BACKGROUND: Complete heart block (CHB) caused by myocardial inflammation is a serious consequence of cardiac sarcoidosis (CS) that requires early diagnosis for effective anti-inflammatory treatment. OBJECTIVE: This study aimed to clarify the cardiac magnetic resonance imaging (MRI) and (18)F-fluoro-2-deoxyglucose positron emission tomography ((18)F-FDG PET) manifestations of newly diagnosed CS with CHB and to assess whether certain imaging features could predict responders to corticosteroid therapy. METHODS: Fifteen newly diagnosed CS patients with CHB and 17 without CHB were examined. We defined abnormal (18)F-FDG uptake on (18)F-FDG PET and increased T2-weighted signal on cardiac MRI as signs of myocardial inflammation and delayed enhancement (DE) on cardiac MRI as a sign of myocardial fibrosis. Ten CHB+ patients were then treated with corticosteroids. RESULTS: The CHB+ group showed higher (18)F-FDG uptake and increased T2-weighted signal in the interventricular septum, which involves the electrical pathway of atrioventricular conduction, than the CHB- group (P = .001 and P < .0001, respectively), whereas there was no group difference in DE (P = .232). Six corticosteroid-treated patients recovered from CHB; all had exhibited increased T2-weighted signal, (18)F-FDG uptake, and DE in the interventricular septum before therapy. In contrast, among the 4 patients without recovery, 2 showed no abnormal (18)F-FDG uptake and 3 had no increased T2-weighted signal in the interventricular septum, but all showed DE. The 2 patients without recovery with abnormal (18)F-FDG uptake showed wall thinning in the interventricular septum. CONCLUSION: Focal inflammation in the interventricular septum was associated with CHB and might predict recovery from CHB after corticosteroids if it coexists with preserved wall thickness.
BACKGROUND: Complete heart block (CHB) caused by myocardial inflammation is a serious consequence of cardiac sarcoidosis (CS) that requires early diagnosis for effective anti-inflammatory treatment. OBJECTIVE: This study aimed to clarify the cardiac magnetic resonance imaging (MRI) and (18)F-fluoro-2-deoxyglucose positron emission tomography ((18)F-FDG PET) manifestations of newly diagnosed CS with CHB and to assess whether certain imaging features could predict responders to corticosteroid therapy. METHODS: Fifteen newly diagnosed CSpatients with CHB and 17 without CHB were examined. We defined abnormal (18)F-FDG uptake on (18)F-FDG PET and increased T2-weighted signal on cardiac MRI as signs of myocardial inflammation and delayed enhancement (DE) on cardiac MRI as a sign of myocardial fibrosis. Ten CHB+ patients were then treated with corticosteroids. RESULTS: The CHB+ group showed higher (18)F-FDG uptake and increased T2-weighted signal in the interventricular septum, which involves the electrical pathway of atrioventricular conduction, than the CHB- group (P = .001 and P < .0001, respectively), whereas there was no group difference in DE (P = .232). Six corticosteroid-treated patients recovered from CHB; all had exhibited increased T2-weighted signal, (18)F-FDG uptake, and DE in the interventricular septum before therapy. In contrast, among the 4 patients without recovery, 2 showed no abnormal (18)F-FDG uptake and 3 had no increased T2-weighted signal in the interventricular septum, but all showed DE. The 2 patients without recovery with abnormal (18)F-FDG uptake showed wall thinning in the interventricular septum. CONCLUSION: Focal inflammation in the interventricular septum was associated with CHB and might predict recovery from CHB after corticosteroids if it coexists with preserved wall thickness.
Authors: Riemer H J A Slart; Andor W J M Glaudemans; Patrizio Lancellotti; Fabien Hyafil; Ron Blankstein; Ronald G Schwartz; Wael A Jaber; Raymond Russell; Alessia Gimelli; François Rouzet; Marcus Hacker; Olivier Gheysens; Sven Plein; Edward J Miller; Sharmila Dorbala; Erwan Donal Journal: J Nucl Cardiol Date: 2018-02 Impact factor: 5.952
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
Authors: Tomas Vita; David R Okada; Mahdi Veillet-Chowdhury; Paco E Bravo; Erin Mullins; Edward Hulten; Mukta Agrawal; Rachna Madan; Viviany R Taqueti; Michael Steigner; Hicham Skali; Raymond Y Kwong; Garrick C Stewart; Sharmila Dorbala; Marcelo F Di Carli; Ron Blankstein Journal: Circ Cardiovasc Imaging Date: 2018-01 Impact factor: 7.792