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Makhdumi M, Assar MD, Meyer DM, Roberts WC. Cardiac sarcoidosis diagnosed after orthotopic heart transplantation and clinically mimicking arrhythmogenic right ventricular cardiomyopathy. Cardiovasc Pathol 2021; 56:107390. [PMID: 34600147 DOI: 10.1016/j.carpath.2021.107390] [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] [Received: 06/03/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 11/15/2022] Open
Abstract
Described herein is a 71-year-old man who underwent orthotopic heart transplant (OHT) for chronic severe heart failure secondary to cardiac sarcoidosis (CS) devoid of non-caseating granulomas but nevertheless characteristic of CS. Clinically, his heart disease had suggested the presence of arrhythmogenic right ventricular cardiomyopathy.
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Affiliation(s)
- Madiha Makhdumi
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas, United States
| | - Manish D Assar
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas, United States; Internal Medicine, Baylor University Medical Center, Dallas, Texas, United States
| | - Dan M Meyer
- Departments of Cardiac Surgery, Baylor University Medical Center, Dallas, Texas, United States; Internal Medicine, Baylor University Medical Center, Dallas, Texas, United States
| | - William C Roberts
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas, United States; Internal Medicine, Baylor University Medical Center, Dallas, Texas, United States.
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2
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Kupari M, Lehtonen J. POINT: Should Isolated Cardiac Sarcoidosis Be Considered a Significant Manifestation of Sarcoidosis? Yes. Chest 2021; 160:36-38. [PMID: 34246374 DOI: 10.1016/j.chest.2020.12.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/13/2020] [Indexed: 10/20/2022] Open
Affiliation(s)
- Markku Kupari
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
| | - Jukka Lehtonen
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
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Abstract
Sarcoidosis is an inflammatory granulomatous disease that can affect any organ. Up to one-quarter of patients with systemic sarcoidosis may have evidence of cardiac involvement. The clinical manifestations of cardiac sarcoidosis (CS) include heart block, atrial arrhythmias, ventricular arrhythmias and heart failure. The diagnosis of CS can be challenging given the patchy infiltration of the myocardium but, with the increased availability of advanced cardiac imaging, more cases of CS are being identified. Immunosuppression with corticosteroids remains the standard therapy for the acute inflammatory phase of CS, but there is an evolving role of steroid-sparing agents. In this article, the authors provide an update on the diagnosis of CS, including the role of imaging; review the clinical manifestations of CS, namely heart block, atrial and ventricular arrhythmias and heart failure; discuss updated management strategies, including immunosuppression, electrophysiological and heart failure therapies; and identify the current gaps in knowledge and future directions for cardiac sarcoidosis.
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Affiliation(s)
- Nisha Gilotra
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - David Okada
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Apurva Sharma
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Jonathan Chrispin
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, US
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Cavigli L, Focardi M, Cameli M, Mandoli GE, Mondillo S, D'Ascenzi F. The right ventricle in “Left-sided” cardiomyopathies: The dark side of the moon. Trends Cardiovasc Med 2020; 31:476-484. [DOI: 10.1016/j.tcm.2020.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/26/2020] [Accepted: 10/09/2020] [Indexed: 02/07/2023]
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5
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Lyme disease and cardiac sarcoidosis: Management of associated ventricular arrhythmias. HeartRhythm Case Rep 2018; 4:584-588. [PMID: 30581738 PMCID: PMC6301890 DOI: 10.1016/j.hrcr.2018.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Okada DR, Bravo PE, Vita T, Agarwal V, Osborne MT, Taqueti VR, Skali H, Chareonthaitawee P, Dorbala S, Stewart G, Di Carli M, Blankstein R. Isolated cardiac sarcoidosis: A focused review of an under-recognized entity. J Nucl Cardiol 2018; 25:1136-1146. [PMID: 27613395 PMCID: PMC5540795 DOI: 10.1007/s12350-016-0658-1] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 08/10/2016] [Indexed: 02/07/2023]
Abstract
There is accumulating evidence for the existence of a phenotype of isolated cardiac sarcoidosis (ICS), or sarcoidosis that only involves the heart. In the absence of biopsy-confirmed cardiac sarcoidosis (CS), existing diagnostic criteria require the presence of extra-cardiac sarcoidosis as an inclusion criterion for the diagnosis of CS. Consequently, in the absence of a positive endomyocardial biopsy, ICS is not diagnosable by current guidelines. Therefore, there is uncertainty regarding the epidemiology, pathobiology, clinical characteristics, prognosis, and optimal treatment of ICS. This review will summarize the available data related to the prevalence and prognosis of ICS and will discuss challenges surrounding the diagnosis and management of this under-recognized entity.
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Affiliation(s)
- David R Okada
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Paco E Bravo
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Tomas Vita
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Vikram Agarwal
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael T Osborne
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Viviany R Taqueti
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Hicham Skali
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | | | - Sharmila Dorbala
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Garrick Stewart
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Marcelo Di Carli
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Ron Blankstein
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA.
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.
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Petrovic M, Buja LM, Kar B, Colnaric J, Damaraju S, Zhao B, Akkanti B, Radovanovic M, Radovancevic R, Loyalka P, Gregoric ID. Cardiac sarcoidosis presenting as arrhythmogenic right ventricular cardiomyopathy/dysplasia with ventricular aneurysms: a case report. Cardiovasc Pathol 2018; 33:1-5. [DOI: 10.1016/j.carpath.2017.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 08/04/2017] [Accepted: 11/02/2017] [Indexed: 11/27/2022] Open
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Muñoz-Ortiz É, Arévalo-Guerrero E, Abad P, Sénior JM. Cardiomiopatías infiltrativas. Presentación de un caso de sarcoidosis cardíaca. IATREIA 2017. [DOI: 10.17533/udea.iatreia.v30n1a07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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10
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Cardiac sarcoidosis: Matching speckle tracking echocardiography to macroscopic Ventricular pathology (a case report). Int J Cardiol 2016; 203:753-6. [PMID: 26590889 DOI: 10.1016/j.ijcard.2015.11.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 11/05/2015] [Indexed: 02/06/2023]
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Siqueira WC, da Cruz SG, Asimaki A, Saffitz JE, Moreira MDCV, Brasileiro G, Rocha LOS. Cardiac sarcoidosis with severe involvement of the right ventricle: a case report. AUTOPSY AND CASE REPORTS 2015; 5:53-63. [PMID: 26894046 PMCID: PMC4757920 DOI: 10.4322/acr.2015.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 11/30/2015] [Indexed: 11/23/2022] Open
Abstract
We present the case of a patient who underwent cardiac transplantation with the diagnosis of idiopathic dilated cardiomyopathy. Once the explanted heart was examined, a type of granulomatous myocarditis compatible with cardiac sarcoidosis was observed. However, there was severe involvement of the right ventricle, with markedly reduced width of the muscular layer and extensive fibrofatty replacement, findings similar to the ones encountered in cases of arrhythmogenic right ventricular cardiomyopathy (ARVC). Confocal immunofluorescence analysis revealed a reduced signal for plakoglobin and desmoplakin at the cardiac intercalated disks. The immunoreactive signal for desmin showed the typical sarcomeric distribution but not a concentrated signal at the intercalated disks, a pattern previously seen in an 11-year-old girl with Carvajal syndrome bearing a C-terminal truncating mutation in the desmoplakin gene. This case illustrates the difficult and challenging work involved in performing a differential diagnosis among idiopathic dilated cardiomyopathy, isolated cardiac sarcoidosis, and ARVC, all of which are clinical entities known to masquerade as one another.
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Affiliation(s)
- Weverton César Siqueira
- Internal Medicine Department - Faculty of Medicine - Federal University of Minas Gerais, Belo Horizonte/MG - Brazil
| | - Samuel Gonçalves da Cruz
- Internal Medicine Department - Faculty of Medicine - Federal University of Minas Gerais, Belo Horizonte/MG - Brazil
| | - Angeliki Asimaki
- Department of Pathology - Beth Israel Deaconess Medical Center - Harvard Medical School, Boston/MA - USA
| | - Jeffrey Ern Saffitz
- Department of Pathology - Beth Israel Deaconess Medical Center - Harvard Medical School, Boston/MA - USA
| | | | - Geraldo Brasileiro
- Pathology and Forensic Department - Faculty of Medicine - Federal University of Minas Gerais, Belo Horizonte/MG - Brazil
| | - Luiz Otávio Savassi Rocha
- Internal Medicine Department - Faculty of Medicine - Federal University of Minas Gerais, Belo Horizonte/MG - Brazil
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Abstract
Myocardial involvement in patients with sarcoidosis can be difficult to diagnose, and requires a high index of suspicion and low threshold for screening. The presentation of cardiac sarcoidosis is variable, and can range from asymptomatic electrocardiographic changes to sudden cardiac death. This review provides an overview of the arrhythmic consequences of cardiac sarcoidosis, with emphasis on the electrophysiologist's role in recognition, diagnostic testing, and management of this rare disease.
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Affiliation(s)
- Matthew M Zipse
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, 12401 East 17th Avenue, B132, Aurora, CO 80045, USA
| | - William H Sauer
- Section of Cardiac Electrophysiology, Division of Cardiology, University of Colorado, 12401 East 17th Avenue, B132, Aurora, CO 80045, USA.
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Jeudy J, Burke AP, White CS, Kramer GBG, Frazier AA. Cardiac Sarcoidosis: The Challenge of Radiologic-Pathologic Correlation:From the Radiologic Pathology Archives. Radiographics 2015; 35:657-79. [DOI: 10.1148/rg.2015140247] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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