Assessment of Cardiac Sarcoidosis with Advanced Imaging Modalities

Orii, Makoto; Imanishi, Toshio

doi:10.1155/2014/897956

Cited by 23 publications

(13 citation statements)

References 82 publications

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“…Autopsy findings have shown myocardial involvement in at least 25% of patients, which could be underestimated due to the microscopic nature of the involvement . Conclusive findings on endomyocardial biopsy can be pathognomonic for CS; however, most often have low diagnostic yield, largely due to its patchy distribution . Therefore, noninvasive tools have been extensively studied to identify sensitive parameters reflecting cardiac infiltration.…”

Section: Discussionmentioning

confidence: 99%

“…1 Conclusive findings on endomyocardial biopsy can be pathognomonic for CS; however, most often have low diagnostic yield, largely due to its patchy distribution. 15 Therefore, noninvasive tools have been extensively studied to identify sensitive parameters reflecting cardiac infiltration. On echocardiography, classic features of CS include regional wall motion abnormalities and wall thinning, usually of the basal anterior septum.…”

Section: Discussionmentioning

confidence: 99%

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Right Heart Involvement in Patients with Sarcoidosis

et al. 2016

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The left ventricle (LV) is affected in 20-25% of patients with sarcoidosis and its involvement is associated with morbidity and mortality. However, effects of sarcoidosis on the right ventricle (RV) are not well documented. Our aims were to investigate the prevalence of RV dysfunction in patients with sarcoidosis and determine whether it is predominantly associated with direct cardiac involvement, severity of lung disease, or pulmonary hypertension (PH). We identified 50 patients with biopsy-proven extra-cardiac sarcoidosis and preserved LV function, who underwent echocardiography, pulmonary function (PF) testing, and cardiovascular magnetic resonance. RV function was quantified by free wall longitudinal strain. Tricuspid valve Doppler and estimated right atrial pressure were used to estimate systolic pulmonary artery pressure. Myocardial late gadolinium enhancement was considered diagnostic for cardiac sarcoidosis and assumed to involve both ventricles. Of the 50 patients, 28 (56%) had RV dysfunction, 4 with poorly defined PF status. Of the remaining 24 patients, 16 (67%) had lung disease, 8 (33%) had PH, and 10 (42%) had LV involvement. Ten patients had greater than one of these findings, and 4 had all 3. In contrast, in 4/24 patients (17%), RV dysfunction could not be explained by these mechanisms, despite severely reduced RV strain. In conclusion, RV dysfunction is common in patients with sarcoidosis and is usually associated with either direct LV involvement, lung disease, or PH, but may occur in the absence of these mechanisms, suggesting the possibility of isolated RV involvement and underscoring the need for imaging protocols that would include RV strain analysis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Right Heart Involvement in Patients with Sarcoidosis

et al. 2016

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“…Myocardial granulomas are detected post-mortem in 12 to 25% of patients with extracardiac sarcoidosis [1,2]. These granulomas lead to subclinical myocardial inflammation, edema, fibrosis, and scars, which in turn result in ventricular remodeling and systolic dysfunction [3]. The prognosis of cardiac sarcoidosis (CS) is poor; a 5-year mortality rate of 25 to 40% in the advanced stages of CS is attributable to arrhythmias, restrictive cardiomyopathy, and sudden cardiac death [4,5].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic and predictive value of speckle tracking echocardiography in cardiac sarcoidosis

Stefano

Bruno

Calle

et al. 2020

BMC Cardiovasc Disord

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Background: Sarcoidosis is a systemic granulomatous disease that may affect the myocardium. This study evaluated the diagnostic and prognostic value of 2-dimensional speckle tracking echocardiography in cardiac sarcoidosis (CS). Methods: Eighty-three patients with extracardiac, biopsy-proven sarcoidosis and definite/probable diagnosis of cardiac involvement diagnosed from January 2005 through December 2016 were included. Strain parameters in early stages of CS, in a subgroup of 23 CS patients with left ventricular ejection fraction (LVEF) within normal limits (LVEF> 52% for men: > 54% for women, mean value: 57.3% ± 3.8%) and no wall motion abnormalities was compared with 97 controls (1:4) without cardiac disease. LV and right ventricular (RV) global longitudinal (GLS), circumferential (GCS), and radial (GRS) strain and strain rate (SR) analyses were performed with TomTec software and correlated with cardiac outcomes (including heart failure and arrhythmias). This study was approved by the Mayo Clinic Institutional Review Board, and all patients gave informed written consent to participate. Results: Mean age of CS patients was 53.6 ± 10.8 years, and 34.9% were women. Mean LVEF was 43.2% ± 12.4%; LV GLS, − 12.4% ± 3.7%; LV GCS, − 17.1% ± 6.5%; LV GRS, 29.3% ± 12.8%; and RV wall GLS, 14.6% ± 6.3%. In the 23 patients with early stage CS with normal LVEF and RV systolic function, strain parameters were significantly reduced when compared with controls (respectively: LV GLS, − 15.9% ± 2.5% vs − 18.2% ± 2.7% [P = .001]; RV GLS, − 16.9% ± 4.5% vs − 24.1% ± 4.0% [P < .001]). A LV GLS value of − 16.3% provided 82.2% sensitivity and 81.2% specificity for the diagnosis of CS (AUC 0.91), while a RV value of − 19.9% provided 88.1% sensitivity and 86.7% specificity (AUC 0.93). Hospital admission and heart failure significantly correlated to impaired LV GLS (> − 14%). Conclusion: Reduced strain values in the LV GLS and RV GLS can be used in the diagnostic algorithm in patients with suspicion of cardiac sarcoidosis. These values also correlate with adverse cardiovascular events.

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“…The diagnosis of CS lacks reliable and specific tools, particularly during the early stages of the disease [24]. Cardiac magnetic resonance can facilitate both the diagnosis and assessment of response to treatment for cardiac sarcoidosis.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Magnetic Resonance Imaging for Diagnosis of Cardiac Sarcoidosis: A Meta-Analysis

Zhang

et al. 2018

Canadian Respiratory Journal

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Background Cardiac magnetic resonance imaging (CMR) is an effective technique for the diagnosis of cardiac sarcoidosis (CS). The efficacy of CMR versus the Japanese Ministry of Health and Welfare (JMHW) guidelines considered as standard criterion for the diagnosis of CS remains to be elucidated. Methods In this systematic review and meta-analysis, we aimed at assessing the diagnostic accuracy of CMR in cardiac sarcoidosis. We searched on PubMed from January 1, 1980, to March 28, 2018, on Embase from January 1, 1980, to March 29, 2018, and on the Cochrane Library from January 1, 1980, to April 1, 2018, using a strategy based on the search terms (sarcoidosis and magnetic resonance imaging) independently. We analyzed the data obtained with Revman 5.3 and Stata 14.0 software. Results Eight studies with a total of 649 participants met the inclusion criteria, and data were extracted. CMR had an overall sensitivity of 0.93 (95% confidence interval (CI), 0.87–0.97) and specificity of 0.85 (95% CI, 0.68–0.94) for the diagnosis of cardiac sarcoidosis. The area under the summary receiver operating characteristic (SROC) curve was 0.95 (95% CI, 0.93–0.97). The subgroup analysis via public year showed that studies between 2011 and 2017 had an overall sensitivity of 0.95 (95% CI, 0.88–0.98) and specificity of 0.92 (95% CI, 0.49–0.99), with an area under the SROC curve being 0.96. Conclusions The results of this meta-analysis suggest that CMR could be used for the diagnosis of cardiac sarcoidosis and screening of patients suspected of CS. With the improvement of the technique, the diagnostic accuracy of MRI has improved.

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Assessment of Cardiac Sarcoidosis with Advanced Imaging Modalities

Cited by 23 publications

References 82 publications

Right Heart Involvement in Patients with Sarcoidosis

Right Heart Involvement in Patients with Sarcoidosis

Diagnostic and predictive value of speckle tracking echocardiography in cardiac sarcoidosis

Cardiac Magnetic Resonance Imaging for Diagnosis of Cardiac Sarcoidosis: A Meta-Analysis

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