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Takaya Y, Nakamura K, Nishii N, Ito H. Clinical outcomes of patients with isolated cardiac sarcoidosis confirmed by clinical diagnostic criteria. Int J Cardiol 2021; 345:49-53. [PMID: 34743890 DOI: 10.1016/j.ijcard.2021.10.150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/08/2021] [Accepted: 10/26/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although isolated cardiac sarcoidosis (CS) is not uncommon, little is known about the prognosis. We aimed to clarify clinical features and clinical outcomes in patients with isolated CS. METHODS Two-hundred eighty-six patients with suspected CS were enrolled. Systemic CS (SCS) was diagnosed by histological or clinical confirmation of sarcoidosis according to the guidelines. Isolated CS was diagnosed by histological or clinical confirmation in the heart alone. The endpoint was cardiac death, hospitalization for heart failure, or fatal ventricular arrhythmia. RESULTS Twenty-one patients were diagnosed with isolated CS, and 63 were diagnosed with SCS. The frequencies of diagnostic criteria, such as high-grade atrioventricular block or fatal ventricular arrhythmia, basal thinning of the ventricular septum, left ventricular contractile dysfunction, positive myocardial uptake of gallium-67 citrate scintigraphy or fluorine-18 fluorodeoxyglucose positron emission tomography, and delayed contrast enhancement of cardiac magnetic resonance, were higher or equivalent in patients with isolated CS, compared to those with SCS. Over a median follow-up of 31 months (range: 1-175 months), cardiac death, hospitalization for heart failure, or fatal ventricular arrhythmia occurred in 14 (67%) patients with isolated CS, 24 (38%) patients with SCS, and 63 (31%) patients without CS. The rate of cardiac events was higher in patients with isolated CS (log-rank test, p = 0.01). Cox proportional hazard analysis showed that isolated CS, age, and New York Heart Association functional class were independently associated with cardiac events. CONCLUSIONS Patients with isolated CS have clinical features compatible with SCS, and have cardiac events at a higher rate.
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Affiliation(s)
- Yoichi Takaya
- Department of Cardiovascular Medicine, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Nobuhiro Nishii
- Department of Cardiovascular Medicine, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Okada DR, Bravo PE, Vita T, Agarwal V, Osborne MT, Taqueti VR, Skali H, Chareonthaitawee P, Dorbala S, Stewart G, Di Carli M, Blankstein R. Isolated cardiac sarcoidosis: A focused review of an under-recognized entity. J Nucl Cardiol 2018; 25:1136-1146. [PMID: 27613395 PMCID: PMC5540795 DOI: 10.1007/s12350-016-0658-1] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 08/10/2016] [Indexed: 02/07/2023]
Abstract
There is accumulating evidence for the existence of a phenotype of isolated cardiac sarcoidosis (ICS), or sarcoidosis that only involves the heart. In the absence of biopsy-confirmed cardiac sarcoidosis (CS), existing diagnostic criteria require the presence of extra-cardiac sarcoidosis as an inclusion criterion for the diagnosis of CS. Consequently, in the absence of a positive endomyocardial biopsy, ICS is not diagnosable by current guidelines. Therefore, there is uncertainty regarding the epidemiology, pathobiology, clinical characteristics, prognosis, and optimal treatment of ICS. This review will summarize the available data related to the prevalence and prognosis of ICS and will discuss challenges surrounding the diagnosis and management of this under-recognized entity.
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Affiliation(s)
- David R Okada
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Paco E Bravo
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Tomas Vita
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Vikram Agarwal
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael T Osborne
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Viviany R Taqueti
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Hicham Skali
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | | | - Sharmila Dorbala
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Garrick Stewart
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Marcelo Di Carli
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Ron Blankstein
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.
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Kuwabara M, Ishimura RN, Ishiwata S, Ohno M. Isolated Cardiac Sarcoidosis Presenting with Stroke. Korean Circ J 2018; 48:236-239. [PMID: 29557112 PMCID: PMC5861318 DOI: 10.4070/kcj.2017.0133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 12/14/2017] [Indexed: 11/11/2022] Open
Affiliation(s)
- Masanari Kuwabara
- Department of Cardiology, Toranomon Hospital, Tokyo, Japan.,Division of Renal Diseases and Hypertension, University of Colorado Denver, School of Medicine, Aurora, CO, USA.
| | | | - Sugao Ishiwata
- Department of Cardiology, Toranomon Hospital, Tokyo, Japan
| | - Minoru Ohno
- Department of Cardiology, Toranomon Hospital, Tokyo, Japan
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Thangam M, Nathan S, Kar B, Petrovic M, Patel M, Loyalka P, Buja LM, Gregoric ID. Primary Cardiac Sarcoidosis with Syncope and Refractory Atrial Arrhythmia: A Case Report and Review of the Literature. Tex Heart Inst J 2016; 43:236-40. [PMID: 27303240 DOI: 10.14503/thij-14-4792] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We discuss the case of a 38-year-old black man who presented at our hospital with his first episode of syncope, recently developed atrial arrhythmias refractory to pharmacologic therapy, and a left atrial thrombus. He was diagnosed with primary cardiac sarcoidosis characterized by predominant involvement of the epicardium that caused atrial fibrillation and atrial flutter. Histologic analysis of his epicardial lesions yielded a diagnosis of sarcoidosis. This patient's atrial arrhythmia was successfully treated with a hybrid operation that involved resection of his atrial appendage, an Epicor maze procedure, and radiofrequency ablation during a catheter-based electrophysiologic study. The cardiac sarcoidosis was successfully managed with corticosteroid therapy. Our case report shows that sarcoidosis can initially manifest itself as syncope with new-onset atrial arrhythmia. Sarcoidosis is important in the differential diagnosis because of its progressive nature and its potential for treatment with pharmacologic, surgical, and catheter-based interventions.
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Takaya Y, Kusano KF, Nakamura K, Ito H. Comparison of outcomes in patients with probable versus definite cardiac sarcoidosis. Am J Cardiol 2015; 115:1293-7. [PMID: 25743209 DOI: 10.1016/j.amjcard.2015.01.562] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 01/29/2015] [Accepted: 01/29/2015] [Indexed: 01/12/2023]
Abstract
Patients with probable cardiac sarcoidosis (CS) who satisfy only clinical cardiac findings for CS are not uncommon. The aim of this study was to compare outcomes between patients with probable CS and those with definite CS treated with steroids. The study population consisted of 101 consecutive patients who satisfied clinical cardiac findings for CS. Patients with definite CS were defined as having histologic or clinical confirmation of CS according to the guidelines and were treated with steroids. Patients with probable CS were defined as having only clinical cardiac findings but not definite CS because of no histologic confirmation or extracardiac sarcoidosis and were not treated with steroids. The end point was major adverse cardiac events. Forty-seven patients had definite CS, and the other 54 had probable CS. Except for serum angiotensin-converting enzyme levels and left ventricular dysfunction, clinical characteristics were similar between the 2 groups. Over a median follow-up period of 15 months, major adverse cardiac events occurred more frequently in patients with probable CS than in those with definite CS (74% vs 53%, p=0.029). The event-free survival rate was worse in patients with probable CS than in those with definite CS (log-rank test, p=0.006). Cox proportional-hazards analysis showed that probable CS was an independent predictor of major adverse cardiac events. In conclusion, outcomes were worse in patients with probable CS than in those with definite CS treated with steroids. The initiation of steroid treatment may be considered for patients who satisfy only clinical cardiac findings for CS.
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Kron J, Sauer W, Mueller G, Schuller J, Bogun F, Sarsam S, Rosenfeld L, Mitiku TY, Cooper JM, Mehta D, Greenspon AJ, Ortman M, Delurgio DB, Valadri R, Narasimhan C, Swapna N, Singh JP, Danik S, Markowitz SM, Almquist AK, Krahn AD, Wolfe LG, Feinstein S, Ellenbogen KA, Crawford T. Outcomes of patients with definite and suspected isolated cardiac sarcoidosis treated with an implantable cardiac defibrillator. J Interv Card Electrophysiol 2015; 43:55-64. [PMID: 25676929 DOI: 10.1007/s10840-015-9978-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 01/20/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE Cardiac sarcoidosis (CS) patients are at increased risk for sudden death. Isolated CS is rare and can be difficult to diagnose. METHODS In this multicenter retrospective review, patients with CS and an implantable cardiac defibrillator (ICD) were identified. RESULTS Of 235 patients with CS and ICD, 13 (5.5 %) had isolated CS, including 7 (3.0 %) with definite isolated CS (biopsy or necropsy-proven) and 6 (2.6 %) with suspected isolated CS based on a constellation of clinical, ECG, and imaging findings. Among 13 patients with isolated CS, 10 (76.9 %) were male, mean age was 53.8 ± 7.6 years, and mean left ventricular ejection fraction was 38.3 ± 16.5. Diagnosis was made by cardiac magnetic resonance (CMR) (n = 2), biopsy (n = 3), CMR and biopsy (n = 2), CMR and positron emission tomography (PET) (n = 2), PET (n = 1), late enhanced cardiac CT (n = 1), pathology at heart transplant (n = 1), and autopsy (n = 1). Eight of 13 (61.5 %) patients with isolated CS had a secondary prevention indication (VT in 6 and VF in 2) vs. 80 of 222 (36.0 %) with sarcoidosis in other organs (p = 0.04). Over a mean of 4.2 years, 9 of 13 (69.2 %) patients with isolated CS received appropriate ICD therapy, including anti-tachycardia pacing (ATP) and/or shock, compared with 75 of 222 (33.8 %) patients with cardiac and extracardiac sarcoidosis (p = 0.0150). Six of 7 (85.7 %) patients with definite isolated CS received appropriate ICD intervention, compared with 78 of 228 patients (34.2 %) without definite isolated CS (p = 0.0192.) CONCLUSIONS In this retrospective study, patients with isolated CS had very high rates of appropriate ICD therapy. Prospective, long-term follow-up of consecutive patients with isolated CS is needed to determine the true natural history and rates of ventricular arrhythmias in this rare and difficult-to-diagnose disease.
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Affiliation(s)
- Jordana Kron
- Department of Cardiac Electrophysiology, Virginia Commonwealth University, P.O. Box 980053, Richmond, VA, 23298-0053, USA,
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Wicks EC, Menezes LJ, Elliott PM. Improving the diagnostic accuracy for detecting cardiac sarcoidosis. Expert Rev Cardiovasc Ther 2015; 13:223-36. [DOI: 10.1586/14779072.2015.1001367] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Isobe M. [The Cutting-edge of Medicine; Clinical features of isolated cardiac sarcoidosis]. ACTA ACUST UNITED AC 2015; 104:120-7. [PMID: 26571786 DOI: 10.2169/naika.104.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Isobe M, Tezuka D. Isolated cardiac sarcoidosis: clinical characteristics, diagnosis and treatment. Int J Cardiol 2014; 182:132-40. [PMID: 25577749 DOI: 10.1016/j.ijcard.2014.12.056] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 11/12/2014] [Accepted: 12/21/2014] [Indexed: 02/07/2023]
Abstract
Sarcoidosis is a systemic disease characterized by the development of noncaseating epithelioid granulomas in multiple organs. Despite extensive investigations over a long period of time, the etiology of this disease remains unknown. Cardiac involvement of this disease is the most ominous complication leading to fatal outcome. Recently, attention has been focused on isolated cardiac sarcoidosis, which exists without clinically apparent sarcoidosis elsewhere. One of the critical issues of isolated cardiac sarcoidosis is difficulty in diagnosis, since existence of the cardiac lesion should be detected from cardiac manifestations alone. Because specificity of biomarkers or sensitivity of histological examination of biopsied sample is very low, diagnosis of isolated cardiac sarcoidosis mainly depends on imaging modalities. In this review article we summarized current knowledge on the pathogenesis of sarcoidosis, clinical features of cardiac sarcoidosis especially that isolated to the heart by showing some typical cases. Utilities and problems of diagnostic imaging tests for this condition including echocardiography, cardiac magnetic resonance imaging, and fluorodeoxyglucose-positron emission tomography are discussed. Advances in pharmacological and nonpharmacological treatment for cardiac sarcoidosis have improved the prognosis of cardiac sarcoidosis to a great deal; however, there are many issues that remain to be solved in the management of isolated cardiac sarcoidosis.
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Affiliation(s)
- Mitsuaki Isobe
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan.
| | - Daisuke Tezuka
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Japan
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Şentürk A, Maraş Y, Argüder E, Karalezli A, Hasanoğlu HC, Öğüt T, Baştuğ S, Karabekir E. What type of different clinical manifestations can cardiac sarcoidosis present? Rheumatol Int 2014; 35:1103-6. [PMID: 25429793 DOI: 10.1007/s00296-014-3183-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 11/18/2014] [Indexed: 11/25/2022]
Abstract
Cardiac sarcoidosis is an infiltrative, granulomatous inflammatory disease of the myocardium. Generally, it can be difficult to diagnose cardiac sarcoidosis clinically because of the non-specific nature of its clinical manifestations. This property can be based on the presence of any clinical evidence of sarcoidosis in the other organs. We present two cases of cardiac sarcoidosis so as to demonstrate its different clinical manifestations. The first patient displayed no cardiac symptoms; the electrocardiogram showed an incidental right bundle branch block. Her cardiac magnetic resonance imaging (CMRI) revealed late-phase opaque material enhancement involving the inferior and inferoseptal segment of the left ventricle. The second patient was severely symptomatic in terms of cardiac involvement, and a transthoracic echocardiogram revealed global hypokinesia and septal brightness; his ejection fraction decreased to 45%. These cases highlighted the challenges encountered in the diagnosis and treatment of cardiac sarcoidosis. CMRI should be considered in all patients who have suspected findings for cardiac involvement.
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Affiliation(s)
- Ayşegül Şentürk
- Department of Chest Disease, Atatürk Training and Research Hospital, Ankara, Turkey
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Isolated cardiac sarcoidosis requiring open-chest myocardial biopsy for differentiation from malignant lymphoma. J Cardiol Cases 2014; 9:239-242. [PMID: 30534336 DOI: 10.1016/j.jccase.2014.03.006] [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: 11/21/2013] [Revised: 02/08/2014] [Accepted: 03/14/2014] [Indexed: 11/23/2022] Open
Abstract
A 68-year-old woman with a history of hypertension was admitted to our hospital because of dyspnea during physical exertion. Echocardiography demonstrated impaired left ventricular systolic function, and her ejection fraction was reduced to 30%. Coronary angiography did not show significant stenosis. Endomyocardial biopsy showed only nonspecific findings without noncaseating granulomas. Cardiac magnetic resonance (CMR) imaging showed transmural late gadolinium enhancement on the basal part of the left ventricle. 18F-Fluorodeoxyglucose positron emission tomography (18F-FDG PET) showed abnormal focal uptake specific to the left ventricle; no abnormal manifestations in other organs were observed. The CMR and 18F-FDG PET features could not rule out either sarcoidosis or malignant lymphoma. Therefore, we conducted open-chest myocardial biopsy to differentiate between the two possible diseases. Histopathological findings showed noncaseating epithelioid cell granuloma, confirming isolated cardiac sarcoidosis. This is an example of a challenging case of diagnosing isolated cardiac sarcoidosis. <Learning objective: We describe a case of "isolated" cardiac sarcoidosis that is of special interest as no abnormal manifestations of sarcoidosis were noted in organs other than the heart; moreover, the condition could not be diagnosed with transvenous endomyocardial biopsy, but was finally confirmed by open-chest myocardial biopsy.>.
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Zacek P, Omran N, Chek JL, Krbal L, Vojacek J, Harrer J. Cardiac Sarcoidosis. J Card Surg 2013; 28:525-8. [DOI: 10.1111/jocs.12163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Pavel Zacek
- Faculty of Medicine and Faculty Hospital, Department of Cardiac Surgery; Charles University in Prague; Hradec Kralove Czech Republic
| | - Nedal Omran
- Faculty of Medicine and Faculty Hospital, Department of Cardiac Surgery; Charles University in Prague; Hradec Kralove Czech Republic
| | - James L. Chek
- Faculty of Medicine and Faculty Hospital, Department of Cardiac Surgery; Charles University in Prague; Hradec Kralove Czech Republic
| | - Lukas Krbal
- Faculty of Medicine and Faculty Hospital, The Fingerland's Department of Pathology; Charles University in Prague; Hradec Kralove Czech Republic
| | - Jan Vojacek
- Faculty of Medicine and Faculty Hospital, Department of Cardiac Surgery; Charles University in Prague; Hradec Kralove Czech Republic
| | - Jan Harrer
- Faculty of Medicine and Faculty Hospital, Department of Cardiac Surgery; Charles University in Prague; Hradec Kralove Czech Republic
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