1
|
Saric P, Bois JP, Giudicessi JR, Rosenbaum AN, Kusmirek JE, Lin G, Chareonthaitawee P. Imaging of Cardiac Sarcoidosis: An Update and Future Aspects. Semin Nucl Med 2024; 54:701-716. [PMID: 38480041 DOI: 10.1053/j.semnuclmed.2024.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 08/20/2024]
Abstract
Cardiac sarcoidosis (CS), an increasingly recognized disease of unknown etiology, is associated with significant morbidity and mortality. Given the limited diagnostic yield of traditional endomyocardial biopsy (EMB), there is increasing reliance on multimodality cardiovascular imaging in the diagnosis and management of CS, with EMB being largely supplanted by the use of 18F-fluorodeoxyglucose (FDG-PET) and cardiac magnetic resonance imaging (CMR). This article aims to provide a comprehensive review of imaging modalities currently utilized in the screening, diagnosis, and monitoring of CS, while highlighting the latest developments in each area.
Collapse
Affiliation(s)
- Petar Saric
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - John P Bois
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | | | | | - Grace Lin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | |
Collapse
|
2
|
Ositelu K, Abraham S, Okwuosa IS. Cardiac Sarcoidosis: Utilizing Cardiac MRI and PET-CT. Curr Cardiol Rep 2024; 26:935-941. [PMID: 39012548 DOI: 10.1007/s11886-024-02093-8] [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] [Accepted: 07/02/2024] [Indexed: 07/17/2024]
Abstract
PURPOSEOF REVIEW Cardiac sarcoidosis is an inflammatory condition that has been associated with deleterious cardiac manifestations. The diagnosis of cardiac sarcoidosis is challenging and can be guided by advanced cardiac imaging. RECENT FINDINGS Endomyocardial biopsy lacks sensitivity in confirming a diagnosis of cardiac sarcoidosis. Studies have shown that the use of cardiac magnetic resonance imaging (MRI) and cardiac Positron Emission Testing (PET) are associated with increased sensitivity and specificity in the diagnosis of cardiac sarcoidosis. Cardiac MRI and cardiac PET CT, although distinct entities, are complimentary in the diagnosis, prognostication of major cardiac events, and aid in the treatment algorithm in patients with cardiac sarcoidosis.
Collapse
Affiliation(s)
- Kamari Ositelu
- Northwestern University, Feinberg School of Medicine, Division of Cardiology, Chicago, IL, USA
| | - Sonu Abraham
- Northwestern University, Feinberg School of Medicine, Division of Cardiology, Chicago, IL, USA
| | - Ike S Okwuosa
- Northwestern University, Feinberg School of Medicine, Division of Cardiology, Chicago, IL, USA.
| |
Collapse
|
3
|
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; 45:2697-2726. [PMID: 38923509 DOI: 10.1093/eurheartj/ehae356] [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: 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.
Collapse
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
| |
Collapse
|
4
|
de Melo JF, Mangold KE, Debertin J, Rosenbaum A, Bois JP, Attia ZI, Friedman PA, Deshmukh AJ, Kapa S, Cooper LT, Abou Ezzeddine OF, Siontis KC. Detection of cardiac sarcoidosis with the artificial intelligence-enhanced electrocardiogram. Heart Rhythm 2024:S1547-5271(24)03119-9. [PMID: 39127231 DOI: 10.1016/j.hrthm.2024.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/29/2024] [Accepted: 08/01/2024] [Indexed: 08/12/2024]
Affiliation(s)
- Jose F de Melo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Kathryn E Mangold
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Julia Debertin
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota
| | - Andrew Rosenbaum
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - John P Bois
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Zachi I Attia
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Suraj Kapa
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Leslie T Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida
| | | | | |
Collapse
|
5
|
Cheng RK, Kittleson MM, Beavers CJ, Birnie DH, Blankstein R, Bravo PE, Gilotra NA, Judson MA, Patton KK, Rose-Bovino L. Diagnosis and Management of Cardiac Sarcoidosis: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e1197-e1216. [PMID: 38634276 DOI: 10.1161/cir.0000000000001240] [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] [Indexed: 04/19/2024]
Abstract
Cardiac sarcoidosis is an infiltrative cardiomyopathy that results from granulomatous inflammation of the myocardium and may present with high-grade conduction disease, ventricular arrhythmias, and right or left ventricular dysfunction. Over the past several decades, the prevalence of cardiac sarcoidosis has increased. Definitive histological confirmation is often not possible, so clinicians frequently face uncertainty about the accuracy of diagnosis. Hence, the likelihood of cardiac sarcoidosis should be thought of as a continuum (definite, highly probable, probable, possible, low probability, unlikely) rather than in a binary fashion. Treatment should be initiated in individuals with clinical manifestations and active inflammation in a tiered approach, with corticosteroids as first-line treatment. The lack of randomized clinical trials in cardiac sarcoidosis has led to treatment decisions based on cohort studies and consensus opinions, with substantial variation observed across centers. This scientific statement is intended to guide clinical practice and to facilitate management conformity by providing a framework for the diagnosis and management of cardiac sarcoidosis.
Collapse
|
6
|
Waller AH, Kim Y. Diagnosis and Outcomes Using Magnetic Resonance Positron Emission Tomography in Known or Suspected Cardiac Sarcoidosis. JACC Cardiovasc Imaging 2024; 17:425-427. [PMID: 38363263 DOI: 10.1016/j.jcmg.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 01/02/2024] [Indexed: 02/17/2024]
Affiliation(s)
- Alfonso H Waller
- Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Department of Radiology, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Division of Cardiovascular Medicine, Department of Medicine, Newark Beth Israel Medical Center, Newark, New Jersey, USA.
| | - Yekaterina Kim
- Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Division of Cardiovascular Medicine, Department of Medicine, Newark Beth Israel Medical Center, Newark, New Jersey, USA
| |
Collapse
|
7
|
Tan JL, Supple GE, Nazarian S. Sarcoid heart disease and imaging. Heart Rhythm O2 2024; 5:50-59. [PMID: 38312203 PMCID: PMC10837178 DOI: 10.1016/j.hroo.2023.11.012] [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: 02/06/2024] Open
Abstract
Cardiac sarcoidosis (CS) can mimic any cardiomyopathy due to its ability to manifest with a variety of clinical presentations. The exact prevalence of CS remains unknown but has been reported ranging from 2.3% to as high as 29.9% among patients presenting with new onset cardiomyopathy and/or atrioventricular block. Early and accurate diagnosis of CS is often challenging due to the nature of disease progression and lack of diagnostic reference standard. The current diagnostic criteria for CS are lacking in sensitivity and specificity. Here, we review the contemporary role of advanced imaging modalities such as cardiac magnetic resonance imaging and positron emission tomography/computed tomography imaging in diagnosing and prognosticating patients with CS.
Collapse
Affiliation(s)
- Jian Liang Tan
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gregory E Supple
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Saman Nazarian
- Electrophysiology Section, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
8
|
Pham T, Abraham J, Sheikh FH. Great mimicker: definite isolated cardiac sarcoidosis masquerading as hypertrophic cardiomyopathy. BMJ Case Rep 2023; 16:e256579. [PMID: 38087480 PMCID: PMC10728929 DOI: 10.1136/bcr-2023-256579] [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] [Indexed: 12/18/2023] Open
Abstract
A healthy man in his 50s was hospitalised after presenting with chest pain and dyspnoea. An echocardiogram revealed asymmetrical septal hypertrophy, leading to a diagnosis of hypertrophic cardiomyopathy. Due to progressive conduction abnormalities during his hospitalisation, further evaluation was performed. Cardiac MRI revealed dense late gadolinium enhancement of the septum in the area of hypertrophy. Additionally, fluorodeoxyglucose-positron emission tomography demonstrated increased uptake within the same region, suggestive of active inflammation. Subsequent endomyocardial biopsy showed non-caseating granulomatous inflammation, consistent with cardiac sarcoidosis. Treatment with prednisone and methotrexate was initiated, and an implantable cardioverter-defibrillator was placed following thorough risk stratification. This case highlights the importance of multimodality imaging and the pursuit of a tissue diagnosis in the evaluation of cardiomyopathy.
Collapse
Affiliation(s)
- Tuan Pham
- Department of Medicine, Adventist Health Portland, Portland, Oregon, USA
| | - Jacob Abraham
- Heart and Vascular Institute, Providence Health and Services Oregon and Southwest Washington, Portland, Oregon, USA
| | - Farooq H Sheikh
- MedStart Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| |
Collapse
|
9
|
Playford D, Stewart S, Harris SA, Chan Y, Strange G. Pattern and Prognostic Impact of Regional Wall Motion Abnormalities in 255 697 Men and 236 641 Women Investigated with Echocardiography. J Am Heart Assoc 2023; 12:e031243. [PMID: 37947119 PMCID: PMC10727298 DOI: 10.1161/jaha.123.031243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/03/2023] [Indexed: 11/12/2023]
Abstract
Background Regional wall motion abnormalities (WMAs) after myocardial infarction are associated with adverse remodeling and increased mortality in the short to medium term. Their long-term prognostic impact is less well understood. Methods and Results Via the National Echo Database of Australia (2000-2019), we identified normal wall motion versus WMA for each left ventricular wall among 492 338 individuals aged 61.9±17.9 years. The wall motion score index was also calculated. We then examined actual 1- and 5-year mortality, plus adjusted risk of long-term mortality according to WMA status. Overall, 39 346/255 697 men (15.4%) and 17 834/236 641 women (7.5%) had a WMA. The likelihood of a WMA was associated with increasing age and greater systolic/diastolic dysfunction. A defect in the inferior versus anterior wall was the most and least common WMA in men (8.0% and 2.5%) and women (3.3% and 1.1%), respectively. Any WMA increased 5-year mortality from 17.5% to 29.7% in men and from 14.9% to 30.8% in women. Known myocardial infarction (hazard ratio [HR], 0.86 [95% CI, 0.80-0.93]) or revascularization (HR, 0.87 [95% CI, 0.82-0.92]) was independently associated with a better prognosis, whereas men (1.22-fold increase) and those with greater systolic/diastolic dysfunction had a worse prognosis. Among those with any WMA, apical (HR, 1.08 [95% CI, 1.02-1.13]) or inferior (HR, 1.09 [95% CI, 1.04-1.15]) akinesis, dyskinesis or aneurysm, or a wall motion score index >3.0 conveyed the worst prognosis. Conclusions In a large real-world clinical cohort, twice as many men as women have a WMA, with inferior WMA the most common. Any WMA confers a poor prognosis, especially inferoapical akinesis/dyskinesis/aneurysm.
Collapse
Affiliation(s)
- David Playford
- Institute for Health Research, University of Notre DameFremantleWestern AustraliaAustralia
- School of MedicineThe University of Notre DameFremantleWestern AustraliaAustralia
| | - Simon Stewart
- Institute for Health Research, University of Notre DameFremantleWestern AustraliaAustralia
- School of Medicine, Dentistry and NursingUniversity of GlasgowGlasgowUnited Kingdom
| | - Sarah Ann Harris
- Institute for Health Research, University of Notre DameFremantleWestern AustraliaAustralia
| | - Yih‐Kai Chan
- Mary MacKillop Institute for Health Research, The Australian Catholic UniversityMelbourneVictoriaAustralia
| | - Geoff Strange
- Institute for Health Research, University of Notre DameFremantleWestern AustraliaAustralia
- Heart Research InstituteSydneyNew South WalesAustralia
- Department of CardiologyRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
| |
Collapse
|
10
|
Kottam A, Hanneman K, Schenone A, Daubert MA, Sidhu GD, Gropler RJ, Garcia MJ. State-of-the-Art Imaging of Infiltrative Cardiomyopathies: A Scientific Statement From the American Heart Association. Circ Cardiovasc Imaging 2023; 16:e000081. [PMID: 37916407 DOI: 10.1161/hci.0000000000000081] [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] [Indexed: 11/03/2023]
Abstract
Infiltrative cardiomyopathies comprise a broad spectrum of inherited or acquired conditions caused by deposition of abnormal substances within the myocardium. Increased wall thickness, inflammation, microvascular dysfunction, and fibrosis are the common pathological processes that lead to abnormal myocardial filling, chamber dilation, and disruption of conduction system. Advanced disease presents as heart failure and cardiac arrhythmias conferring poor prognosis. Infiltrative cardiomyopathies are often diagnosed late or misclassified as other more common conditions, such as hypertrophic cardiomyopathy, hypertensive heart disease, ischemic or other forms of nonischemic cardiomyopathies. Accurate diagnosis is also critical because clinical features, testing methodologies, and approach to treatment vary significantly even within the different types of infiltrative cardiomyopathies on the basis of the type of substance deposited. Substantial advances in noninvasive cardiac imaging have enabled accurate and early diagnosis. thereby eliminating the need for endomyocardial biopsy in most cases. This scientific statement discusses the role of contemporary multimodality imaging of infiltrative cardiomyopathies, including echocardiography, nuclear and cardiac magnetic resonance imaging in the diagnosis, prognostication, and assessment of response to treatment.
Collapse
|
11
|
Shrivastav R, Hajra A, Krishnan S, Bandyopadhyay D, Ranjan P, Fuisz A. Evaluation and Management of Cardiac Sarcoidosis with Advanced Imaging. Heart Fail Clin 2023; 19:475-489. [PMID: 37714588 DOI: 10.1016/j.hfc.2023.06.002] [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] [Indexed: 09/17/2023]
Abstract
A high clinical suspicion in the setting of appropriate history, physical exam, laboratory, and imaging parameters is often required to set the groundwork for diagnosis and management. Echocardiography may show septal thinning, evidence of systolic and diastolic dysfunction, along with impaired global longitudinal strain. Cardiac MRI reveals late gadolinium enhancement along with evidence of myocardial edema and inflammation on T2 weighted imaging and parametric mapping. 18F-FDG PET detects the presence of active inflammation and the presence of scar. Involvement of the right ventricle on MRI or PET confers a high risk for adverse cardiac events and mortality.
Collapse
Affiliation(s)
- Rishi Shrivastav
- Department of Cardiology, Icahn School of Medicine at Mount Sinai/Mount Sinai Morningside Hospital, Cardiovascular Institute, 1111 Amsterdam Avenue, Clark Building, 2nd Floor, New York, NY 10023, USA
| | - Adrija Hajra
- Department of Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 1825 Eastchester Road, Bronx, NY 10461, USA
| | - Suraj Krishnan
- Department of Internal Medicine, Jacobi Hospital/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Dhrubajyoti Bandyopadhyay
- Department of Cardiology, New York Medical College, Westchester Medical Center, 100 Woods Road, Valhalla, NY 10595, USA
| | - Pragya Ranjan
- Department of Cardiology, New York Medical College, Westchester Medical Center, 100 Woods Road, Valhalla, NY 10595, USA.
| | - Anthon Fuisz
- Department of Cardiology, New York Medical College, Westchester Medical Center, 100 Woods Road, Valhalla, NY 10595, USA
| |
Collapse
|
12
|
Sergienko VB, Ansheles AA. [Positron emission tomography in cardiological practice]. TERAPEVT ARKH 2023; 95:531-536. [PMID: 38159001 DOI: 10.26442/00403660.2023.07.202278] [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: 09/28/2023] [Accepted: 09/28/2023] [Indexed: 01/03/2024]
Abstract
The utility of positron emission tomography in cardiology currently goes beyond the ischemic heart disease and covers an increasingly wider range of non-coronary pathology, which requires timely expert diagnostics, including chronic heart disease of any etiology, valvular and electrophysiology disorders, cardiooncology. Authors emphasize the importance of the development of positron emission tomography technologies in the Russian Federation. This includes the development and implementation of new radiopharmaceuticals for the diagnosis of pathological processes of the cardiovascular system, systemic and local inflammation, including atherosclerosis, impaired perfusion and myocardial metabolism, and also for solving specific diagnostic tasks in comorbid pathology.
Collapse
Affiliation(s)
- V B Sergienko
- Chazov National Medical Research Center of Cardiology
| | - A A Ansheles
- Chazov National Medical Research Center of Cardiology
| |
Collapse
|
13
|
Dugan ES, Majid M, Kafil TS, Abdelghaffar B, Yaker ZS, Kumar A, Taimeh Z, Tan C, Cremer PC, Klein AL. Lymphocytic Perimyocarditis Masquerading as Steroid-Dependent Recurrent Pericarditis. JACC Case Rep 2023; 21:101960. [PMID: 37719287 PMCID: PMC10500337 DOI: 10.1016/j.jaccas.2023.101960] [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: 06/05/2023] [Accepted: 06/28/2023] [Indexed: 09/19/2023]
Abstract
Lymphocytic myocarditis is a pattern of myocardial inflammation typically associated with viral, autoimmune, or idiopathic causes. We present a case of lymphocytic perimyocarditis masquerading as steroid-dependent recurrent pericarditis. This case shows the advantages of using multimodal cardiac imaging and endomyocardial biopsy in clarifying diagnosis in treatment-resistant cases. (Level of Difficulty: Advanced.).
Collapse
Affiliation(s)
- Eunice S. Dugan
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland, Ohio, USA
| | - Muhammad Majid
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland, Ohio, USA
| | - Tahir S. Kafil
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland, Ohio, USA
| | - Bahaa Abdelghaffar
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland, Ohio, USA
| | - Zachary S. Yaker
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ashwin Kumar
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland, Ohio, USA
- Department of Internal Medicine, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Ziad Taimeh
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland, Ohio, USA
| | - Carmela Tan
- Department of Pathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Paul C. Cremer
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland, Ohio, USA
| | - Allan L. Klein
- Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland, Ohio, USA
| |
Collapse
|
14
|
Kurashima S, Kitai T, Xanthopoulos A, Skoularigis J, Triposkiadis F, Izumi C. Diagnosis of cardiac sarcoidosis: histological evidence vs. imaging. Expert Rev Cardiovasc Ther 2023; 21:693-702. [PMID: 37776232 DOI: 10.1080/14779072.2023.2266367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 09/29/2023] [Indexed: 10/02/2023]
Abstract
INTRODUCTION The prognosis for cardiac sarcoidosis (CS) remains unfavorable. Although early and accurate diagnosis is crucial, the low detection rate of endomyocardial biopsy makes accurate diagnosis challenging. AREAS COVERED The Heart Rhythm Society (HRS) consensus statement and the Japanese Circulation Society (JCS) guidelines are two major diagnostic criteria for the diagnosis of CS. While the requirement of positive histology for the diagnosis in the HRS criteria can result in overlooked cases, the JCS guidelines advocate for a group of 'clinical' diagnoses based on advanced imaging, including cardiovascular magnetic resonance and 18F-fluorodeoxyglucose positron emission tomography, which do not require histological evidence. Recent studies have supported the usefulness of clinical diagnosis of CS. However, other evidence suggests that clinical CS may sometimes be inaccurate. This article describes the advantages and disadvantages of the current diagnostic criteria for CS, and typical imaging and clinical courses. EXPERT OPINION The diagnosis of clinical CS has been made possible by recent developments in multimodality imaging. However, it is still crucial to look for histological signs of sarcoidosis in other organs in addition to the endomyocardium. Additionally, phenotyping based on clinical manifestations such as heart failure, conduction abnormality or ventricular arrhythmia, and extracardiac abnormalities is clinically significant.
Collapse
Affiliation(s)
- Shinichi Kurashima
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Andrew Xanthopoulos
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece
| | - John Skoularigis
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece
| | | | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| |
Collapse
|
15
|
Crosier R, Kafil TS, Paterson DI. Imaging for Cardiovascular Complications of COVID-19: Cardiac Manifestations in Context. Can J Cardiol 2023; 39:779-792. [PMID: 36731604 PMCID: PMC9886397 DOI: 10.1016/j.cjca.2023.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/29/2022] [Accepted: 01/18/2023] [Indexed: 02/01/2023] Open
Abstract
After the first confirmed case in 2019, COVID-19 rapidly spread worldwide and overwhelmed the medical community. In the intervening time, we have learned about COVID-19's clinical manifestations and have developed effective therapies and preventative vaccines. Severe COVID-19 infection is associated with many cardiovascular disorders in the acute phase, and patients recovered from illness can also manifest long-term sequelae, including long COVID syndrome. Furthermore, severe acute respiratory syndrome-related coronavirus-2 messenger RNA (mRNA) vaccination can trigger rare cases of myopericarditis. We have gained significant knowledge of the acute and long-term cardiovascular complications of COVID-19- and mRNA vaccine-associated myocarditis through clinical and investigative studies using cardiac imaging. In this review, we describe how cardiovascular imaging can be used to understand the cardiovascular complications and cardiac injury associated with acute COVID-19 infection, review the imaging findings in patients recovered from illness, and discuss the role and limitations of cardiac imaging in COVID-19 mRNA vaccine-associated myocarditis.
Collapse
Affiliation(s)
- Rebecca Crosier
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Tahir S Kafil
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - D Ian Paterson
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
| |
Collapse
|
16
|
Madamanchi C, Weinberg RL, Murthy VL. Utility of serum ketone levels for assessment of myocardial glucose suppression for 18F-fluorodeoxyglucose PET in patients referred for evaluation of endocarditis. J Nucl Cardiol 2023; 30:928-937. [PMID: 36823484 DOI: 10.1007/s12350-023-03209-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/20/2022] [Indexed: 02/25/2023]
Abstract
BACKGROUND 18F-FDG PET/CT is used to diagnose cardiac sarcoidosis and endocarditis. It requires myocardial glucose utilization (MGU) suppression to avoid false positives, which occur in up to 20% of patients. Serum beta-hydroxybutyrate (BHB) levels may help identify incomplete suppression of MGU. We determined the optimal timing and diagnostic thresholds to identify incomplete suppression of MGU. METHODS AND RESULTS We retrospectively identified 114 patients referred for 18F-FDG PET/CT for endocarditis, wherein myocardial uptake outside of paravalvular regions is not related to pathology and can be confidently ascribed as being due to inadequate suppression of MGU. Patients followed a high-fat, low-carbohydrate diet and received heparin. Serum BHB, insulin, glucose and hemoglobin A1c were measured. Maximum standardized uptake value (SUVmax) of left ventricle (LV) and mean SUV (SUVmean) in LV blood pool (LVBP) was measured. Logistic regression and area under the receiver-operating characteristic analyses were used to quantify the relationship between biomarkers and MGU suppression. A threshold of BHB ≥ 0.35 mmol·L-1 to detect suppression resulted in sensitivity of 88% and specificity of 61%. A threshold of BHB ≥ 0.95 mmol·L-1 resulted in sensitivity of 45% and specificity of 100%. AUC was 0.87. BHB measured ~ 4 hours prior to 18F-FDG injection performed similarly to or better than later timepoints. CONCLUSIONS Serum BHB levels are useful for assessing suppression of MGU and could simplify interpretation of 18F-FDG PET/CT inflammation studies.
Collapse
Affiliation(s)
- Chaitanya Madamanchi
- Frankel Cardiovascular Center, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Richard L Weinberg
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Venkatesh L Murthy
- Frankel Cardiovascular Center, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
17
|
Wang J, Zhang J, Hosadurg N, Iwanaga Y, Chen Y, Liu W, Wan K, Patel AR, Wicks EC, Gkoutos GV, Han Y, Chen Y. Prognostic Value of RV Abnormalities on CMR in Patients With Known or Suspected Cardiac Sarcoidosis. JACC Cardiovasc Imaging 2023; 16:361-372. [PMID: 36752447 PMCID: PMC11229671 DOI: 10.1016/j.jcmg.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/01/2022] [Accepted: 11/14/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Left ventricular abnormalities in cardiac sarcoidosis (CS) are associated with adverse cardiovascular events, whereas the prognostic value of right ventricular (RV) involvement found on cardiac magnetic resonance is unclear. OBJECTIVES This study aimed to systematically assess the prognostic value of right ventricular ejection fraction (RVEF) and RV late gadolinium enhancement (LGE) in known or suspected CS. METHODS This study was prospectively registered in PROSPERO (CRD42022302579). PubMed, Embase, and Web of Science were searched to identify studies that evaluated the association between RVEF or RV LGE on clinical outcomes in CS. A composite endpoint of all-cause death, cardiovascular events, or sudden cardiac death (SCD) was used. A meta-analysis was performed to determine the pooled risk ratio (RR) for these adverse events. The calculated sensitivity, specificity, and area under the curve with 95% CIs were weighted and summarized. RESULTS Eight studies including a total of 899 patients with a mean follow-up duration of 3.2 ± 0.7 years were included. The pooled RR of RV systolic dysfunction was 3.1 (95% CI: 1.7-5.5; P < 0.01) for composite events and 3.0 (95% CI: 1.3-7.0; P < 0.01) for SCD events. In addition, CS patients with RV LGE had a significant risk for composite events (RR: 4.8 [95% CI: 2.4-9.6]; P < 0.01) and a higher risk for SCD (RR: 9.5 [95% CI: 4.4-20.5]; P < 0.01) than patients without RV LGE. Furthermore, the pooled area under the curve, sensitivity, and specificity of RV LGE for identifying patients with CS who were at highest SCD risk were 0.8 (95% CI: 0.8-0.9), 69% (95% CI: 50%-84%), and 90% (95% CI: 70%-97%), respectively. CONCLUSIONS In patients with known or suspected CS, RVEF and RV LGE were both associated with adverse events. Furthermore, RV LGE shows good discrimination in identifying CS patients at high risk of SCD.
Collapse
Affiliation(s)
- Jie Wang
- Cardiology Division, Department of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China; College of Medical and Dental Sciences, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Jinquan Zhang
- West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - Nisha Hosadurg
- Division of Cardiovascular Medicine, The University of Virginia Health System, Charlottesville, Virginia, USA
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yuxin Chen
- West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - Wei Liu
- West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - Ke Wan
- Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Amit R Patel
- Division of Cardiovascular Medicine, The University of Virginia Health System, Charlottesville, Virginia, USA
| | - Eleanor C Wicks
- Oxford University Hospitals, John Radcliffe Hospital, Headley Way, Headington, Oxford, United Kingdom
| | - Georgios V Gkoutos
- College of Medical and Dental Sciences, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, England; Health Data Research UK, Midlands Site, United Kingdom
| | - Yuchi Han
- Cardiovascular Division, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Yucheng Chen
- Cardiology Division, Department of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Center of Rare Diseases, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| |
Collapse
|
18
|
Aitken M, Davidson M, Chan MV, Urzua Fresno C, Vasquez LI, Huo YR, McAllister BJ, Broncano J, Thavendiranathan P, McInnes MDF, Iwanochko MR, Balter M, Moayedi Y, Farrell A, Hanneman K. Prognostic Value of Cardiac MRI and FDG PET in Cardiac Sarcoidosis: A Systematic Review and Meta-Analysis. Radiology 2023; 307:e222483. [PMID: 36809215 DOI: 10.1148/radiol.222483] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Background There is no consensus regarding the relative prognostic value of cardiac MRI and fluorodeoxyglucose (FDG) PET in cardiac sarcoidosis. Purpose To perform a systematic review and meta-analysis of the prognostic value of cardiac MRI and FDG PET for major adverse cardiac events (MACE) in cardiac sarcoidosis. Materials and Methods In this systematic review, MEDLINE, Ovid Epub, CENTRAL, Embase, Emcare, and Scopus were searched from inception until January 2022. Studies that evaluated the prognostic value of cardiac MRI or FDG PET in adults with cardiac sarcoidosis were included. The primary outcome of MACE was assessed as a composite including death, ventricular arrhythmia, and heart failure hospitalization. Summary metrics were obtained using random-effects meta-analysis. Meta-regression was used to assess covariates. Risk of bias was assessed using the Quality in Prognostic Studies, or QUIPS, tool. Results Thirty-seven studies were included (3489 patients with mean follow-up of 3.1 years ± 1.5 [SD]); 29 studies evaluated MRI (2931 patients) and 17 evaluated FDG PET (1243 patients). Five studies directly compared MRI and PET in the same patients (276 patients). Left ventricular late gadolinium enhancement (LGE) at MRI and FDG uptake at PET were both predictive of MACE (odds ratio [OR], 8.0 [95% CI: 4.3, 15.0] [P < .001] and 2.1 [95% CI: 1.4, 3.2] [P < .001], respectively). At meta-regression, results varied by modality (P = .006). LGE (OR, 10.4 [95% CI: 3.5, 30.5]; P < .001) was also predictive of MACE when restricted to studies with direct comparison, whereas FDG uptake (OR, 1.9 [95% CI: 0.82, 4.4]; P = .13) was not. Right ventricular LGE and FDG uptake were also associated with MACE (OR, 13.1 [95% CI: 5.2, 33] [P < .001] and 4.1 [95% CI: 1.9, 8.9] [P < .001], respectively). Thirty-two studies were at risk for bias. Conclusion Left and right ventricular late gadolinium enhancement at cardiac MRI and fluorodeoxyglucose uptake at PET were predictive of major adverse cardiac events in cardiac sarcoidosis. Limitations include few studies with direct comparison and risk of bias. Systematic review registration no. CRD42021214776 (PROSPERO) © RSNA, 2023 Supplemental material is available for this article.
Collapse
Affiliation(s)
- Matthew Aitken
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Malcolm Davidson
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Michael V Chan
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Camila Urzua Fresno
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Leon I Vasquez
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Ya R Huo
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Brylie J McAllister
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Jordi Broncano
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Paaladinesh Thavendiranathan
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Matthew D F McInnes
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Mark R Iwanochko
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Meyer Balter
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Yasbanoo Moayedi
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Ashley Farrell
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| | - Kate Hanneman
- From the Department of Medical Imaging (M.A., C.U.F., P.T., K.H.) and Division of Cardiology (P.T., M.R.I., Y.M.), Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Faculty of Medicine, University of Toronto, Toronto, Canada (M.D.); Department of Radiology, Concord Hospital Clinical School, The University of Sydney, Sydney, Australia (M.V.C., Y.R.H.); Qscan Imaging Group, Clayfield, Australia (L.I.V.); Department of Radiology, Gold Coast University Hospital, Southport, Australia (B.J.M.); Cardiothoracic Imaging Unit, Hospital San Juan de Dios, HT Médica, Córdoba, Spain (J.B.); Toronto General Hospital Research Institute, University Health Network, University of Toronto, Toronto, Canada (P.T., K.H.); Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (M.D.F.M.); Division of Molecular Imaging, Toronto General Hospital, University Health Network, University of Toronto, Toronto, Canada (M.R.I.); Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.); and Department of Library and Information Services, University Health Network, University of Toronto, Toronto, Canada (A.F.)
| |
Collapse
|
19
|
Treiber J, Novak D, Fischer-Rasokat U, Wolter JS, Kriechbaum S, Weferling M, von Jeinsen B, Hain A, Rieth AJ, Siemons T, Keller T, Hamm CW, Rolf A. Regional extracellular volume within late gadolinium enhancement-positive myocardium to differentiate cardiac sarcoidosis from myocarditis of other etiology: a cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 2023; 25:8. [PMID: 36755275 PMCID: PMC9909902 DOI: 10.1186/s12968-023-00918-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 01/12/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) plays a pivotal role in diagnosing myocardial inflammation. In addition to late gadolinium enhancement (LGE), native T1 and T2 mapping as well as extracellular volume (ECV) are essential tools for tissue characterization. However, the differentiation of cardiac sarcoidosis (CS) from myocarditis of other etiology can be challenging. Positron-emission tomography-computed tomography (PET-CT) regularly shows the highest Fluordesoxyglucose (FDG) uptake in LGE positive regions. It was therefore the aim of this study to investigate, whether native T1, T2, and ECV measurements within LGE regions can improve the differentiation of CS and myocarditis compared with using global native T1, T2, and ECV values alone. METHODS PET/CT confirmed CS patients and myocarditis patients (both acute and chronic) from a prospective registry were compared with respect to regional native T1, T2, and ECV. Acute and chronic myocarditis were defined based on the 2013 European Society of Cardiology position paper on myocarditis. All parametric measures and ECV were acquired in standard fashion on three short-axis slices according to the ConSept study for global values and within PET-CT positive regions of LGE. RESULTS Between 2017 and 2020, 33 patients with CS and 73 chronic and 35 acute myocarditis patients were identified. The mean ECV (± SD) in LGE regions of CS patients was higher than in myocarditis patients (CS vs. acute and chronic, respectively: 0.65 ± 0.12 vs. 0.45 ± 0.13 and 0.47 ± 0.1; p < 0.001). Acute and chronic myocarditis patients had higher global native T1 values (1157 ± 54 ms vs. 1196 ± 63 ms vs. 1215 ± 74 ms; p = 0.001). There was no difference in global T2 and ECV values between CS and acute or chronic myocarditis patients. CONCLUSION This is the first study to show that the calculation of regional ECV within LGE-positive regions may help to differentiate CS from myocarditis. Further studies are warranted to corroborate these findings.
Collapse
Affiliation(s)
- Julia Treiber
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
- German Center for Cardiovascular Research (DZHK), Rhine-Main Partner Site, Frankfurt am Main, Germany
| | - Dijana Novak
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
| | - Ulrich Fischer-Rasokat
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
- German Center for Cardiovascular Research (DZHK), Rhine-Main Partner Site, Frankfurt am Main, Germany
| | - Jan Sebastian Wolter
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
- German Center for Cardiovascular Research (DZHK), Rhine-Main Partner Site, Frankfurt am Main, Germany
| | - Steffen Kriechbaum
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
- German Center for Cardiovascular Research (DZHK), Rhine-Main Partner Site, Frankfurt am Main, Germany
| | - Maren Weferling
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
- German Center for Cardiovascular Research (DZHK), Rhine-Main Partner Site, Frankfurt am Main, Germany
| | - Beatrice von Jeinsen
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
- German Center for Cardiovascular Research (DZHK), Rhine-Main Partner Site, Frankfurt am Main, Germany
| | - Andreas Hain
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
| | - Andreas J Rieth
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
- German Center for Cardiovascular Research (DZHK), Rhine-Main Partner Site, Frankfurt am Main, Germany
| | - Tamo Siemons
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
| | - Till Keller
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
- Medical Clinic 1, Justus-Liebig-Universität Giessen, Giessen, Germany
- German Center for Cardiovascular Research (DZHK), Rhine-Main Partner Site, Frankfurt am Main, Germany
| | - Christian W Hamm
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany
- Medical Clinic 1, Justus-Liebig-Universität Giessen, Giessen, Germany
- German Center for Cardiovascular Research (DZHK), Rhine-Main Partner Site, Frankfurt am Main, Germany
| | - Andreas Rolf
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany.
- Medical Clinic 1, Justus-Liebig-Universität Giessen, Giessen, Germany.
- German Center for Cardiovascular Research (DZHK), Rhine-Main Partner Site, Frankfurt am Main, Germany.
| |
Collapse
|
20
|
Ahn SS, Ta K, Thorn SL, Onofrey JA, Melvinsdottir IH, Lee S, Langdon J, Sinusas AJ, Duncan JS. Co-attention spatial transformer network for unsupervised motion tracking and cardiac strain analysis in 3D echocardiography. Med Image Anal 2023; 84:102711. [PMID: 36525845 PMCID: PMC9812938 DOI: 10.1016/j.media.2022.102711] [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] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 10/15/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
Myocardial ischemia/infarction causes wall-motion abnormalities in the left ventricle. Therefore, reliable motion estimation and strain analysis using 3D+time echocardiography for localization and characterization of myocardial injury is valuable for early detection and targeted interventions. Previous unsupervised cardiac motion tracking methods rely on heavily-weighted regularization functions to smooth out the noisy displacement fields in echocardiography. In this work, we present a Co-Attention Spatial Transformer Network (STN) for improved motion tracking and strain analysis in 3D echocardiography. Co-Attention STN aims to extract inter-frame dependent features between frames to improve the motion tracking in otherwise noisy 3D echocardiography images. We also propose a novel temporal constraint to further regularize the motion field to produce smooth and realistic cardiac displacement paths over time without prior assumptions on cardiac motion. Our experimental results on both synthetic and in vivo 3D echocardiography datasets demonstrate that our Co-Attention STN provides superior performance compared to existing methods. Strain analysis from Co-Attention STNs also correspond well with the matched SPECT perfusion maps, demonstrating the clinical utility for using 3D echocardiography for infarct localization.
Collapse
Affiliation(s)
- Shawn S Ahn
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA.
| | - Kevinminh Ta
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA
| | - Stephanie L Thorn
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University, New Haven, CT, USA
| | - John A Onofrey
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA; Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| | - Inga H Melvinsdottir
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University, New Haven, CT, USA
| | - Supum Lee
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University, New Haven, CT, USA
| | - Jonathan Langdon
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| | - Albert J Sinusas
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University, New Haven, CT, USA; Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA
| | - James S Duncan
- Department of Biomedical Engineering, Yale University, New Haven, CT, USA; Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, USA; Department of Electrical Engineering, Yale University, New Haven, CT, USA.
| |
Collapse
|
21
|
Strambu IR. Challenges of cardiac sarcoidosis. Front Med (Lausanne) 2023; 10:999066. [PMID: 36936210 PMCID: PMC10018021 DOI: 10.3389/fmed.2023.999066] [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: 07/20/2022] [Accepted: 02/14/2023] [Indexed: 03/06/2023] Open
Abstract
Sarcoidosis is a multisystem granulomatosis of unknown origin, which can involve almost any organ. Most frequently the disease involves the lungs and mediastinal lymph nodes, but it can affect the skin, the eyes, nervous system, the heart, kidneys, joints, muscles, calcium metabolism, and probably any other anecdotical organ involvement. Cardiac sarcoidosis is one of the most challenging involvements, as it can lead to cardiac mortality and morbidity, and also because the diagnosis may be difficult. With no specific symptoms, cardiac sarcoidosis may be difficult to suspect in a patient with no previous extra-cardiac sarcoidosis diagnosis. This manuscript reviews the current knowledge of the diagnosis and decision to treat cardiac sarcoidosis, and illustrates the information with a case presentation of a young adult with no risk factors, no previous diagnosis of sarcoidosis, and with cardiac symptoms impairing his quality of life.
Collapse
Affiliation(s)
- Irina R. Strambu
- Pulmonology Department, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
- Institute of Pneumophthysiology “Marius Nasta”, Bucharest, Romania
- *Correspondence: Irina R. Strambu,
| |
Collapse
|
22
|
Chareonthaitawee P, Gutberlet M. Clinical Utilization of Multimodality Imaging for Myocarditis and Cardiac Sarcoidosis. Circ Cardiovasc Imaging 2023; 16:e014091. [PMID: 36649452 DOI: 10.1161/circimaging.122.014091] [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] [Indexed: 01/19/2023]
Abstract
Myocarditis is defined as inflammation of the myocardium according to clinical, histological, biochemical, immunohistochemical, or imaging findings. Inflammation can be categorized histologically by cell type or pattern, and many causes have been implicated, including infectious, most commonly viral, systemic autoimmune diseases, vaccine-associated processes, environmental factors, toxins, and hypersensitivity to drugs. Sarcoid myocarditis is increasingly recognized as an important cause of cardiomyopathy and has important diagnostic, prognostic, and therapeutic implications in patients with systemic sarcoidosis. The clinical presentation of myocarditis may include an asymptomatic, subacute, acute, fulminant, or chronic course and may have focal or diffuse involvement of the myocardium depending on the cause and time point of the disease. For most causes of myocarditis except sarcoidosis, myocardial biopsy is the gold standard but is limited due to risk, cost, availability, and variable sensitivity. Diagnostic criteria have been established for both myocarditis and cardiac sarcoidosis and include clinical and imaging findings particularly the use of cardiac magnetic resonance and positron emission tomography. Beyond diagnosis, imaging findings may also provide prognostic value. This case-based review focuses on the current state of multimodality imaging for the diagnosis and management of myocarditis and cardiac sarcoidosis, highlighting multimodality imaging approaches with practical clinical vignettes, with a discussion of knowledge gaps and future directions.
Collapse
|
23
|
Brazile TL, Saul M, Nouraie SM, Gibson K. Characteristics and survival of patients diagnosed with cardiac sarcoidosis: A case series. Front Med (Lausanne) 2022; 9:1051412. [PMID: 36582282 PMCID: PMC9792839 DOI: 10.3389/fmed.2022.1051412] [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: 09/22/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022] Open
Abstract
Background Sarcoidosis is a multiorgan system granulomatous disease of unknown etiology. It is hypothesized that a combination of environmental, occupational, and/or infectious factors provoke an immunological response in genetically susceptible individuals, resulting in a diversity of manifestations throughout the body. In the United States, cardiac sarcoidosis (CS) is diagnosed in 5% of patients with systemic sarcoidosis, however, autopsy results suggest that cardiac involvement may be present in > 50% of patients. CS is debilitating and significantly decreases quality of life and survival. Currently, there are no gold-standard clinical diagnostic or monitoring criteria for CS. Methods We identified patients with a diagnosis of sarcoidosis who were seen at the Simmons Center from 2007 to 2020 who had a positive finding of CS documented with cardiovascular magnetic resonance (CMR) and/or endomyocardial biopsy as found in the electronic health record. Medical records were independently reviewed for interpretation and diagnostic features of CS including late gadolinium enhancement (LGE) patterns, increased signal on T2-weighted imaging, and non-caseating granulomas, respectively. Extracardiac organ involvement, cardiac manifestations, comorbid conditions, treatment history, and vital status were also abstracted. Results We identified 44 unique patients with evidence of CS out of 246 CMR reports and 9 endomyocardial biopsy pathology reports. The first eligible case was diagnosed in 2007. The majority of patients (73%) had pulmonary manifestations, followed by hepatic manifestations (23%), cutaneous involvement (23%), and urolithiasis (20%). Heart failure was the most common cardiac manifestation affecting 59% of patients. Of these, 39% had a documented left ventricular ejection fraction of < 50% on CMR. Fifty eight percent of patients had a conduction disease and 44% of patients had documented ventricular arrhythmias. Pharmacotherapy was usually initiated for extracardiac manifestations and 93% of patients had been prescribed prednisone. ICD implantation occurred in 43% of patients. Patients were followed up for a median of 5.4 (IQR: 2.4-8.5) years. The 10-year survival was 70%. In addition to age, cutaneous involvement was associated with an increased risk of death (age-adjusted OR 8.47, 95% CI = 1.11-64.73). Conclusion CMR is an important tool in the non-invasive diagnosis of CS. The presence of LGE on CMR in a pattern consistent with CS has been shown to be a predictor of mortality and likely contributed to a high proportion of patients undergoing ICD implantation to decrease risk of sudden cardiac death. Clinical implications Additional studies are necessary to develop robust criteria for the diagnosis of CS with CMR, assess the benefit of serial imaging for disease monitoring, and evaluate the effect of immunosuppression on disease progression.
Collapse
Affiliation(s)
- Tiffany L. Brazile
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States,University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Melissa Saul
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Seyed Mehdi Nouraie
- University of Pittsburgh and The Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease, Pittsburgh, PA, United States
| | - Kevin Gibson
- University of Pittsburgh and The Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease, Pittsburgh, PA, United States,*Correspondence: Kevin Gibson,
| |
Collapse
|
24
|
Assessment of Cardiac Sarcoidosis: FDG PET and BMIPP SPECT. Curr Cardiol Rep 2022; 24:1873-1882. [PMID: 36282434 DOI: 10.1007/s11886-022-01803-4] [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] [Accepted: 10/11/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW Cardiac sarcoidosis (CS) is an inflammatory disease of unknown etiology that can lead to life-threatening arrhythmias, heart failure, and death. Advanced cardiac imaging modalities have improved the clinician's ability to detect this disease. The purpose of this review is to discuss the recent evidence of cardiac metabolic imaging as assessed by [18F]FDG PET and [123I]BMIPP SPECT in the evaluation of CS patients. RECENT FINDINGS [18F]FDG PET is the gold standard to identify myocardial inflammation. [123I]BMIPP SPECT can uncover early myocardial damage as well as advanced stages of CS when fibrosis prevails. In presence of inflammation, myocardial [18F]FDG uptake is increased, but in contrast, BMIPP myocardial uptake is reduced or even suppressed. Thus, a complementary role of cardiac metabolic imaging by [18F]FDG PET and BMIPP SPECT has been proposed to detect the whole spectrum of CS. [18F]FDG PET is considered an important tool to improve the diagnosis and optimize the management of CS. The role of [123I]BMIPP SPECT in diagnosing CS is still under investigation. Further studies are needed to evaluate the clinical utility of combined cardiac metabolic imaging in the diagnosis, prognosis, and for selecting treatments in CS patients.
Collapse
|
25
|
Rosario KF, Brezitski K, Arps K, Milne M, Doss J, Karra R. Cardiac Sarcoidosis: Current Approaches to Diagnosis and Management. Curr Allergy Asthma Rep 2022; 22:171-182. [PMID: 36308680 DOI: 10.1007/s11882-022-01046-x] [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: 10/04/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Cardiac sarcoidosis (CS) is an important cause of non-ischemic cardiomyopathy and has specific diagnostic and therapeutic considerations. With advances in imaging techniques and treatment approaches, the approach to monitoring disease progression and management of CS continues to evolve. The purpose of this review is to highlight advances in CS diagnosis and treatment and present a center's multidisciplinary approach to CS care. RECENT FINDINGS In this review, we highlight advances in granuloma biology along with contemporary diagnostic approaches. Moreover, we expand on current targets of immunosuppression focused on granuloma biology and concurrent advances in the cardiovascular care of CS in light of recent guideline recommendations. Here, we review advances in the understanding of the sarcoidosis granuloma along with contemporary diagnostic and therapeutic considerations for CS. Additionally, we highlight knowledge gaps and areas for future research in CS treatment.
Collapse
Affiliation(s)
- Karen Flores Rosario
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA
| | - Kyla Brezitski
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA
| | - Kelly Arps
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA
| | - Megan Milne
- Division of Rheumatology, Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA
| | - Jayanth Doss
- Division of Rheumatology, Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA
| | - Ravi Karra
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, 27710, USA.
- Department of Pathology, Duke University Medical Center, Box 102152 DUMC, Durham, NC, 27710, USA.
| |
Collapse
|
26
|
Patel VN, Pieper JA, Poitrasson-Rivière A, Kopin D, Cascino T, Aaronson K, Murthy VL, Koelling T. The prognostic value of positron emission tomography in the evaluation of suspected cardiac sarcoidosis. J Nucl Cardiol 2022; 29:2460-2470. [PMID: 34505261 DOI: 10.1007/s12350-021-02780-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 07/29/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To assess the prognostic value of positron emission tomography (PET) imaging in patients undergoing evaluation for known or suspected cardiac sarcoidosis (CS) while not on active immunotherapy. BACKGROUND Previous studies have attempted to identify the value of PET imaging to aid in risk stratification of patients with CS, however, most cohorts have included patients currently on immunosuppression, which may confound scan results by suppressing positive findings. METHODS We retrospectively analyzed 197 patients not on immunosuppression who underwent 18F-fluorodeoxyglucose (FDG) PET scans for evaluation of known or suspected CS. The primary endpoint of the study was time to ventricular arrhythmia (VT/VF), or death. Candidate predictors were identified by univariable Cox proportional hazards regression. Independent predictors were identified by performing multivariable Cox regression with stepwise forward selection. RESULTS Median follow-up time was 531 [IQR 309, 748] days. 41 patients met the primary endpoint. After stepwise forward selection, left ventricular ejection fraction (LVEF) (HR 0.98, 95% CI 0.96-0.99, P = 0.02), history of VT/VF (HR 4.19, 95% CI 2.15-8.17, P < 0.001), and summed rest score (SRS) (HR 1.06, 95% CI 1.02-1.12, P = 0.01) were predictive of the primary endpoint. Quantitative and qualitative measures of FDG uptake on PET were not predictive of clinical events. CONCLUSIONS Among untreated patients who underwent PET scans to evaluate known or suspected CS, LVEF, history of VT/VF, and SRS were associated with adverse clinical outcomes.
Collapse
Affiliation(s)
- Vaiibhav N Patel
- Division of Cardiovascular Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Justin A Pieper
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA.
- Division of Cardiovascular Medicine, Ross Heart Hospital, The Ohio State University, 452 W 10th Avenue, Columbus, OH, 43210, USA.
| | | | - David Kopin
- Division of Cardiovascular Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Thomas Cascino
- Division of Cardiovascular Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Keith Aaronson
- Division of Cardiovascular Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Venkatesh L Murthy
- Division of Cardiovascular Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
- Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Todd Koelling
- Division of Cardiovascular Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
27
|
Bokhari S, Sheikh T. Cardiac sarcoidosis: Advantages and limitations of advanced cardiac imaging. J Nucl Cardiol 2022; 29:2145-2148. [PMID: 34426934 DOI: 10.1007/s12350-021-02757-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Sabahat Bokhari
- Divison of Cardiology, Lehigh Valley Health Network, Allentown, PA, USA.
| | - Tarick Sheikh
- Divison of Cardiology, Lehigh Valley Health Network, Allentown, PA, USA
| |
Collapse
|
28
|
Sato K, Kawamatsu N, Yamamoto M, Machino-Ohtsuka T, Ishizu T, Ieda M. Utility of Updated Japanese Circulation Society Guidelines to Diagnose Isolated Cardiac Sarcoidosis. J Am Heart Assoc 2022; 11:e025565. [PMID: 35766294 PMCID: PMC9333401 DOI: 10.1161/jaha.122.025565] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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 In the population with cardiac sarcoidosis (CS), approximately one third lacks extracardiac involvement and is considered to have isolated CS. Recently, the Japanese Circulation Society updated the diagnostic criteria for CS, providing a methodology for diagnosing isolated CS. We aimed to assess the characteristics of isolated CS diagnosed using a multimodal imaging approach according to the updated Japanese Circulation Society guidelines. Methods and Results We retrospectively identified 161 consecutive patients who underwent 18F-fluorodeoxyglucose positron emission tomography for suspected CS between 2012 and 2019. According to the guidelines, patients were classified as having CS with extracardiac involvement, isolated CS, or no CS. We compared the characteristics of multimodality imaging and the prevalence of major adverse cardiovascular events. The Japanese Circulation Society criteria classified 28 patients (17%) as having CS with 4 (2%) with histological confirmation, 21 (13%) as isolated CS, and 112 (70%) as no CS. Compared with CS, isolated CS showed higher left ventricular volume and reduced left ventricular ejection fraction (P<0.01 for all). During the median follow-up period of 522 days, 24 patients had major adverse cardiovascular events. Isolated CS (hazard ratio, 3.35; [95% CI, 1.08-10.39], P=0.036) was independently associated with major adverse cardiovascular events after adjusting for reduced left ventricular ejection fraction and steroid. In the subgroup of 41 patients with serial 18F-fluorodeoxyglucose positron emission tomography evaluation, only updated CS criteria were associated with improvement in myocardial inflammation on 18F-fluorodeoxyglucose positron emission tomography. Conclusions Isolated CS detected using the updated Japanese Circulation Society guidelines was associated with poor event-free survival and should be managed with caution.
Collapse
Affiliation(s)
- Kimi Sato
- Department of Cardiology, Faculty of Medicine University of Tsukuba Japan
| | - Naoto Kawamatsu
- Department of Cardiology, Faculty of Medicine University of Tsukuba Japan
| | - Masayoshi Yamamoto
- Department of Cardiology, Faculty of Medicine University of Tsukuba Japan
| | | | - Tomoko Ishizu
- Department of Cardiology, Faculty of Medicine University of Tsukuba Japan
| | - Masaki Ieda
- Department of Cardiology, Faculty of Medicine University of Tsukuba Japan
| |
Collapse
|
29
|
Aitken M, Chan MV, Urzua Fresno C, Farrell A, Islam N, McInnes MDF, Iwanochko M, Balter M, Moayedi Y, Thavendiranathan P, Metser U, Veit-Haibach P, Hanneman K. Diagnostic Accuracy of Cardiac MRI versus FDG PET for Cardiac Sarcoidosis: A Systematic Review and Meta-Analysis. Radiology 2022; 304:566-579. [PMID: 35579526 DOI: 10.1148/radiol.213170] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background There is limited consensus regarding the relative diagnostic performance of cardiac MRI and fluorodeoxyglucose (FDG) PET for cardiac sarcoidosis. Purpose To perform a systematic review and meta-analysis to compare the diagnostic accuracy of cardiac MRI and FDG PET for cardiac sarcoidosis. Materials and Methods Medline, Ovid Epub, Cochrane Central Register of Controlled Trials, Embase, Emcare, and Scopus were searched from inception until January 2022. Inclusion criteria included studies that evaluated the diagnostic accuracy of cardiac MRI or FDG PET for cardiac sarcoidosis in adults. Data were independently extracted by two investigators. Summary accuracy metrics were obtained by using bivariate random-effects meta-analysis. Meta-regression was used to assess the effect of different covariates. Risk of bias was assessed using the Quality Assessment Tool for Diagnostic Accuracy Studies-2 tool. The study protocol was registered a priori in the International Prospective Register of Systematic Reviews (Prospero protocol CRD42021214776). Results Thirty-three studies were included (1997 patients, 687 with cardiac sarcoidosis); 17 studies evaluated cardiac MRI (1031 patients) and 26 evaluated FDG PET (1363 patients). Six studies directly compared cardiac MRI and PET in the same patients (303 patients). Cardiac MRI had higher sensitivity than FDG PET (95% vs 84%; P = .002), with no difference in specificity (85% vs 82%; P = .85). In a sensitivity analysis restricted to studies with direct comparison, point estimates were similar to those from the overall analysis: cardiac MRI and FDG PET had sensitivities of 92% and 81% and specificities of 72% and 82%, respectively. Covariate analysis demonstrated that sensitivity for FDG PET was highest with quantitative versus qualitative evaluation (93% vs 76%; P = .01), whereas sensitivity for MRI was highest with inclusion of T2 imaging (99% vs 88%; P = .001). Thirty studies were at risk of bias. Conclusion Cardiac MRI had higher sensitivity than fluorodeoxyglucose PET for diagnosis of cardiac sarcoidosis but similar specificity. Limitations, including risk of bias and few studies with direct comparison, necessitate additional study. © RSNA, 2022 Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Matthew Aitken
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Michael Vinchill Chan
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Camila Urzua Fresno
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Ashley Farrell
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Nayaar Islam
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Matthew D F McInnes
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Mark Iwanochko
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Meyer Balter
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Yasbanoo Moayedi
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Paaladinesh Thavendiranathan
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Ur Metser
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Patrick Veit-Haibach
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| | - Kate Hanneman
- From the Department of Medical Imaging, Peter Munk Cardiac Centre (M.A., M.V.C., C.U.F., P.T., U.M., P.V.H., K.H.), Division of Cardiology, Peter Munk Cardiac Centre (M.I., Y.M., P.T.), and Division of Molecular Imaging (U.M., P.V.H.), Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G 2N2; Department of Library and Information Services (A.F.) and Toronto General Hospital Research Institute (P.T., K.H.), University Health Network, University of Toronto, Toronto, Canada; Department of Radiology and Epidemiology, University of Ottawa, Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada (N.I., M.D.F.M.); and Division of Respiratory Medicine, Sinai Health System, University of Toronto, Toronto, Canada (M.B.)
| |
Collapse
|
30
|
Vakrakou AG, Kolilekas L, Lama N, Katsanos S, Stratakos G, Tsougos I, Manali E, Grigoriou E, Psarra K, Kilidireas C, Papiris S, Kelekis NL, Gialafos EJ. Peripheral blood natural killer cells in sarcoidosis are associated with early cardiac involvement. Eur J Clin Invest 2022; 52:e13742. [PMID: 35037712 DOI: 10.1111/eci.13742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/28/2021] [Accepted: 01/02/2022] [Indexed: 12/01/2022]
Abstract
AIM To evaluate the distribution of circulating immune cell subsets in peripheral blood of patients with sarcoidosis and investigate if there is an association with an underlying cardiac involvement. METHODS AND RESULTS Eighty-five newly diagnosed treatment-naïve patients with sarcoidosis (50 women) were included in the study. All patients underwent a thorough cardiac investigation, including cardiac magnetic resonance imaging (CMR). Of all patients, 19 (23.53%) had myocardial involvement, and the NK subpopulation in these patients in peripheral blood was significantly decreased compared to patients without (n = 63, p = 0.001 and p = 0.003 respectively). The absolute number of NKT cells (CD3+CD16/56+ ) in patients with cardiac involvement was highly correlated with T2 map increased values in MRI (r = -686, p = 0.041) showing that low NKT cell count correlates with the inflammatory process of the heart. No difference in CD19, CD3, CD4, CD8 and CD3- NK cell counts was found between groups. Lung severity was not found to correlate with the number of NK cells. CONCLUSION We found that low NK cell count in peripheral blood of patients with sarcoidosis is associated with cardiac involvement, and the number of NK-T cells correlates with CMR findings indicative of myocardial inflammation. This finding might have a potential clinical application in detecting clinically silent cardiac involvement in sarcoidosis and may also suggest potential targets for therapeutic interventions.
Collapse
Affiliation(s)
- Aigli G Vakrakou
- Neuroimmunology Laboratory, 1st Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Immunology and Histocompatibility Department, Evangelismos Hospital, Athens, Greece
| | | | - Niki Lama
- Research Unit of Radiology and Medical Imaging, 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Spiros Katsanos
- Department of Cardiology, Medical School, General University Hospital "Attikon", National and Kapodistrian University of Athens, Athens, Greece
| | - Grigorios Stratakos
- Respiratory Medicine Department, Athens Chest Hospital 'Sotiria' Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ilias Tsougos
- Department of Cardiology, Heart Failure and Preventive Cardiology Section, Ygeia Hospital, Athens, Greece
| | - Effrosyni Manali
- Pulmonary Medicine Department, Medical School, General University Hospital 'Attikon', National and Kapodistrian University of Athens, Athens, Greece
| | - Eirini Grigoriou
- Immunology and Histocompatibility Department, Evangelismos Hospital, Athens, Greece
| | - Katherina Psarra
- Immunology and Histocompatibility Department, Evangelismos Hospital, Athens, Greece
| | - Constantinos Kilidireas
- Neuroimmunology Laboratory, 1st Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece.,First Department of Neurology, Medical School, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Spiros Papiris
- Pulmonary Medicine Department, Medical School, General University Hospital 'Attikon', National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos L Kelekis
- Research Unit of Radiology and Medical Imaging, 2nd Department of Radiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Elias J Gialafos
- Department of Cardiology, Medical School, General University Hospital "Attikon", National and Kapodistrian University of Athens, Athens, Greece.,First Department of Neurology, Medical School, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| |
Collapse
|
31
|
Raman SV, Markl M, Patel AR, Bryant J, Allen BD, Plein S, Seiberlich N. 30-minute CMR for common clinical indications: a Society for Cardiovascular Magnetic Resonance white paper. J Cardiovasc Magn Reson 2022; 24:13. [PMID: 35232470 PMCID: PMC8886348 DOI: 10.1186/s12968-022-00844-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/16/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Despite decades of accruing evidence supporting the clinical utility of cardiovascular magnetic resonance (CMR), adoption of CMR in routine cardiovascular practice remains limited in many regions of the world. Persistent use of long scan times of 60 min or more contributes to limited adoption, though techniques available on most scanners afford routine CMR examination within 30 min. Incorporating such techniques into standardize protocols can answer common clinical questions in daily practice, including those related to heart failure, cardiomyopathy, ventricular arrhythmia, ischemic heart disease, and non-ischemic myocardial injury. BODY: In this white paper, we describe CMR protocols of 30 min or shorter duration with routine techniques with or without stress perfusion, plus specific approaches in patient and scanner room preparation for efficiency. Minimum requirements for the scanner gradient system, coil hardware and pulse sequences are detailed. Recent advances such as quantitative myocardial mapping and other add-on acquisitions can be incorporated into the proposed protocols without significant extension of scan duration for most patients. CONCLUSION Common questions in clinical cardiovascular practice can be answered in routine CMR protocols under 30 min; their incorporation warrants consideration to facilitate increased access to CMR worldwide.
Collapse
Affiliation(s)
- Subha V. Raman
- Division of Cardiovascular Medicine and Krannert CV Research Center, Indiana University School of Medicine, Indianapolis, IN USA
- Cardiovascular Institute, IU Health, Indianapolis, IN USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Evanston, IL USA
| | - Amit R. Patel
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, IL USA
| | - Jennifer Bryant
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Bradley D. Allen
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Nicole Seiberlich
- Department of Radiology, University of Michigan, 1150 West Medical Center Drive, Ann Arbor, MI 48109 USA
| |
Collapse
|
32
|
Wand AL, Chrispin J, Saad E, Mukherjee M, Hays AG, Gilotra NA. Current State and Future Directions of Multimodality Imaging in Cardiac Sarcoidosis. Front Cardiovasc Med 2022; 8:785279. [PMID: 35155601 PMCID: PMC8828956 DOI: 10.3389/fcvm.2021.785279] [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: 09/29/2021] [Accepted: 12/31/2021] [Indexed: 12/19/2022] Open
Abstract
Cardiac sarcoidosis (CS) is an increasingly recognized cause of heart failure and arrhythmia. Historically challenging to identify, particularly in the absence of extracardiac sarcoidosis, diagnosis of CS has improved with advancements in cardiac imaging. Recognition as well as management may require interpretation of multiple imaging modalities. Echocardiography may serve as an initial screening study for cardiac involvement in patients with systemic sarcoidosis. Cardiac magnetic resonance imaging (CMR) provides information on diagnosis as well as risk stratification, particularly for ventricular arrhythmia in the setting of late gadolinium enhancement. More recently, 18F-fluorodeoxyglucose position emission tomography (FDG-PET) has assumed a valuable role in the diagnosis and longitudinal management of patients with CS, allowing for the assessment of response to treatment. Hybrid FDG-PET/CT may also be used in the evaluation of extracardiac inflammation, permitting the identification of biopsy sites for diagnostic confirmation. Herein we examine the approach to diagnosis and management of CS using multimodality imaging via a case-based review.
Collapse
Affiliation(s)
- Alison L Wand
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jonathan Chrispin
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Elie Saad
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Monica Mukherjee
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Allison G Hays
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Nisha A Gilotra
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| |
Collapse
|
33
|
Brunken RC. Is quantitative fluorine-18 fluorodeoxyglucose PET image analysis the key to Identify cardiac sarcoidosis? J Nucl Cardiol 2022; 29:97-100. [PMID: 32676908 DOI: 10.1007/s12350-020-02272-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 06/25/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Richard C Brunken
- Department of Radiology, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.
- Department of Nuclear Medicine/Jb3, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
| |
Collapse
|
34
|
Manabe O, Oyama-Manabe N, Aikawa T, Tsuneta S, Tamaki N. Advances in Diagnostic Imaging for Cardiac Sarcoidosis. J Clin Med 2021; 10:jcm10245808. [PMID: 34945105 PMCID: PMC8704832 DOI: 10.3390/jcm10245808] [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: 11/11/2021] [Revised: 12/05/2021] [Accepted: 12/09/2021] [Indexed: 11/16/2022] Open
Abstract
Sarcoidosis is a systemic granulomatous disease of unknown etiology, and its clinical presentation depends on the affected organ. Cardiac sarcoidosis (CS) is one of the leading causes of death among patients with sarcoidosis. The clinical manifestations of CS are heterogeneous, and range from asymptomatic to life-threatening arrhythmias and progressive heart failure due to the extent and location of granulomatous inflammation in the myocardium. Advances in imaging techniques have played a pivotal role in the evaluation of CS because histological diagnoses obtained by myocardial biopsy tend to have lower sensitivity. The diagnosis of CS is challenging, and several approaches, notably those using positron emission tomography and cardiac magnetic resonance imaging (MRI), have been reported. Delayed-enhanced computed tomography (CT) may also be used for diagnosing CS in patients with MRI-incompatible devices and allows acceptable evaluation of myocardial hyperenhancement in such patients. This article reviews the advances in imaging techniques for the evaluation of CS.
Collapse
Affiliation(s)
- Osamu Manabe
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama 330-8503, Japan; (O.M.); (T.A.)
| | - Noriko Oyama-Manabe
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama 330-8503, Japan; (O.M.); (T.A.)
- Correspondence: ; Tel.: +81-48-647-2111
| | - Tadao Aikawa
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama 330-8503, Japan; (O.M.); (T.A.)
| | - Satonori Tsuneta
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo 060-8648, Japan;
| | - Nagara Tamaki
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan;
| |
Collapse
|
35
|
Yuheng Jiang J, Wong VCK, Yun J, Pathan F, Mansberg R. Disseminated sarcoidosis involving lymph nodes, bone and spleen with progressive cardiac sarcoidosis on 18F-FDG PET/CT and cardiac MRI. Radiol Case Rep 2021; 16:3610-3613. [PMID: 34603568 PMCID: PMC8463740 DOI: 10.1016/j.radcr.2021.08.055] [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: 08/10/2021] [Revised: 08/20/2021] [Accepted: 08/21/2021] [Indexed: 11/29/2022] Open
Abstract
A 63-year-old lady with a background of ischemic heart disease was referred for 18F-FDG PET/CT for multiple lytic bone lesions which showed disseminated FDG avid lesions in the skeleton, nodal stations as well as spleen simulating advanced malignancy such as diffuse lymphomatous disease. A diagnosis of sarcoidosis was pathologically confirmed with bone biopsy. Following treatment, repeat PET/CT revealed significant regression of FDG avid lesions, however prominent uptake in the lateral ventricular wall was suspicious for active cardiac sarcoidosis, particularly given recurrent chest pain. This was confirmed on cardiac MRI and correlation with PET enabled discrimination between ischemic and non-ischemic fibrosis.
Collapse
Affiliation(s)
- James Yuheng Jiang
- Department of Nuclear Medicine and PET, Nepean Hospital, Kingswood, New South Wales, 2747, Australia
| | - Veronica Chi Ken Wong
- Department of Nuclear Medicine and PET, Nepean Hospital, Kingswood, New South Wales, 2747, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, 2006, Australia
| | - James Yun
- Department of Clinical Immunology and Allergy, Nepean Hospital, Kingswood, New South Wales, 2747, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, 2006, Australia
| | - Faraz Pathan
- Department of Cardiology, Nepean Hospital, Kingswood, New South Wales, 2747, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, 2006, Australia
| | - Robert Mansberg
- Department of Nuclear Medicine and PET, Nepean Hospital, Kingswood, New South Wales, 2747, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, 2006, Australia
| |
Collapse
|
36
|
Gilotra NA, Griffin JM, Pavlovic N, Houston BA, Chasler J, Goetz C, Chrispin J, Sharp M, Kasper EK, Chen ES, Blankstein R, Cooper LT, Joyce E, Sheikh FH. Sarcoidosis-Related Cardiomyopathy: Current Knowledge, Challenges, and Future Perspectives State-of-the-Art Review. J Card Fail 2021; 28:113-132. [PMID: 34260889 DOI: 10.1016/j.cardfail.2021.06.016] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 06/21/2021] [Indexed: 12/21/2022]
Abstract
The prevalence of sarcoidosis-related cardiomyopathy is increasing. Sarcoidosis impacts cardiac function through granulomatous infiltration of the heart, resulting in conduction disease, arrhythmia, and/or heart failure. The diagnosis of cardiac sarcoidosis (CS) can be challenging and requires clinician awareness as well as differentiation from overlapping diagnostic phenotypes, such as other forms of myocarditis and arrhythmogenic cardiomyopathy. Clinical manifestations, extracardiac involvement, histopathology, and advanced cardiac imaging can all lend support to a diagnosis of CS. The mainstay of therapy for CS is immunosuppression; however, no prospective clinical trials exist to guide management. Patients may progress to developing advanced heart failure or ventricular arrhythmia, for which ventricular assist device therapies or heart transplantation may be considered. The existing knowledge gaps in CS call for an interdisciplinary approach to both patient care and future investigation to improve mechanistic understanding and therapeutic strategies.
Collapse
Affiliation(s)
- Nisha A Gilotra
- Advanced Heart Failure/Transplant Cardiology Section, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Jan M Griffin
- Advanced Heart Failure/Transplant Cardiology Section, Division of Cardiology, Columbia University School of Medicine, New York, New York
| | - Noelle Pavlovic
- Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Brian A Houston
- Advanced Heart Failure/Transplant Cardiology Section, Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Jessica Chasler
- Department of Pharmacy, Johns Hopkins Hospital, Baltimore, Maryland
| | - Colleen Goetz
- Infiltrative Cardiomyopathy and Advanced Heart Failure Programs, MedStar Heart and Vascular Institute, Georgetown University, Washington, DC
| | - Jonathan Chrispin
- Clinical Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michelle Sharp
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Edward K Kasper
- Advanced Heart Failure/Transplant Cardiology Section, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Edward S Chen
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ron Blankstein
- Departments of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Leslie T Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida
| | - Emer Joyce
- Department of Cardiology, Mater Misericordiae University Hospital and University College Dublin School of Medicine, Dublin, Ireland
| | - Farooq H Sheikh
- Infiltrative Cardiomyopathy and Advanced Heart Failure Programs, MedStar Heart and Vascular Institute, Georgetown University, Washington, DC
| |
Collapse
|
37
|
Jamal F, Saud Khan M, Yang J, Steigner ML, Keraliya A, Aghayev A. Systemic Sarcoidosis With Cardiac Involvement Resembling Lymphoma on Imaging: Case Journey From Scrotum to Heart. Circ Cardiovasc Imaging 2021; 14:e012598. [PMID: 34233482 DOI: 10.1161/circimaging.121.012598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Faisal Jamal
- Cardiovascular Imaging Program, Department of Radiology (F.J., M.L.S., A.K., A.A.), Brigham and Women's Hospital, Boston, MA
| | - Mohammad Saud Khan
- Department of Medicine, The Miriam Hospital and Warren Alpert School of Brown University, Providence, RI (M.S.K.)
| | - Jing Yang
- Department of Pathology (J.Y.), Brigham and Women's Hospital, Boston, MA
| | - Michael L Steigner
- Cardiovascular Imaging Program, Department of Radiology (F.J., M.L.S., A.K., A.A.), Brigham and Women's Hospital, Boston, MA
| | - Abhishek Keraliya
- Cardiovascular Imaging Program, Department of Radiology (F.J., M.L.S., A.K., A.A.), Brigham and Women's Hospital, Boston, MA
| | - Ayaz Aghayev
- Cardiovascular Imaging Program, Department of Radiology (F.J., M.L.S., A.K., A.A.), Brigham and Women's Hospital, Boston, MA
| |
Collapse
|
38
|
Pijl JP, Nienhuis PH, Kwee TC, Glaudemans AWJM, Slart RHJA, Gormsen LC. Limitations and Pitfalls of FDG-PET/CT in Infection and Inflammation. Semin Nucl Med 2021; 51:633-645. [PMID: 34246448 DOI: 10.1053/j.semnuclmed.2021.06.008] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
White blood cells activated by either a pathogen or as part of a systemic inflammatory disease are characterized by high energy consumption and are therefore taking up the glucose analogue PET tracer FDG avidly. It is therefore not surprising that a steadily growing body of research and clinical reports now supports the use of FDG PET/CT to diagnose a wide range of patients with non-oncological diseases. However, using FDG PET/CT in patients with infectious or inflammatory diseases has some limitations and potential pitfalls that are not necessarily as pronounced in oncology FDG PET/CT. Some of these limitations are of a general nature and related to the laborious acquisition of PET images in patients that are often acutely ill, whereas others are more disease-specific and related to the particular metabolism in some of the organs most commonly affected by infections or inflammatory disease. Both inflammatory and infectious diseases are characterized by a more diffuse and less pathognomonic pattern of FDG uptake than oncology FDG PET/CT and the affected organs also typically have some physiological FDG uptake. In addition, patients referred to PET/CT with suspected infection or inflammation are rarely treatment naïve and may have received varying doses of antibiotics, corticosteroids or other immune-modulating drugs at the time of their examination. Combined, this results in a higher rate of false positive FDG findings and also in some cases a lower sensitivity to detect active disease. In this review, we therefore discuss the limitations and pitfalls of FDG PET/CT to diagnose infections and inflammation taking these issues into consideration. Our review encompasses the most commonly encountered inflammatory and infectious diseases in head and neck, in the cardiovascular system, in the abdominal organs and in the musculoskeletal system. Finally, new developments in the field of PET/CT that may help overcome some of these limitations are briefly highlighted.
Collapse
Affiliation(s)
- Jordy P Pijl
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen
| | - Pieter H Nienhuis
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen
| | - Thomas C Kwee
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen
| | - Andor W J M Glaudemans
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen
| | - Riemer H J A Slart
- Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen; Faculty of Science and Technology, Department of Biomedical Photonic Imaging, University of Twente, Enschede
| | - Lars C Gormsen
- Department of Nuclear Medicine & PET Center, Aarhus University Hospital, Aarhus N.
| |
Collapse
|
39
|
Campisi R, Merani MF, Rodríguez MI. BMIPP SPECT in cardiac sarcoidosis: A marker of risk? J Nucl Cardiol 2021; 28:930-935. [PMID: 33904149 DOI: 10.1007/s12350-021-02626-6] [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: 03/31/2021] [Accepted: 03/31/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Roxana Campisi
- Departments of Nuclear Medicine and Cardiovascular Imaging, Diagnóstico Maipú, Diagnóstico Maipú, Av. Maipú 1668, Vicente López (B1602ABQ), Buenos Aires, Argentina.
- Department of Nuclear Medicine, Instituto Argentino de Diagnóstico y Tratamiento S.A, Buenos Aires, Argentina.
| | - María Fernanda Merani
- Departments of Nuclear Medicine and Cardiovascular Imaging, Diagnóstico Maipú, Diagnóstico Maipú, Av. Maipú 1668, Vicente López (B1602ABQ), Buenos Aires, Argentina
- Department of Nuclear Medicine, Instituto Argentino de Diagnóstico y Tratamiento S.A, Buenos Aires, Argentina
| | - Marina I Rodríguez
- Departments of Nuclear Medicine and Cardiovascular Imaging, Diagnóstico Maipú, Diagnóstico Maipú, Av. Maipú 1668, Vicente López (B1602ABQ), Buenos Aires, Argentina
| |
Collapse
|
40
|
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.
Collapse
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
| |
Collapse
|
41
|
Aitken W, Tsang D, Chaparro S, Kir D. Cardiac sarcoidosis masquerading as ventricular tachycardia storm: a challenging diagnosis. BMJ Case Rep 2021; 14:14/2/e237530. [PMID: 33563689 PMCID: PMC7875304 DOI: 10.1136/bcr-2020-237530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 67-year-old African-American woman with remote history of complete heart block (s/p pacemaker 3 years ago) and recent onset of ventricular tachycardia (VT) (s/p VT ablation and cardiac resynchronisation therapy defibrillator upgrade 3 months ago) presented to the hospital with VT storm. Workup showed newly reduced left ventricular ejection fraction with global hypokinesis (20%) and restrictive physiology. Positive technetium pyrophosphate scan was suspicious for TTR amyloid while serological workup revealed a monoclonal gammopathy. Cardiac MRI was contraindicated given remote brain aneurysm clip. Given clinical suspicion for cardiac sarcoidosis and divergent non-invasive workup, endomyocardial biopsy was performed which showed non-necrotising granulomas consistent with cardiac sarcoidosis. She was started on steroids with clinical improvement. Cardiac sarcoidosis is a challenging clinical diagnosis, particularly in patients without extracardiac manifestations. This case highlights the importance of a detailed and thorough workup of non-ischaemic cardiomyopathy and being cognizant of infiltrative disease as it can change patient management and outcomes.
Collapse
Affiliation(s)
- William Aitken
- Department of Cardiology, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Darren Tsang
- Department of Cardiology, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sandra Chaparro
- Department of Cardiology, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Devika Kir
- Department of Cardiology, Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, Florida, USA
| |
Collapse
|
42
|
Montalto S, Better N. Assessing severity of cardiac sarcoid: Is SUV the answer? J Nucl Cardiol 2020; 27:2011-2016. [PMID: 30483957 DOI: 10.1007/s12350-018-01534-6] [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: 11/11/2018] [Accepted: 11/12/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Stephanie Montalto
- Department of Cardiology, Royal Melbourne Hospital, Parkville, VIC, 3050, Australia
| | - Nathan Better
- Department of Cardiology, Royal Melbourne Hospital, Parkville, VIC, 3050, Australia.
- Department of Nuclear Medicine, Royal Melbourne Hospital, Parkville, VIC, 3050, Australia.
- Department of Medicine, University of Melbourne, Parkville, VIC, 3050, Australia.
| |
Collapse
|
43
|
Jameson A, Revels J, Wang LL, Wang DT, Wang SS. Sarcoidosis, the master mimicker. Curr Probl Diagn Radiol 2020; 51:60-72. [PMID: 33308891 DOI: 10.1067/j.cpradiol.2020.10.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/30/2020] [Accepted: 10/16/2020] [Indexed: 01/02/2023]
Abstract
Sarcoidosis is an idiopathic multisystem disorder characterized by noncaseating granulomas. The article focuses on the typical imaging manifestations of sarcoid and the common differentials that need to be included when appropriate. Mistaking a sarcoid-mimicking disease for sarcoid can result in increased patient morbidity and mortality. The pulmonary system is the most common system involved and is typically the best understood by the radiologist, however a deeper knowledge of the pulmonary findings and features of sarcoid in other organ systems is critical. There is a myriad of sarcoid imaging manifestations that can involve every organ system. Often a confidant diagnosis of sarcoid can be made, however a broad differential may need to be considered- differential diagnoses include primary neoplasm, metastatic disease, infectious, and inflammatory etiologies. Radiologist familiarity with the multimodality multisystem imaging findings of sarcoid can help guide clinical management and optimize patient care.
Collapse
Affiliation(s)
- Austin Jameson
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH.
| | - Jonathan Revels
- Department of Radiology, University of New Mexico, Albuquerque, NM
| | - Lily L Wang
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH
| | - David T Wang
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH
| | - Sherry S Wang
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT
| |
Collapse
|
44
|
Masri SC, Bellumkonda L. Sarcoid Heart Disease: an Update on Diagnosis and Management. Curr Cardiol Rep 2020; 22:177. [PMID: 33119794 DOI: 10.1007/s11886-020-01429-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an update on cardiac sarcoidosis (CS) and to discuss the current recommendations and progress in diagnosis and management of this disease. Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Cardiac involvement is seen in at least 25% and is associated with poor prognosis. Manifestations of cardiac sarcoidosis (CS) can vary from presence of silent myocardial granulomas, which may lead to sudden death, to symptomatic conduction abnormalities, ventricular arrhythmias, and heart failure. RECENT FINDINGS We discuss newer imaging modalities such as cardiac magnetic resonance imaging and positron emission tomography in conjunction with clinical criteria increasingly used for diagnosing and prognosticating patients with CS. Immunosuppression (primarily corticosteroids) is recommended for treatment of CS; however, its efficacy has never been proven in prospective randomized studies. The role of imaging to guide the use of immunotherapy is unknown. Cardiac sarcoidosis continues to challenge clinicians due to its protean presentations, lack of diagnostic standards, and data for risk stratification and treatment. There is a need for prospective, randomized controlled trials to understand how best to diagnose and treat cardiac sarcoidosis.
Collapse
Affiliation(s)
- Sofia Carolina Masri
- Division of Cardiology, Department of Medicine, University of Wisconsin, Madison, WI, USA.
| | - Lavanya Bellumkonda
- Division of Cardiology, Department of Medicine, Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|
45
|
Abstract
Use of cardiac magnetic resonance (CMR) to aid in diagnosis, management, and prognosis of ischemic and nonischemic cardiomyopathy has advanced tremendously in the past several decades. These advances have expanded our understanding of both ischemic and nonischemic cardiomyopathies while also allowing for new avenues of diagnosis and treatment. This review summarizes key concepts of CMR technology and CMR use in the diagnosis and prognosis in ischemic, infiltrative, inflammatory, and other nonischemic cardiomyopathies and discusses the use of CMR in the patient presenting with ventricular arrhythmia with unclear diagnosis and advances in CMR in the management cardiomyopathy.
Collapse
|
46
|
Higueruela-Mínguez C, Martín-García A, Chamorro AJ, Marcos M, Ragozzino S. Cardiac Involvement In Multiorgan Sarcoidosis: Prognostic and Therapeutic Implications. Cureus 2020; 12:e10714. [PMID: 33145123 PMCID: PMC7598214 DOI: 10.7759/cureus.10714] [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: 11/19/2022] Open
Abstract
Sarcoidosis is a systemic granulomatous disease with a highly variable clinical impact. Accurate prognostic evaluation is fundamental to establish the best therapeutic approach. Multiorgan disease and especially the involvement of vital organs, such as the heart, are associated with worse outcomes and often require more aggressive therapy. Here, we describe the case of a young adult with sarcoidosis with lymph node, pulmonary, hepatosplenic, and cardiac involvement. This clinical scenario emphasizes the importance of a thorough prognostic assessment and highlights some of the main unmet clinical needs for the risk stratification and management of these patients.
Collapse
Affiliation(s)
| | - Ana Martín-García
- Cardiology, University Hospital and University of Salamanca, Salamanca, ESP.,Cardiology, Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, ESP.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, ESP
| | | | - Miguel Marcos
- Internal Medicine, University Hospital of Salamanca, Salamanca, ESP.,Internal Medicine, Institute of Biomedical Research of Salamanca (IBSAL), Salamanca, ESP
| | - Silvio Ragozzino
- Internal Medicine, University Hospital of Salamanca, Salamanca, ESP
| |
Collapse
|
47
|
Mikulic S, Patel P, Sheffield S, Kandah F, Velarde G. Heerfordt-Waldenström Syndrome Manifesting as Cardiac Sarcoidosis. Cureus 2020; 12:e10619. [PMID: 32983747 PMCID: PMC7515795 DOI: 10.7759/cureus.10619] [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] [Indexed: 12/14/2022] Open
Abstract
Sarcoidosis is a granulomatous disease histologically characterized by non-caseating granulomas. Although it usually affects the lungs, it can affect any organ system and present with a wide variety of symptoms. Heerfordt-Waldenström Syndrome, or uveoparotid fever, is a rare form of sarcoidosis that presents with a combination of fever, parotitis, facial paralysis, and uveitis. In this case report, we demonstrate a rare manifestation of sarcoidosis in a patient who presents with both the aforementioned syndrome and cardiac involvement. This case serves to highlight the importance of identifying the various clinical manifestations and management of systemic sarcoidosis.
Collapse
Affiliation(s)
- Sebastian Mikulic
- Internal Medicine, University of Florida Health Jacksonville, Jacksonville, USA
| | - Pujan Patel
- Cardiology, University of Florida Health Jacksonville, Jacksonville, USA
| | - Sandra Sheffield
- Internal Medicine, University of Florida Health Jacksonville, Jacksonville, USA
| | - Fadi Kandah
- Internal Medicine, University of Florida Health Jacksonville, Jacksonville, USA
| | - Gladys Velarde
- Cardiology, University of Florida Health Jacksonville, Jacksonville, USA
| |
Collapse
|
48
|
Advanced Nuclear Medicine and Molecular Imaging in the Diagnosis of Cardiomyopathy. AJR Am J Roentgenol 2020; 215:1208-1217. [PMID: 32901569 DOI: 10.2214/ajr.20.22790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE. The purpose of this article is to summarize the protocol, interpretation, and diagnostic performance of nuclear medicine and molecular imaging in imaging two distinctive, underdiagnosed cardiomyopathies: cardiac amyloidosis and cardiac sarcoidosis. CONCLUSION. Emerging new radiotracers and advanced molecular imaging modalities enable us to noninvasively characterize certain types of cardiomyopathies, including cardiac amyloidosis and cardiac sarcoidosis, with great confidence. We expect to improve recognition and promote the application of such advanced techniques in the imaging and management of these potentially lethal cardiomyopathies.
Collapse
|
49
|
Khalaf S, Al-Mallah MH. Fluorodeoxyglucose Applications in Cardiac PET: Viability, Inflammation, Infection, and Beyond. Methodist Debakey Cardiovasc J 2020; 16:122-129. [PMID: 32670472 DOI: 10.14797/mdcj-16-2-122] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
With its high temporal and spatial resolution and relatively low radiation exposure, positron emission tomography (PET) is increasingly being used in the management of cardiac patients, particularly those with inflammatory cardiomyopathies such as sarcoidosis. This review discusses the role of PET imaging in assessing myocardial viability, inflammatory cardiomyopathies, and endocarditis; describes the different protocols needed to acquire images for specific imaging tests; and examines imaging interpretation for each image dataset-including identification of the mismatch defect in viability imaging, which is associated with significant improvement in LV function after revascularization. We also review the role of fluorodeoxyglucose PET in cardiac sarcoidosis diagnosis, the complementary role of magnetic resonance imaging in inflammatory cardiomyopathy, and the emerging use of cardiac PET in prosthetic valve endocarditis.
Collapse
Affiliation(s)
- Shaden Khalaf
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
| | - Mouaz H Al-Mallah
- HOUSTON METHODIST DEBAKEY HEART & VASCULAR CENTER, HOUSTON METHODIST HOSPITAL, HOUSTON, TEXAS
| |
Collapse
|
50
|
Wiefels C, Lamai O, Kandolin R, Birnie D, Leung E, Mesquita CT, Beanlands R. The Role of 18F-FDG PET/CT in Cardiac Sarcoidosis. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2020. [DOI: 10.36660/ijcs.20200033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|