Daisuke Tezuka1, Masahiro Terashima2, Yoko Kato3, Akira Toriihara4, Kensuke Hirasawa3, Taro Sasaoka3, Shunji Yoshikawa3, Yasuhiro Maejima3, Takashi Ashikaga3, Jun-Ichi Suzuki5, Kenzo Hirao6, Mitsuaki Isobe7. 1. Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan; Cardiovascular Imaging Clinic, Tokyo, Japan; Department of Advanced Clinical Science and Therapeutics, University of Tokyo, Tokyo, Japan. 2. Cardiovascular Imaging Clinic, Tokyo, Japan. 3. Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan. 4. Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo, Japan. 5. Department of Advanced Clinical Science and Therapeutics, University of Tokyo, Tokyo, Japan. 6. Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan; Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan. 7. Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan. Electronic address: isobemi.cvm@tmd.ac.jp.
Abstract
BACKGROUND: Isolated cardiac sarcoidosis (iCS) is difficult to diagnose in patients without histologic evidence of sarcoidosis. We aimed to clarify the clinical characteristics of iCS, including imaging features on cardiac magnetic resonance imaging (MRI) and (18)F-fluoro-2-deoxyglucose positron-emission tomography/computerized tomography (FDG-PET/CT) scans. We also reviewed the therapeutic effect of corticosteroids and determined the long-term prognosis. METHODS AND RESULTS: We retrospectively reviewed 83 consecutive patients with suspicious CS from 1997 to 2013. Systemic sarcoidosis with CS (sCS, n = 30) and iCS (n = 11) were diagnosed according to clinical criteria. In iCS cases, sarcoidosis was not detected in any other organs. The clinical features did not significantly differ between sCS and iCS cases, except for ejection fraction, which was lower in iCS (P = .025). Nine sCS and 4 iCS cases showed late gadolinium enhancement, and the lesions tended to be on the epicardial side (76.9% P = .011) and septal wall (52.9% P < .001). The coefficient of variance for the myocardial standardized uptake value of FDG-PET/CT was higher in sCS (0.32 ± 0.13; n = 19) and iCS (0.32 ± 0.09; n = 7) than in control cases (n = 31; P < .001). B-Type natriuretic peptide level was improved after prednisolone treatment in both groups. Kaplan-Meier curve indicated that prognosis was not different between sCS and iCS cases. CONCLUSIONS: The clinical cardiac characteristics of iCS cases were similar to those of sCS. Cardiac MRI and FDG-PET, noninvasive imaging modalities, could be useful modalities to detect myocardial involvement in the cases with definite or suspected iCS.
BACKGROUND: Isolated cardiac sarcoidosis (iCS) is difficult to diagnose in patients without histologic evidence of sarcoidosis. We aimed to clarify the clinical characteristics of iCS, including imaging features on cardiac magnetic resonance imaging (MRI) and (18)F-fluoro-2-deoxyglucose positron-emission tomography/computerized tomography (FDG-PET/CT) scans. We also reviewed the therapeutic effect of corticosteroids and determined the long-term prognosis. METHODS AND RESULTS: We retrospectively reviewed 83 consecutive patients with suspicious CS from 1997 to 2013. Systemic sarcoidosis with CS (sCS, n = 30) and iCS (n = 11) were diagnosed according to clinical criteria. In iCS cases, sarcoidosis was not detected in any other organs. The clinical features did not significantly differ between sCS and iCS cases, except for ejection fraction, which was lower in iCS (P = .025). Nine sCS and 4 iCS cases showed late gadolinium enhancement, and the lesions tended to be on the epicardial side (76.9% P = .011) and septal wall (52.9% P < .001). The coefficient of variance for the myocardial standardized uptake value of FDG-PET/CT was higher in sCS (0.32 ± 0.13; n = 19) and iCS (0.32 ± 0.09; n = 7) than in control cases (n = 31; P < .001). B-Type natriuretic peptide level was improved after prednisolone treatment in both groups. Kaplan-Meier curve indicated that prognosis was not different between sCS and iCS cases. CONCLUSIONS: The clinical cardiac characteristics of iCS cases were similar to those of sCS. Cardiac MRI and FDG-PET, noninvasive imaging modalities, could be useful modalities to detect myocardial involvement in the cases with definite or suspected iCS.
Authors: G Cameron Coleman; Peter W Shaw; Pelbreton C Balfour; Jorge A Gonzalez; Christopher M Kramer; Amit R Patel; Michael Salerno Journal: JACC Cardiovasc Imaging Date: 2016-07-20
Authors: David R Okada; Paco E Bravo; Tomas Vita; Vikram Agarwal; Michael T Osborne; Viviany R Taqueti; Hicham Skali; Panithaya Chareonthaitawee; Sharmila Dorbala; Garrick Stewart; Marcelo Di Carli; Ron Blankstein Journal: J Nucl Cardiol Date: 2016-09-09 Impact factor: 5.952