Intra-cardiac distribution of late gadolinium enhancement in cardiac sarcoidosis and dilated cardiomyopathy

Current State and Future Directions of Multimodality Imaging in Cardiac Sarcoidosis

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.

Atypical presentation of cardiac sarcoidosis: role of multimodality imaging and review of literature

Cardiac sarcoidosis (CS) is challenging to determine, consequently is under-recognised in clinical practice. The accurate prevalence of CS is possibly underestimated due to unspecific symptoms, subclinical illness and the dearth of universally accepted diagnostic criteria. Totally, non-invasive diagnosis of CS was proposed in 2015 by the Japanese Ministry of Health and Welfare using positron emission tomography and cardiac MRI findings as major criteria and substituting histological verification. We present a case of a 60-year-old woman with pulmonary sarcoidosis presenting with progressively worsening palpitations and recurrent syncope. Her initial evaluation at another hospital facility revealed normal cardiac testing. A detailed evaluation with echocardiography and cardiac MRI helped us arrive at the diagnosis of CS, which resulted in appropriate treatment and resolution of symptoms. We discuss CS in general, the clinical disease, diagnostic algorithms, latest guidelines and management.

The role of Cardiac Magnetic Resonance (CMR) in the diagnosis of cardiomyopathy: A systematic review

Background

Myocardial pathologies are significant causes of morbidity and mortality in patients worldwide. Ischemic and non-ischemic cardiomyopathies have become a worldwide epidemic of the 21st century with an increasing impact on health care systems. The 2012 European Society of Cardiology and 2013 American College of Cardiology Foundation/American Heart Association guidelines provide current therapy guidance to reduce mortality and morbidity.

Methods

This was a systematic review involving cardiac magnetic resonance (CMR) studies for the diagnosis of cardiomyopathy from January 2013 to April 2017. Out of 62 reviewed studies, only 12 were included in our study.

Results

The average sensitivity and specificity of CMR in the diagnosis of cardiomyopathy was 86.75% (95% confidence interval [CI], 70.30% to 92.58%) and 81.75% (95% CI, 73.0% to 87.6%), respectively, and the positive predictive and negative predictive values were 80.17% and 86.75%, respectively.

Conclusion

Despite some limitations, our study shows that CMR has high sensitivity, specificity, and positive predictive value in diagnosing different types of cardiomyopathy. CMR may be used to differentiate types of cardiomyopathy, accurately quantify the chamber dimensions, volumes, and cardiac function, which make it useful for prognosis as well.

The role of cardiac magnetic resonance (CMR) in the diagnosis of cardiomyopathy: A systematic review

Background

Myocardial pathologies are significant causes of morbidity and mortality in patients worldwide. Ischemic and non-ischemic cardiomyopathies have become a worldwide epidemic of the 21st century with an increasing impact on health care systems. The 2012 European Society of Cardiology and 2013 American College of Cardiology Foundation/American Heart Association guidelines provide current therapy guidance to reduce mortality and morbidity.

Methods

This was a systematic review involving cardiac magnetic resonance (CMR) studies for the diagnosis of cardiomyopathy from January 2013 to April 2017. Out of 62 reviewed studies, only 12 were included in our study.

Results

The average sensitivity and specificity of CMR in the diagnosis of cardiomyopathy was 86.75% (95% confidence interval [CI], 70.30% to 92.58%) and 81.75% (95% CI, 73.0% to 87.6%), respectively, and the positive predictive and negative predictive values were 80.17% and 86.75%, respectively.

Conclusion

Despite some limitations, our study shows that CMR has high sensitivity, specificity, and positive predictive value in diagnosing different types of cardiomyopathy. CMR may be used to differentiate types of cardiomyopathy, accurately quantify the chamber dimensions, volumes, and cardiac function, which make it useful for prognosis as well.

Multimodality Imaging to Diagnose Isolated Cardiac Sarcoidosis and Determine Regional Inflammatory Activity Levels

•Cardiac sarcoidosis should be considered in patients with heart failure. •Criteria for isolated cardiac sarcoidosis requires positive endomyocardial biopsy. •Studies should evaluate a noninvasive approach to isolated cardiac sarcoidosis.