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Lucinian YA, Martineau P, Abikhzer G, Harel F, Pelletier-Galarneau M. Novel tracers to assess myocardial inflammation with radionuclide imaging. J Nucl Cardiol 2024:102012. [PMID: 39069249 DOI: 10.1016/j.nuclcard.2024.102012] [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: 02/16/2024] [Revised: 07/08/2024] [Accepted: 07/15/2024] [Indexed: 07/30/2024]
Abstract
Myocardial inflammation plays a central role in the pathophysiology of various cardiac diseases. While FDG-PET is currently the primary method for molecular imaging of myocardial inflammation, its effectiveness is hindered by physiological myocardial uptake as well as its propensity for uptake by multiple disease-specific mechanisms. Novel radiotracers targeting diverse inflammatory immune cells and molecular pathways may provide unique insight through the visualization of underlying mechanisms central to the pathogenesis of inflammatory cardiac diseases, offering opportunities for increased understanding of immunocardiology. Moreover, the potentially enhanced specificity may lead to better quantification of disease activity, aiding in the guidance and monitoring of immunomodulatory therapy. This review aims to provide an update on advancements in non-FDG radiotracers for imaging myocardial inflammatory diseases, with a focus on cardiac sarcoidosis, myocarditis, and acute myocardial infarction.
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Affiliation(s)
| | | | - Gad Abikhzer
- Jewish General Hospital, Montreal, Quebec, Canada
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Lasica R, Djukanovic L, Savic L, Krljanac G, Zdravkovic M, Ristic M, Lasica A, Asanin M, Ristic A. Update on Myocarditis: From Etiology and Clinical Picture to Modern Diagnostics and Methods of Treatment. Diagnostics (Basel) 2023; 13:3073. [PMID: 37835816 PMCID: PMC10572782 DOI: 10.3390/diagnostics13193073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
Although the frequency of myocarditis in the general population is very difficult to accurately determine due to the large number of asymptomatic cases, the incidence of this disease is increasing significantly due to better defined criteria for diagnosis and the development of modern diagnostic methods. The multitude of different etiological factors, the diversity of the clinical picture, and the variability of the diagnostic findings make this disease often demanding both for the selection of the diagnostic modality and for the proper therapeutic approach. The previously known most common viral etiology of this disease is today overshadowed by new findings based on immune-mediated processes, associated with diseases that in their natural course can lead to myocardial involvement, as well as the iatrogenic cause of myocarditis, which is due to use of immune checkpoint inhibitors in the treatment of cancer patients. Suspecting that a patient with polymorphic and non-specific clinical signs and symptoms, such as changes in ECG and echocardiography readings, has myocarditis is the starting point in the diagnostic algorithm. Cardio magnetic resonance imaging is non-invasive and is the gold standard for diagnosis and clinical follow-up of these patients. Endomyocardial biopsy as an invasive method is the diagnostic choice in life-threatening cases with suspicion of fulminant myocarditis where the diagnosis has not yet established or there is no adequate response to the applied therapeutic regimen. The treatment of myocarditis is increasingly demanding and includes conservative methods of treating heart failure, immunomodulatory and immunospressive therapy, methods of mechanical circulatory support, and heart transplantation. The goal of developing new diagnostic and therapeutic methods is to reduce mortality from this complex disease, which is still high.
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Affiliation(s)
- Ratko Lasica
- Department of Cardiology, Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.D.); (L.S.); (G.K.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Lazar Djukanovic
- Department of Cardiology, Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.D.); (L.S.); (G.K.); (M.A.)
| | - Lidija Savic
- Department of Cardiology, Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.D.); (L.S.); (G.K.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Gordana Krljanac
- Department of Cardiology, Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.D.); (L.S.); (G.K.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Marija Zdravkovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
- Department of Cardiology, University Medical Center Bezanijska Kosa, 11000 Belgrade, Serbia
| | - Marko Ristic
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
| | | | - Milika Asanin
- Department of Cardiology, Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (L.D.); (L.S.); (G.K.); (M.A.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Arsen Ristic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
- Department of Cardiology, University Clinical Center of Serbia, 11000 Belgrade, Serbia;
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Kurashima S, Kitai T, Xanthopoulos A, Skoularigis J, Triposkiadis F, Izumi C. Diagnosis of cardiac sarcoidosis: histological evidence vs. imaging. Expert Rev Cardiovasc Ther 2023; 21:693-702. [PMID: 37776232 DOI: 10.1080/14779072.2023.2266367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 09/29/2023] [Indexed: 10/02/2023]
Abstract
INTRODUCTION The prognosis for cardiac sarcoidosis (CS) remains unfavorable. Although early and accurate diagnosis is crucial, the low detection rate of endomyocardial biopsy makes accurate diagnosis challenging. AREAS COVERED The Heart Rhythm Society (HRS) consensus statement and the Japanese Circulation Society (JCS) guidelines are two major diagnostic criteria for the diagnosis of CS. While the requirement of positive histology for the diagnosis in the HRS criteria can result in overlooked cases, the JCS guidelines advocate for a group of 'clinical' diagnoses based on advanced imaging, including cardiovascular magnetic resonance and 18F-fluorodeoxyglucose positron emission tomography, which do not require histological evidence. Recent studies have supported the usefulness of clinical diagnosis of CS. However, other evidence suggests that clinical CS may sometimes be inaccurate. This article describes the advantages and disadvantages of the current diagnostic criteria for CS, and typical imaging and clinical courses. EXPERT OPINION The diagnosis of clinical CS has been made possible by recent developments in multimodality imaging. However, it is still crucial to look for histological signs of sarcoidosis in other organs in addition to the endomyocardium. Additionally, phenotyping based on clinical manifestations such as heart failure, conduction abnormality or ventricular arrhythmia, and extracardiac abnormalities is clinically significant.
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Affiliation(s)
- Shinichi Kurashima
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Andrew Xanthopoulos
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece
| | - John Skoularigis
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece
| | | | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
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Reddy P, Cooper LT. Two bad actors: can cardiac magnetic resonance distinguish idiopathic granulomatous from giant cell myocarditis? Eur Heart J Cardiovasc Imaging 2023; 24:413-414. [PMID: 36762649 DOI: 10.1093/ehjci/jead012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Affiliation(s)
- Prajwal Reddy
- Cardiovascular Diseases, Mayo Clinic College of Medicine, 4500 San Pablo, Jacksonville, FL 32250, USA
| | - Leslie T Cooper
- Cardiovascular Diseases, Mayo Clinic College of Medicine, 4500 San Pablo, Jacksonville, FL 32250, USA
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A Review of the Role of Imaging Modalities in the Evaluation of Viral Myocarditis with a Special Focus on COVID-19-Related Myocarditis. Diagnostics (Basel) 2022; 12:diagnostics12020549. [PMID: 35204637 PMCID: PMC8870822 DOI: 10.3390/diagnostics12020549] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/03/2022] [Accepted: 02/06/2022] [Indexed: 12/12/2022] Open
Abstract
Viral myocarditis is inflammation of the myocardium secondary to viral infection. The clinical presentation of viral myocarditis is very heterogeneous and can range from nonspecific symptoms of malaise and fatigue in subclinical disease to a more florid presentation, such as acute cardiogenic shock and sudden cardiac death in severe cases. The accurate and prompt diagnosis of viral myocarditis is very challenging. Endomyocardial biopsy is considered to be the gold standard test to confirm viral myocarditis; however, it is an invasive procedure, and the sensitivity is low when myocardial involvement is focal. Cardiac imaging hence plays an essential role in the noninvasive evaluation of viral myocarditis. The current coronavirus disease 2019 (COVID-19) pandemic has generated considerable interest in the use of imaging in the early detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related myocarditis. This article reviews the role of various cardiac imaging modalities used in the diagnosis and assessment of viral myocarditis, including COVID-19-related myocarditis.
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Birnie DH, Nery PB, Beanlands RS. COUNTERPOINT: Should Isolated Cardiac Sarcoidosis Be Considered a Significant Manifestation of Sarcoidosis? No. Chest 2021; 160:38-42. [PMID: 34246375 DOI: 10.1016/j.chest.2020.12.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 12/13/2020] [Indexed: 10/20/2022] Open
Affiliation(s)
- David H Birnie
- University of Ottawa Heart Institute, Ottawa, ON, Canada.
| | - Pablo B Nery
- University of Ottawa Heart Institute, Ottawa, ON, Canada
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Cao J, Schwartz YY, Lomasney JW, Narang A, Okwuosa IS, Avery R, Passman RS, Cooper LT, Vorovich E. A Case of Rapidly Progressing Granulomatous Myocarditis: What Is the Diagnosis? Circ Heart Fail 2021; 14:e007800. [PMID: 33677978 DOI: 10.1161/circheartfailure.120.007800] [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)
- Jessica Cao
- Department of Internal Medicine (J.C., Y.Y.S.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Yosef Y Schwartz
- Department of Internal Medicine (J.C., Y.Y.S.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jon W Lomasney
- Department of Pathology (J.W.L.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Akhil Narang
- Division of Cardiology (A.N., I.S.O., R.A., R.S.P., E.V.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ike S Okwuosa
- Division of Cardiology (A.N., I.S.O., R.A., R.S.P., E.V.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ryan Avery
- Division of Cardiology (A.N., I.S.O., R.A., R.S.P., E.V.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Rod S Passman
- Division of Cardiology (A.N., I.S.O., R.A., R.S.P., E.V.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Leslie T Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL (L.T.C.)
| | - Esther Vorovich
- Division of Cardiology (A.N., I.S.O., R.A., R.S.P., E.V.), Northwestern University Feinberg School of Medicine, Chicago, IL
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Nordenswan HK, Lehtonen J, Ekström K, Räisänen-Sokolowski A, Mäyränpää MI, Vihinen T, Miettinen H, Kaikkonen K, Haataja P, Kerola T, Rissanen TT, Kokkonen J, Alatalo A, Pietilä-Effati P, Utriainen S, Kupari M. Manifestations and Outcome of Cardiac Sarcoidosis and Idiopathic Giant Cell Myocarditis by 25-Year Nationwide Cohorts. J Am Heart Assoc 2021; 10:e019415. [PMID: 33660520 PMCID: PMC8174201 DOI: 10.1161/jaha.120.019415] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [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 Cardiac sarcoidosis (CS) and giant cell myocarditis (GCM) share many histopathologic and clinical features. Whether they are parts of a one-disease continuum has been discussed. Methods and Results We compared medical record data of 351 CS and 28 GCM cases diagnosed in Finland since the late 1980s and followed until February 2018 for a composite end point of cardiac death, aborted sudden death, and heart transplantation. Heart failure was the presenting manifestation in 50% versus 15% (P<0.001), and high-grade atrioventricular block in 21% versus 43% (P=0.044), of GCM and CS, respectively. At presentation, left ventricular ejection fraction was ≤50% in 81% of cases of GCM versus in 48% of CS (P=0.004). The median (interquartile range) of plasma NT-proBNP (N-terminal pro-B-type natriuretic peptide) was 5273 (2782-11309) ng/L on admission in GCM versus 859 (290-1950) ng/L in CS (P<0.001), and cardiac troponin T exceeded 50 ng/L in 17 of 19 cases of GCM versus in 48 of 239 cases of CS (P<0.001). The 5-year estimate of event-free survival was 77% (95% CI, 72%-82%) in CS versus 27% (95% CI, 10%-45%) in GCM (P<0.001). By Cox regression analysis, GCM predicted cardiac events with a hazard ratio of 5.16 (95% CI, 2.82-9.45), which, however, decreased to 1.58 (95% CI, 0.71-3.52) after inclusion of markers of myocardial injury and dysfunction in the model. Conclusions GCM differs from CS in presenting with more extensive myocardial injury and having worse long-term outcome. Yet the key determinant of prognosis appears to be the extent of myocardial injury rather than the histopathologic diagnosis.
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Affiliation(s)
- Hanna-Kaisa Nordenswan
- Heart and Lung Center University of Helsinki and Helsinki University Central Hospital Helsinki Finland
| | - Jukka Lehtonen
- Heart and Lung Center University of Helsinki and Helsinki University Central Hospital Helsinki Finland
| | - Kaj Ekström
- Heart and Lung Center University of Helsinki and Helsinki University Central Hospital Helsinki Finland
| | - Anne Räisänen-Sokolowski
- Department of Pathology University of Helsinki and Helsinki University Central Hospital Helsinki Finland
| | - Mikko I Mäyränpää
- Department of Pathology University of Helsinki and Helsinki University Central Hospital Helsinki Finland
| | | | | | - Kari Kaikkonen
- Medical Research Center Oulu University and University Hospital of Oulu Oulu Finland
| | - Petri Haataja
- Heart HospitalTampere University Hospital Tampere Finland
| | - Tuomas Kerola
- Department of Internal Medicine Päijät-Häme Central Hospital Lahti Finland
| | | | | | | | | | | | - Markku Kupari
- Heart and Lung Center University of Helsinki and Helsinki University Central Hospital Helsinki Finland
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Birnie DH, Nair V, Veinot JP. Cardiac Sarcoidosis and Giant Cell Myocarditis: Actually, 2 Ends of the Same Disease? J Am Heart Assoc 2021; 10:e020542. [PMID: 33660527 PMCID: PMC8174207 DOI: 10.1161/jaha.121.020542] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- David H Birnie
- Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada
| | - Vidhya Nair
- Department of Pathology and Laboratory Medicine The Ottawa Hospital and University of Ottawa Ottawa Ontario Canada
| | - John P Veinot
- Department of Pathology and Laboratory Medicine The Ottawa Hospital and University of Ottawa Ottawa Ontario Canada
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