Eleanor C Wicks1,2,3, Leon J Menezes1,2,4, Anna Barnes1,2, Saidi A Mohiddin1,2, Neha Sekhri1, Joanna C Porter1,5, Helen L Booth1,5, Emily Garrett1, Riyaz S Patel1,4, Menelaos Pavlou6, Ashley M Groves2,4, Perry M Elliott1,4. 1. University College London Institute for Cardiovascular Science and Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, EC1A 7BE, London, UK. 2. Institute of Nuclear Medicine, University College London Hospitals, UK. 3. Oxford University Hospitals, John Radcliffe Hospital, Headley Way, Headington, Oxford, OX3 9DU, UK. 4. National Institute for Health Research University College London Hospitals and Barts Heart Biomedical Research Centres, UK. 5. Department of Respiratory Medicine, University College London Hospitals, 5th Floor, University College Hospital, 235 Euston Road, London, NW1 2BU, UK. 6. Department of Statistical Science, University College London, London, UK.
Abstract
Aims: Cardiac death is the leading cause of mortality in patients with sarcoidosis, yet cardiac involvement often remains undetected. Cardiovascular magnetic resonance imaging (CMR) and 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) have been used to diagnose cardiac sarcoidosis (CS) yet never simultaneously in a cohort. This study sought to assess the diagnostic and prognostic utility of simultaneous hybrid cardiac PET/MR. Methods and results: Fifty-one consecutive patients with suspected CS (age 50 ± 13 years, 31 males) underwent simultaneous PET/MR following a high-fat/low-carbohydrate diet and 12-h fast. Blinded image analysis of FDG uptake and late gadolinium enhancement (LGE) was performed using the American Heart Association (AHA) 16-segment model. The sensitivity and specificity of PET/MR for diagnosing CS was estimated using the Japanese Ministry of Health and Welfare guidelines. The primary endpoint was a composite of death, aborted sudden cardiac death, sustained ventricular arrhythmia, complete heart block, and hospital admission with decompensated heart failure. The secondary endpoints were a fall in left ventricular ejection fraction (LVEF) >10%, non-sustained ventricular tachycardia and other cardiac-related hospital admission. The prevalence of CS was 65% (n = 33). The sensitivity of PET and CMR alone for detecting CS was 0.85 and 0.82, respectively. Hybrid PET/MR was superior for detecting CS with sensitivity, specificity, positive, and negative predictive values of 0.94, 0.44, 0.76, and 0.80, respectively. There was poor inter-modality agreement for the location of cardiac abnormalities (k = 0.02). Over the median follow-up of 2.2 years, there were 18 (35%) adverse events. Cardiac RV PET abnormalities and presence of LGE were independent predictors of adverse events. Abnormalities found on both PET and magnetic resonance imaging was the strongest predictor of major adverse cardiac events. Conclusion: Simultaneous PET/MR is an accurate method for diagnosing CS. FDG-PET and CMR combined offers complementary information on disease pathophysiology. The presence of LGE and FDG uptake on PET/MR identifies patients at higher risk of adverse events. PET and CMR should therefore be considered in the assessment of disease presence, stage, and prognosis in CS.
Aims: Cardiac death is the leading cause of mortality in patients with sarcoidosis, yet cardiac involvement often remains undetected. Cardiovascular magnetic resonance imaging (CMR) and 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) have been used to diagnose cardiac sarcoidosis (CS) yet never simultaneously in a cohort. This study sought to assess the diagnostic and prognostic utility of simultaneous hybrid cardiac PET/MR. Methods and results: Fifty-one consecutive patients with suspected CS (age 50 ± 13 years, 31 males) underwent simultaneous PET/MR following a high-fat/low-carbohydrate diet and 12-h fast. Blinded image analysis of FDG uptake and late gadolinium enhancement (LGE) was performed using the American Heart Association (AHA) 16-segment model. The sensitivity and specificity of PET/MR for diagnosing CS was estimated using the Japanese Ministry of Health and Welfare guidelines. The primary endpoint was a composite of death, aborted sudden cardiac death, sustained ventricular arrhythmia, complete heart block, and hospital admission with decompensated heart failure. The secondary endpoints were a fall in left ventricular ejection fraction (LVEF) >10%, non-sustained ventricular tachycardia and other cardiac-related hospital admission. The prevalence of CS was 65% (n = 33). The sensitivity of PET and CMR alone for detecting CS was 0.85 and 0.82, respectively. Hybrid PET/MR was superior for detecting CS with sensitivity, specificity, positive, and negative predictive values of 0.94, 0.44, 0.76, and 0.80, respectively. There was poor inter-modality agreement for the location of cardiac abnormalities (k = 0.02). Over the median follow-up of 2.2 years, there were 18 (35%) adverse events. Cardiac RV PET abnormalities and presence of LGE were independent predictors of adverse events. Abnormalities found on both PET and magnetic resonance imaging was the strongest predictor of major adverse cardiac events. Conclusion: Simultaneous PET/MR is an accurate method for diagnosing CS. FDG-PET and CMR combined offers complementary information on disease pathophysiology. The presence of LGE and FDG uptake on PET/MR identifies patients at higher risk of adverse events. PET and CMR should therefore be considered in the assessment of disease presence, stage, and prognosis in CS.
Authors: Thomas A Hope; Zahi A Fayad; Kathryn J Fowler; Dawn Holley; Andrei Iagaru; Alan B McMillan; Patrick Veit-Haiback; Robert J Witte; Greg Zaharchuk; Ciprian Catana Journal: J Nucl Med Date: 2019-05-23 Impact factor: 10.057
Authors: Marc A Miller; David H Adams; Dimosthenis Pandis; Philip M Robson; Amit Pawale; Renata Pyzik; Steve L Liao; Ahmed El-Eshmawi; Percy Boateng; Jalaj Garg; Stephen Waterford; Menachem M Weiner; Srinivas R Dukkipati; Vivek Y Reddy; Zahi A Fayad; Maria G Trivieri Journal: JAMA Cardiol Date: 2020-05-27 Impact factor: 14.676
Authors: Marc A Miller; David H Adams; Dimosthenis Pandis; Philip M Robson; Amit Pawale; Renata Pyzik; Steve L Liao; Ahmed El-Eshmawi; Percy Boateng; Jalaj Garg; Stephen Waterford; Menachem M Weiner; Srinivas R Dukkipati; Vivek Y Reddy; Zahi A Fayad; Maria G Trivieri Journal: JAMA Cardiol Date: 2020-09-01 Impact factor: 14.676
Authors: Maria Giovanna Trivieri; Paolo Spagnolo; David Birnie; Peter Liu; Wonder Drake; Jason C Kovacic; Robert Baughman; Zahi A Fayad; Marc A Judson Journal: J Am Coll Cardiol Date: 2020-10-20 Impact factor: 24.094