Diagnosis of cardiac sarcoidosis: an era of paradigm shift

Sharma, Apurva; Okada, David R.; Yacoub, Harout; Chrispin, Jonathan; Bokhari, Sabahat

doi:10.1007/s12149-019-01431-z

Cited by 21 publications

(18 citation statements)

References 34 publications

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“…10 One explanation for this observation is that LGE detects fibrosis or scar tissue which is histologically a late finding of CS, while early inflammation or edema may not be detected unless a T2 sequence was used. 4,7 This is clinically relevant, as an autopsy study of 84 patients demonstrated that even microscopic myocardial sarcoidosis could account for arrhythmias and sudden cardiac death. 3 In a separate analysis of sarcoidosis patients that included studies, LVGLS was significantly lower in patients who suffered…”

Section: Discussionmentioning

confidence: 99%

“…6 Very rarely, cardiac involvement or even sudden cardiac death may be the first manifestation of systemic sarcoidosis. 7 Currently, all patients with biopsy-proven extra-cardiac sarcoidosis routinely undergo screening for cardiac sarcoidosis with an electrocardiogram (EKG), with or without an echocardiogram. 5 Advanced imaging modalities such as (CMR) and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) are reserved for individuals suspected to have cardiac involvement based on initial screening.…”

Section: Introductionmentioning

confidence: 99%

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Speckle tracking echocardiography can predict subclinical myocardial involvement in patients with sarcoidosis: A meta‐analysis

et al. 2020

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Background: This meta-analysis aims to evaluate the utility of speckle tracking echocardiography (STE) as a tool to evaluate for cardiac sarcoidosis (CS) early in its course. Electrocardiography and echocardiography have limited sensitivity in this role, while advanced imaging modalities such as cardiac magnetic resonance (CMR) and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) are limited by cost and availability. Methods: We compiled English language articles that reported left ventricular global longitudinal strain (LVGLS) or global circumferential strain (GCS) in patients with confirmed extra-cardiac sarcoidosis versus healthy controls. Studies that exclusively included patients with probable or definite CS were excluded. Continuous data were pooled as a standard mean difference (SMD), comparing sarcoidosis group with healthy controls. A random-effect model was adopted in all analyses. Heterogeneity was assessed using Q and I2 statistics. Results: Nine studies were included in our final analysis with an aggregate of 967 patients. LVGLS was significantly lower in the extra-cardiac sarcoidosis group as compared with controls, SMD −3.98, 95% confidence interval (CI): −5.32, −2.64, P < .001, also was significantly lower in patients who suffered major cardiac events (MCE), −3.89, 95% CI −6.14, −1.64, P < .001. GCS was significantly lower in the extra-cardiac sarcoidosis group as compared with controls, SMD: −3.33, 95% CI −4.71, −1.95, P < .001. Conclusion: LVGLS and GCS were significantly lower in extra-cardiac sarcoidosis patients despite not exhibiting any cardiac symptoms. LVGLS correlates with MCEs in CS. Further studies are required to investigate the role of STE in the early screening of CS.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Speckle tracking echocardiography can predict subclinical myocardial involvement in patients with sarcoidosis: A meta‐analysis

et al. 2020

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“…Due to its patchy and mid-myocardial involvement, EMB has an elevated number of false-negative and there is an ongoing debate whether positive histology is required for the diagnosis. 26 New imaging techniquespositron emission tomography (PET), cardiac magnetic resonance imaging (MRI), electrocardiography, and electroanatomic voltage mapping -can increase the sensitivity of the EMB. 27 The JMHW defines the presence of myocardial Gallium-67 uptake, a SPECT tracer, as a major criterion, due to its high specificity (despite its low sensitivity).…”

Section: Diagnosismentioning

confidence: 99%

The Role of 18F-FDG PET/CT in Cardiac Sarcoidosis

Wiefels¹,

Lamai²,

Kandolin³

et al. 2020

International Journal of Cardiovascular Sciences

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Cardiac sarcoidosis (CS) is a rare and potentially fatal condition, characterized by the presence of non-necrotizing granulomatous inflammation and concomitant fibrosis. A variety of clinical manifestation has been described, such as conduction disorders, ventricular arrythmias, congestive heart failure and sudden cardiac death, making a prompt diagnosis and early treatment desirable. Endomyocardial biopsy is the gold-standard diagnostic test, but has a low sensitivity due to the multifocal aspect of the disease. Advanced imaging modalities, such as cardiac magnetic resonance and positron emission tomography (PET) with 18F-fluorodeoxyglucose are now part of the diagnostic criteria and also assist in determining treatment response. However, the interpretation of those studies can be challenging and needs to be made by specialists, as the misdiagnosis could be harmful for the patient. This article describes the pathophysiology of CS and advanced imaging modalities (with a major focus on PET) that should be considered for diagnostic approach and therapy monitoring. Also, newer clinical trials evaluating treatment strategies are described.

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“… 4) PET can detect all types of cardiac amyloidosis ( 9 ) using specific ligands, e.g., 11 C-PIB ( Fig. 3 ) and help diagnose cardiac sarcoidosis by visualizing cardiac areas of high metabolism corresponding to sarcoid granulomas ( 10 ). 5)PET assessment of how well the myocyte transforms chemical into mechanical energy (myocardial external efficiency; 11), up to now still a research area.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%