particularly of CMR and 18-Fluorodeoxyglucose Positron Emission Tomography (18F-FDG PET) that can give the best cost/benefit ratio in terms of the diagnostic approach. Imaging can be very useful in replacing the endomyocardial biopsy in selected cases, to avoid unnecessary, and potentially dangerous, invasive maneuvers.
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Affiliation(s)
- Claudio Tana
- COVID-19 Medicine Unit and Geriatrics Clinic, SS Annunziata Hospital of Chieti, 66100 Chieti, Italy; (F.C.); (M.A.G.)
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Radiology, “SS Annunziata” Hospital, “G. d’Annunzio” University, 66100 Chieti, Italy; (C.M.); (F.R.)
| | - Iginio Donatiello
- Internal Medicine Unit, University Hospital of Salerno, 84121 Salerno, Italy;
| | - Luciano Mucci
- Internal Medicine Unit, Hospital of Fano, Azienda Ospedaliera Ospedali Riuniti Marche, 61032 Fano, Italy;
| | - Marco Tana
- 2nd Medicine Unit and Department of Vascular Medicine and Cardiovascular Ultrasound, SS Annunziata Hospital of Chieti, 66100 Chieti, Italy;
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Radiology, “SS Annunziata” Hospital, “G. d’Annunzio” University, 66100 Chieti, Italy; (C.M.); (F.R.)
| | - Francesco Cipollone
- COVID-19 Medicine Unit and Geriatrics Clinic, SS Annunziata Hospital of Chieti, 66100 Chieti, Italy; (F.C.); (M.A.G.)
- Department of Medicine and Science of Aging, and CAST, G D’Annunzio University of Chieti, 66100 Chieti, Italy;
| | - Maria Adele Giamberardino
- COVID-19 Medicine Unit and Geriatrics Clinic, SS Annunziata Hospital of Chieti, 66100 Chieti, Italy; (F.C.); (M.A.G.)
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AlBassam O, Redwood T, Bowers N, Iwanochko R. Acute inflammatory pericarditis secondary to cardiac sarcoidosis evaluated by 18F-fluorodeoxyglucose PET/CT imaging. J Nucl Cardiol 2021; 28:763-767. [PMID: 32095937 DOI: 10.1007/s12350-019-01880-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 08/21/2019] [Indexed: 10/24/2022]
Affiliation(s)
- Omar AlBassam
- Division of Cardiology, University of Toronto, Toronto, Canada
| | - Tahira Redwood
- Division of Cardiology, University of Toronto, Toronto, Canada
| | - Nicolas Bowers
- Division of Cardiology, University of Toronto, Toronto, Canada
| | - Robert Iwanochko
- Division of Cardiology, University of Toronto, Toronto, Canada.
- Nuclear Cardiology, University of Toronto, University Health Network, Toronto, Canada.
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Lemay S, Massot M, Philippon F, Belzile D, Turgeon PY, Beaudoin J, Laliberté C, Fortin S, Dion G, Milot J, Trottier M, Gosselin J, Charbonneau É, Birnie DH, Sénéchal M. Ten Questions Cardiologists Should Be Able to Answer About Cardiac Sarcoidosis: Case-Based Approach and Contemporary Review. CJC Open 2021; 3:532-548. [PMID: 34027358 PMCID: PMC8129447 DOI: 10.1016/j.cjco.2020.11.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/24/2020] [Indexed: 12/17/2022] Open
Abstract
Sarcoidosis is an inflammatory multisystemic disease of unknown etiology characterized by the formation of noncaseating epithelioid cell granulomas. Cardiac sarcoidosis might be life-threatening and its diagnosis and treatment remain a challenge nowadays. The aim of this review is to provide an updated overview of cardiac sarcoidosis and, through 10 practical clinical questions and real-life challenging case scenarios, summarize the main clinical presentation, diagnostic criteria, imaging findings, and contemporary treatment.
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Affiliation(s)
- Sylvain Lemay
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec City, Québec, Canada
| | - Montse Massot
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec City, Québec, Canada
| | - François Philippon
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec City, Québec, Canada
| | - David Belzile
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec City, Québec, Canada
| | - Pierre Yves Turgeon
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec City, Québec, Canada
| | - Jonathan Beaudoin
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec City, Québec, Canada
| | - Claudine Laliberté
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec City, Québec, Canada
| | - Sophie Fortin
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec City, Québec, Canada
| | - Geneviève Dion
- Department of Pneumology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec City, Québec, Canada
| | - Julie Milot
- Department of Pneumology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec City, Québec, Canada
| | - Mikaël Trottier
- Department of Nuclear Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec City, Québec, Canada
| | - Justin Gosselin
- Department of Internal Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec City, Québec, Canada
| | - Éric Charbonneau
- Department of Cardiac Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec City, Québec, Canada
| | - David H. Birnie
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Mario Sénéchal
- Department of Cardiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Laval University, Québec City, Québec, Canada
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Tomdio A, Syed H, Ellenbogen K, Kron J. Complete heart block in cardiac sarcoidosis reversed by corticosteroid therapy: time course of resolution. BMJ Case Rep 2021; 14:14/3/e240834. [PMID: 33687942 PMCID: PMC7944970 DOI: 10.1136/bcr-2020-240834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 53-year-old man was admitted for recurrent syncope and found to have complete heart block (CHB). Cardiac magnetic resonance imaging MRI) showed extensive patchy late gadolinium enhancement in the apical and lateral walls, consistent with cardiac sarcoidosis (CS) but no scar in the septum. A fluorodeoxyglucose (FDG)-positron emission tomography showed FDG uptake in the septum and basal lateral walls. Imaging suggested active inflammation in the septum affecting atrioventricular (AV) conduction but no irreversible fibrosis. Diagnosis of isolated CS requires a high level of suspicion and multidisciplinary teamwork involving heart failure specialists, electrophysiologists and rheumatologists. After specialist and patient discussion, treatment of the disease was initiated with prednisone 40 mg daily, 11 months after presenting with CHB. Three weeks later, ECG with pacing inhibited showed second-degree AV block Mobitz type II and 4 weeks later, AV conduction recovery. This highlights the importance of immediate therapy in reversing AV conduction abnormalities in CS.
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Affiliation(s)
- Anna Tomdio
- Cardiovascular Disease, VCU Health, Richmond, Virginia, USA
| | | | | | - Jordana Kron
- Cardiovascular Disease, VCU Health, Richmond, Virginia, USA
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42
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Affiliation(s)
- Vasileios Kouranos
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Rakesh Sharma
- National Heart and Lung Institute, Imperial College London, London, UK .,Cardiology Department, Royal Brompton and Harefield NHS Foundation Trust, London, UK
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43
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Birnie DH, Nair V, Veinot JP. Cardiac Sarcoidosis and Giant Cell Myocarditis: Actually, 2 Ends of the Same Disease? J Am Heart Assoc 2021; 10:e020542. [PMID: 33660527 PMCID: PMC8174207 DOI: 10.1161/jaha.121.020542] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- David H Birnie
- Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada
| | - Vidhya Nair
- Department of Pathology and Laboratory Medicine The Ottawa Hospital and University of Ottawa Ottawa Ontario Canada
| | - John P Veinot
- Department of Pathology and Laboratory Medicine The Ottawa Hospital and University of Ottawa Ottawa Ontario Canada
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44
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Rosenthal DG, Fang CD, Groh CA, Nah G, Vittinghoff E, Dewland TA, Vedantham V, Marcus GM. Heart Failure, Atrioventricular Block, and Ventricular Tachycardia in Sarcoidosis. J Am Heart Assoc 2021; 10:e017692. [PMID: 33599141 PMCID: PMC8174291 DOI: 10.1161/jaha.120.017692] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Sarcoidosis is a granulomatous disease usually affecting the lungs, although cardiac morbidity may be common. The risk of these outcomes and the characteristics that predict them remain largely unknown. This study investigates the epidemiology of heart failure, atrioventricular block, and ventricular tachycardia among patients with and without sarcoidosis. Methods and Results We identified California residents aged ≥21 years using the Office of Statewide Health Planning and Development ambulatory surgery, emergency, or inpatient databases from 2005 to 2015. The risk of sarcoidosis on incident heart failure, atrioventricular block, and ventricular tachycardia were each determined. Linkage to the Social Security Death Index was used to ascertain overall mortality. Among 22 527 964 California residents, 19 762 patients with sarcoidosis (0.09%) were identified. Sarcoidosis was the strongest predictor of heart failure (hazard ratio [HR], 11.2; 95% CI, 10.7-11.7), atrioventricular block (HR, 117.7; 95% CI, 103.3-134.0), and ventricular tachycardia (HR, 26.1; 95% CI, 24.2-28.1) identified among all risk factors. The presence of any cardiac involvement best predicted each outcome. Approximately 22% (95% CI, 18%-26%) of the relationship between sarcoidosis and increased mortality was explained by the presence of at least 1 of these cardiovascular outcomes. Conclusions The magnitude of risk associated with sarcoidosis as a predictor of heart failure, atrioventricular block, and ventricular tachycardia, exceeds all established risk factors. Surveillance for and anticipation of these outcomes among patients with sarcoidosis is indicated, and consideration of a sarcoidosis diagnosis may be prudent among patients with heart failure, atrioventricular block, or ventricular tachycardia.
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Affiliation(s)
- David G Rosenthal
- Division of Cardiology, Electrophysiology Section University of California, San Francisco CA
| | - Christina D Fang
- Division of Cardiology, Electrophysiology Section University of California, San Francisco CA
| | - Christopher A Groh
- Division of Cardiology, Electrophysiology Section University of California, San Francisco CA
| | - Gregory Nah
- Division of Cardiology, Electrophysiology Section University of California, San Francisco CA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics University of California, San Francisco CA
| | - Thomas A Dewland
- Division of Cardiology, Electrophysiology Section University of California, San Francisco CA
| | - Vasanth Vedantham
- Division of Cardiology, Electrophysiology Section University of California, San Francisco CA
| | - Gregory M Marcus
- Division of Cardiology, Electrophysiology Section University of California, San Francisco CA
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Rosenfeld LE, Chung MK, Harding CV, Spagnolo P, Grunewald J, Appelbaum J, Sauer WH, Culver DA, Joglar JA, Lin BA, Jellis CL, Dickfeld TM, Kwon DH, Miller EJ, Cremer PC, Bogun F, Kron J, Bock A, Mehta D, Leis P, Siontis KC, Kaufman ES, Crawford T, Zimetbaum P, Zishiri ET, Singh JP, Ellenbogen KA, Chrispin J, Quadri S, Vincent LL, Patton KK, Kalbfleish S, Callahan TD, Murgatroyd F, Judson MA, Birnie D, Okada DR, Maulion C, Bhat P, Bellumkonda L, Blankstein R, Cheng RK, Farr MA, Estep JD. Arrhythmias in Cardiac Sarcoidosis Bench to Bedside: A Case-Based Review. Circ Arrhythm Electrophysiol 2021; 14:e009203. [PMID: 33591816 DOI: 10.1161/circep.120.009203] [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] [Indexed: 12/17/2022]
Abstract
Cardiac sarcoidosis is a component of an often multiorgan granulomatous disease of still uncertain cause. It is being recognized with increasing frequency, mainly as the result of heightened awareness and new diagnostic tests, specifically cardiac magnetic resonance imaging and 18F-fluorodeoxyglucose positron emission tomography scans. The purpose of this case-based review is to highlight the potentially life-saving importance of making the early diagnosis of cardiac sarcoidosis using these new tools and to provide a framework for the optimal care of patients with this disease. We will review disease mechanisms as currently understood, associated arrhythmias including conduction abnormalities, and atrial and ventricular tachyarrhythmias, guideline-directed diagnostic criteria, screening of patients with extracardiac sarcoidosis, and the use of pacemakers and defibrillators in this setting. Treatment options, including those related to heart failure, and those which may help clarify disease mechanisms are included.
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Affiliation(s)
- Lynda E Rosenfeld
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (L.E.R., E.J.M., C.M., L.B.)
| | - Mina K Chung
- Cleveland Clinic, OH (M.K.C., D.A.C., C.L.J., D.H.K., P.C.C., A.B., T.D.C., P.B., J.D.E.)
| | - Clifford V Harding
- Department of Pathology, Case Western Reserve University, Cleveland, OH (C.V.H.)
| | - Paolo Spagnolo
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy (P.S.)
| | | | - Jason Appelbaum
- University of Maryland School of Medicine, Baltimore (J.A., T.-M.D.)
| | - William H Sauer
- Brigham and Women's Hospital (W.H.S., R.B.), Harvard Medical School, Boston, MA
| | - Daniel A Culver
- Cleveland Clinic, OH (M.K.C., D.A.C., C.L.J., D.H.K., P.C.C., A.B., T.D.C., P.B., J.D.E.)
| | - Jose A Joglar
- University of Texas-Southwestern Medical Center, Dallas (J.A.J.)
| | - Ben A Lin
- Keck School of Medicine, University of Southern California, Los Angeles (B.A.L.)
| | - Christine L Jellis
- Cleveland Clinic, OH (M.K.C., D.A.C., C.L.J., D.H.K., P.C.C., A.B., T.D.C., P.B., J.D.E.)
| | | | - Deborah H Kwon
- Cleveland Clinic, OH (M.K.C., D.A.C., C.L.J., D.H.K., P.C.C., A.B., T.D.C., P.B., J.D.E.)
| | - Edward J Miller
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (L.E.R., E.J.M., C.M., L.B.)
| | - Paul C Cremer
- Cleveland Clinic, OH (M.K.C., D.A.C., C.L.J., D.H.K., P.C.C., A.B., T.D.C., P.B., J.D.E.)
| | - Frank Bogun
- University of Michigan Medical School, Ann Arbor (F.B., T.C.)
| | - Jordana Kron
- Virginia Commonwealth University School of Medicine, Richmond (J.K., K.A.E.)
| | - Ashley Bock
- Cleveland Clinic, OH (M.K.C., D.A.C., C.L.J., D.H.K., P.C.C., A.B., T.D.C., P.B., J.D.E.)
| | - Davendra Mehta
- Icahn School of Medicine Mount Sinai, New York City, NY (D.M., P.L.)
| | - Paul Leis
- Icahn School of Medicine Mount Sinai, New York City, NY (D.M., P.L.)
| | | | - Elizabeth S Kaufman
- Metro Health Campus, Case Western Reserve University, Cleveland, OH (E.S.K.)
| | - Thomas Crawford
- University of Michigan Medical School, Ann Arbor (F.B., T.C.)
| | - Peter Zimetbaum
- Beth Israel Deaconess Medical Center (P.Z.), Harvard Medical School, Boston, MA
| | - Edwin T Zishiri
- Michigan Heart and Vascular Institute, Ypsilanti, MI (E.T.Z.)
| | - Jagmeet P Singh
- Massachusetts General Hospital (J.P.S.), Harvard Medical School, Boston, MA
| | | | - Jonathan Chrispin
- Johns Hopkins University School of Medicine, Baltimore, MD (J.C., D.R.O.)
| | - Syed Quadri
- George Washington University School of Medicine, Washington DC (S.Q.)
| | - Logan L Vincent
- University of Washington School of Medicine, Seattle (L.L.V., K.K.P., R.K.C.)
| | - Kristen K Patton
- University of Washington School of Medicine, Seattle (L.L.V., K.K.P., R.K.C.)
| | | | - Thomas D Callahan
- Cleveland Clinic, OH (M.K.C., D.A.C., C.L.J., D.H.K., P.C.C., A.B., T.D.C., P.B., J.D.E.)
| | | | | | - David Birnie
- University of Ottawa Heart Institute, ON, Canada (D.B.)
| | - David R Okada
- Johns Hopkins University School of Medicine, Baltimore, MD (J.C., D.R.O.)
| | - Christopher Maulion
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (L.E.R., E.J.M., C.M., L.B.)
| | - Pavan Bhat
- Cleveland Clinic, OH (M.K.C., D.A.C., C.L.J., D.H.K., P.C.C., A.B., T.D.C., P.B., J.D.E.)
| | - Lavanya Bellumkonda
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (L.E.R., E.J.M., C.M., L.B.)
| | - Ron Blankstein
- Brigham and Women's Hospital (W.H.S., R.B.), Harvard Medical School, Boston, MA
| | - Richard K Cheng
- University of Washington School of Medicine, Seattle (L.L.V., K.K.P., R.K.C.)
| | - Maryjane A Farr
- Columbia University Irving Medical Center, New York City, NY (M.A.F.)
| | - Jerry D Estep
- Cleveland Clinic, OH (M.K.C., D.A.C., C.L.J., D.H.K., P.C.C., A.B., T.D.C., P.B., J.D.E.)
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Challenges in Cardiac and Pulmonary Sarcoidosis: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 76:1878-1901. [PMID: 33059834 DOI: 10.1016/j.jacc.2020.08.042] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 12/17/2022]
Abstract
Sarcoidosis is a complex disease with heterogeneous clinical presentations that can affect virtually any organ. Although the lung is typically the most common organ involved, combined pulmonary and cardiac sarcoidosis (CS) account for most of the morbidity and mortality associated with this disease. Pulmonary sarcoidosis can be asymptomatic or result in impairment in quality of life and end-stage, severe, and/or life-threatening disease. The latter outcome is seen almost exclusively in those with fibrotic pulmonary sarcoidosis, which accounts for 10% to 20% of pulmonary sarcoidosis patients. CS is problematic to diagnose and may cause significant morbidity and death from heart failure or ventricular arrhythmias. The diagnosis of CS usually requires surrogate cardiac imaging biomarkers, as endomyocardial biopsy has relatively low yield, even with directed electrophysiological mapping. Treatment of CS is often multifactorial, involving a combination of antigranulomatous therapy and pharmacotherapy for cardiac arrhythmias and/or heart failure in addition to device placement and cardiac transplantation.
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Noll AE, William AD, Varma N. A Patient Presenting With a Viral Prodrome, Palpitations, Dizziness, and Heart Block. JAMA Cardiol 2021; 6:236-237. [PMID: 33237258 DOI: 10.1001/jamacardio.2020.5926] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Andrew E Noll
- Section of Electrophysiology and Pacing, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Amila D William
- Section of Electrophysiology and Pacing, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio.,Swedish Heart and Vascular Institute, Seattle, Washington
| | - Niraj Varma
- Section of Electrophysiology and Pacing, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
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Casali M, Lauri C, Altini C, Bertagna F, Cassarino G, Cistaro A, Erba AP, Ferrari C, Mainolfi CG, Palucci A, Prandini N, Baldari S, Bartoli F, Bartolomei M, D’Antonio A, Dondi F, Gandolfo P, Giordano A, Laudicella R, Massollo M, Nieri A, Piccardo A, Vendramin L, Muratore F, Lavelli V, Albano D, Burroni L, Cuocolo A, Evangelista L, Lazzeri E, Quartuccio N, Rossi B, Rubini G, Sollini M, Versari A, Signore A. State of the art of 18F-FDG PET/CT application in inflammation and infection: a guide for image acquisition and interpretation. Clin Transl Imaging 2021; 9:299-339. [PMID: 34277510 PMCID: PMC8271312 DOI: 10.1007/s40336-021-00445-w] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 06/19/2021] [Indexed: 02/06/2023]
Abstract
AIM The diagnosis, severity and extent of a sterile inflammation or a septic infection could be challenging since there is not one single test able to achieve an accurate diagnosis. The clinical use of 18F-fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) imaging in the assessment of inflammation and infection is increasing worldwide. The purpose of this paper is to achieve an Italian consensus document on [18F]FDG PET/CT or PET/MRI in inflammatory and infectious diseases, such as osteomyelitis (OM), prosthetic joint infections (PJI), infective endocarditis (IE), prosthetic valve endocarditis (PVE), cardiac implantable electronic device infections (CIEDI), systemic and cardiac sarcoidosis (SS/CS), diabetic foot (DF), fungal infections (FI), tuberculosis (TBC), fever and inflammation of unknown origin (FUO/IUO), pediatric infections (PI), inflammatory bowel diseases (IBD), spine infections (SI), vascular graft infections (VGI), large vessel vasculitis (LVV), retroperitoneal fibrosis (RF) and COVID-19 infections. METHODS In September 2020, the inflammatory and infectious diseases focus group (IIFG) of the Italian Association of Nuclear Medicine (AIMN) proposed to realize a procedural paper about the clinical applications of [18F]FDG PET/CT or PET/MRI in inflammatory and infectious diseases. The project was carried out thanks to the collaboration of 13 Italian nuclear medicine centers, with a consolidate experience in this field. With the endorsement of AIMN, IIFG contacted each center, and the pediatric diseases focus group (PDFC). IIFG provided for each team involved, a draft with essential information regarding the execution of [18F]FDG PET/CT or PET/MRI scan (i.e., indications, patient preparation, standard or specific acquisition modalities, interpretation criteria, reporting methods, pitfalls and artifacts), by limiting the literature research to the last 20 years. Moreover, some clinical cases were required from each center, to underline the teaching points. Time for the collection of each report was from October to December 2020. RESULTS Overall, we summarized 291 scientific papers and guidelines published between 1998 and 2021. Papers were divided in several sub-topics and summarized in the following paragraphs: clinical indications, image interpretation criteria, future perspectivess and new trends (for each single disease), while patient preparation, image acquisition, possible pitfalls and reporting modalities were described afterwards. Moreover, a specific section was dedicated to pediatric and PET/MRI indications. A collection of images was described for each indication. CONCLUSIONS Currently, [18F]FDG PET/CT in oncology is globally accepted and standardized in main diagnostic algorithms for neoplasms. In recent years, the ever-closer collaboration among different European associations has tried to overcome the absence of a standardization also in the field of inflammation and infections. The collaboration of several nuclear medicine centers with a long experience in this field, as well as among different AIMN focus groups represents a further attempt in this direction. We hope that this document will be the basis for a "common nuclear physicians' language" throughout all the country. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40336-021-00445-w.
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Affiliation(s)
- Massimiliano Casali
- Nuclear Medicine Unit, Azienda Unità Sanitaria Locale IRCCS, Reggio Emilia, Italy
| | - Chiara Lauri
- grid.7841.aNuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, “Sapienza” University of Rome, Rome, Italy
| | - Corinna Altini
- grid.7644.10000 0001 0120 3326Nuclear Medicine Unit, Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - Francesco Bertagna
- grid.412725.7Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - Gianluca Cassarino
- grid.5608.b0000 0004 1757 3470Nuclear Medicine Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | | | - Anna Paola Erba
- grid.5395.a0000 0004 1757 3729Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Cristina Ferrari
- grid.7644.10000 0001 0120 3326Nuclear Medicine Unit, Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - Ciro Gabriele Mainolfi
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, University “Federico II”, Naples, Italy
| | - Andrea Palucci
- grid.415845.9Department of Nuclear Medicine, “Ospedali Riuniti di Torrette” Hospital, Ancona, Italy
| | - Napoleone Prandini
- grid.418324.80000 0004 1781 8749Nuclear Medicine Unit, Department of Diagnostic Imaging, Centro Diagnostico Italiano, Milan, Italy
| | - Sergio Baldari
- grid.10438.3e0000 0001 2178 8421Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and of Morpho-Functional Imaging, University of Messina, Messina, Italy
| | - Francesco Bartoli
- grid.5395.a0000 0004 1757 3729Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Mirco Bartolomei
- grid.416315.4Nuclear Medicine Unit, Oncological Medical and Specialists Department, University Hospital of Ferrara, Ferrara, Italy
| | - Adriana D’Antonio
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, University “Federico II”, Naples, Italy
| | - Francesco Dondi
- grid.412725.7Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - Patrizia Gandolfo
- grid.418324.80000 0004 1781 8749Nuclear Medicine Unit, Department of Diagnostic Imaging, Centro Diagnostico Italiano, Milan, Italy
| | - Alessia Giordano
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, University “Federico II”, Naples, Italy
| | - Riccardo Laudicella
- grid.10438.3e0000 0001 2178 8421Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and of Morpho-Functional Imaging, University of Messina, Messina, Italy
| | | | - Alberto Nieri
- grid.416315.4Nuclear Medicine Unit, Oncological Medical and Specialists Department, University Hospital of Ferrara, Ferrara, Italy
| | | | - Laura Vendramin
- grid.5608.b0000 0004 1757 3470Nuclear Medicine Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Francesco Muratore
- Rheumatology Unit, Azienda Unità Sanitaria Locale IRCCS, Reggio Emilia, Italy
| | - Valentina Lavelli
- grid.7644.10000 0001 0120 3326Nuclear Medicine Unit, Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - Domenico Albano
- grid.412725.7Nuclear Medicine, University of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - Luca Burroni
- grid.415845.9Department of Nuclear Medicine, “Ospedali Riuniti di Torrette” Hospital, Ancona, Italy
| | - Alberto Cuocolo
- grid.4691.a0000 0001 0790 385XDepartment of Advanced Biomedical Sciences, University “Federico II”, Naples, Italy
| | - Laura Evangelista
- grid.5608.b0000 0004 1757 3470Nuclear Medicine Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Elena Lazzeri
- grid.5395.a0000 0004 1757 3729Regional Center of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy
| | - Natale Quartuccio
- grid.419995.9Nuclear Medicine Unit, A.R.N.A.S. Civico di Cristina and Benfratelli Hospitals, Palermo, Italy
| | - Brunella Rossi
- Nuclear Medicine Unit, Department of Services, ASUR MARCHE-AV5, Ascoli Piceno, Italy
| | - Giuseppe Rubini
- grid.7644.10000 0001 0120 3326Nuclear Medicine Unit, Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - Martina Sollini
- grid.417728.f0000 0004 1756 8807Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Annibale Versari
- Nuclear Medicine Unit, Azienda Unità Sanitaria Locale IRCCS, Reggio Emilia, Italy
| | - Alberto Signore
- grid.7841.aNuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, “Sapienza” University of Rome, Rome, Italy
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Flores RJ, Flaherty KR, Jin Z, Bokhari S. The prognostic value of quantitating and localizing F-18 FDG uptake in cardiac sarcoidosis. J Nucl Cardiol 2020; 27:2003-2010. [PMID: 30421379 DOI: 10.1007/s12350-018-01504-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 09/27/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND There is no identified level of FDG uptake in cardiac sarcoidosis (CS) associated with increased risk of arrhythmias, conduction disease, heart failure, or death. We aim to utilize standardized uptake value (SUV) quantitation and localization to identify patients at increased risk of cardiac events. METHODS AND RESULTS F18-FDG PET/CT with MPI was used in CS diagnosis (N = 67). Mean and max SUV were measured and grouped as basal, mid, and apical disease. Post-scan ventricular tachycardia, AICD placement, complete heart block, pacemaker placement, atrial fibrillation, heart failure, and cardiac-related hospital admissions were recorded (mean follow up 2.98 ± 2 years). Poisson regression analysis revealed that max SUV, mean SUV, as well as mean basal SUV, and LVEF were significantly associated with total cardiac events. Max SUV odds ratio (OR) = 1.068 (95% CI 1.024-1.114, P = 0.002), mean SUV OR = 1.059 (95% CI 1.008-1.113, P = 0.023), mean SUV OR = 1.061 (95% CI 1.012-1.112, P = 0.014), scan LVEF OR = 0.731 (95% CI 0.664-0.805, P < 0.001). CONCLUSIONS SUV at time of CS diagnosis has significant associations with future cardiac events. Patients with higher SUV, particularly in basal segments, are at increased risk of events. Further studies are needed to identify treatment methods utilizing risk stratification of CS.
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Affiliation(s)
- R J Flores
- Internal Medicine, Columbia University Medical Center, New York, NY, USA.
| | - K R Flaherty
- Internal Medicine, Division of Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Z Jin
- Department of Biostatistics, Columbia University, New York, NY, USA
| | - S Bokhari
- Internal Medicine, Division of Cardiology, Columbia University Medical Center, New York, NY, USA
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50
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Rudbeck-Resdal J, Christiansen MK, Johansen JB, Nielsen JC, Bundgaard H, Jensen HK. Aetiologies and temporal trends of atrioventricular block in young patients: a 20-year nationwide study. Europace 2020; 21:1710-1716. [PMID: 31424500 PMCID: PMC6826204 DOI: 10.1093/europace/euz206] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 07/09/2019] [Indexed: 12/26/2022] Open
Abstract
Aims To describe aetiologies and temporal trends in young patients with atrioventricular block (AVB). Methods and results We identified all patients in Denmark, receiving their first pacemaker because of AVB before the age of 50 years between 1996 and 2015. Medical records were reviewed and clinical information and diagnostic work-up results were obtained to evaluate the aetiology. We used Poisson regression testing for temporal trends. One thousand and twenty-seven patients were identified, median age at time of implantation was 38 (interquartile range 25–45) years, 584 (56.9%) were male. The aetiologies were complications to cardiac surgery [n = 157 (15.3%)], congenital AVB [n = 93 (9.0%)], cardioinhibitory reflex [n = 52 (5.0%)], congenital heart disease [n = 43 (4.2%)], complication to radiofrequency ablation [n = 35 (3.4%)], cardiomyopathy [n = 31 (3.0%)], endocarditis [n = 18 (1.7%)], muscular dystrophy [n = 14 (1.4%)], ischaemic heart disease [n = 14 (1.4%)], sarcoidosis [n = 11 (1.1%)], borreliosis [n = 9 (0.9%)], hereditary [n = 6 (0.6%)], side-effect to antiarrhythmics [n = 6 (0.6%)], planned His-ablation [n = 5 (0.5%)], complication to alcohol septal ablation [n = 5 (0.5%)], and other known aetiologies [n = 11 (1.1%)]. The aetiology remained unknown in 517 (50.3%) cases. While the number of patients with unknown aetiology increased during the study period (P < 0.001), we observed no significant change in the number of patients with identified aetiology (P = 0.35). Conclusion In a nationwide cohort, the aetiology of AVB was identified in only half the patients younger than 50 years referred for first-time pacemaker implantation. The number of patients with unknown aetiology increased during the study period. These findings indicate need for better insight into aetiologies of AVB and improved diagnostic work-up guidelines.
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Affiliation(s)
- Johnni Rudbeck-Resdal
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, Aarhus N, Denmark.,Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Boulevard 82, Aarhus N, Denmark
| | - Morten K Christiansen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, Aarhus N, Denmark
| | - Jens B Johansen
- Department of Cardiology, Danish Pacemaker and ICD Registry, Odense University Hospital, J. B. Winsløws Vej 4, Odense, Denmark
| | - Jens C Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, Aarhus N, Denmark.,Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Boulevard 82, Aarhus N, Denmark
| | - Henning Bundgaard
- Unit for Inherited Cardiovascular Diseases, The Heart Centre, Department of Cardiology B2142, National University Hospital, University of Copenhagen, Blegdamsvej 9, Copenhagen, Denmark
| | - Henrik K Jensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, Aarhus N, Denmark.,Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Boulevard 82, Aarhus N, Denmark
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