Effect of Immunosuppressive Therapy and Biopsy Status in Monitoring Therapy Response in Suspected Cardiac Sarcoidosis

Rojulpote, Chaitanya; Bhattaru, Abhijit; Jean, Christopher; Adams, Sarah LaChance; Patel, Vandan; Vidula, Mahesh K.; Selvaraj, Senthil; Dubroff, Jacob; Peyster, Eliot; Clancy, Caitlin B.; Patterson, Karen; Marchlinski, Francis E.; Rossman, Milton D.; Goldberg, Lee R.; Bravo, Paco E.

doi:10.1016/j.jcmg.2022.05.015

Cited by 15 publications

(5 citation statements)

References 16 publications

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“…12,[68][69][70] Corticosteroids are initiated at doses of 30 to 40 mg/d of prednisone equivalent because there is no demonstrated benefit with higher starting doses. [71][72][73] For those with life-threatening manifestations such as cardiogenic shock, higher initial corticosteroid doses, including intravenous doses of methylprednisolone of up to 1000 mg/d, can be prescribed until other causes of acute myocarditis (such as giant-cell myocarditis) are excluded.…”

Section: Immunomodulating Agentsmentioning

confidence: 99%

Diagnosis and Management of Cardiac Sarcoidosis: A Scientific Statement From the American Heart Association

Cheng,

Kittleson,

Beavers

et al. 2024

Circulation

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Cardiac sarcoidosis is an infiltrative cardiomyopathy that results from granulomatous inflammation of the myocardium and may present with high-grade conduction disease, ventricular arrhythmias, and right or left ventricular dysfunction. Over the past several decades, the prevalence of cardiac sarcoidosis has increased. Definitive histological confirmation is often not possible, so clinicians frequently face uncertainty about the accuracy of diagnosis. Hence, the likelihood of cardiac sarcoidosis should be thought of as a continuum (definite, highly probable, probable, possible, low probability, unlikely) rather than in a binary fashion. Treatment should be initiated in individuals with clinical manifestations and active inflammation in a tiered approach, with corticosteroids as first-line treatment. The lack of randomized clinical trials in cardiac sarcoidosis has led to treatment decisions based on cohort studies and consensus opinions, with substantial variation observed across centers. This scientific statement is intended to guide clinical practice and to facilitate management conformity by providing a framework for the diagnosis and management of cardiac sarcoidosis.

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Section: Immunomodulating Agentsmentioning

confidence: 99%

Diagnosis and Management of Cardiac Sarcoidosis: A Scientific Statement From the American Heart Association

Cheng,

Kittleson,

Beavers

et al. 2024

Circulation

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“…It was shown that reduction of myocardial inflammation was associated with an improvement in LVEF [ 26 , 46 , 47 , 102 ]. Several studies indicated that serial FDG-PET is feasible to determine the extent of disease activity and to quantitatively assess the response of CS to therapy [ 103 , 104 ]. To evaluate response to treatment baseline and follow-up cardiac FDG-PET scans are performed.…”

Section: Treatmentmentioning

confidence: 99%

“…Other centers use clinical assessment, ECG, device interrogation, echocardiography and biomarkers to assess patient response and use a selective PET strategy, performing repeated PET study only if the results of the above mentioned examinations are discrepant, or raise suspicion of insufficient treatment response or relapse. Their rationale for the selective PET strategy is that in a recent study the rate of major cardiac events did not differ significantly between patients showing a complete clearance of FDG uptake vs. no response on early follow-up PET [ 20 , 26 , 104 ]. After discontinuing immunosuppressive therapy follow-up visits continue annually for 3–5 years and every other year thereafter [ 20 ].…”

Section: Treatmentmentioning

confidence: 99%

Cardiac Sarcoidosis: A Comprehensive Clinical Review

Vereckei,

Besenyi,

Nagy

et al. 2024

Rev. Cardiovasc. Med.

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Sarcoidosis is an inflammatory multisystemic disease of unknown etiology characterized by the formation of non-caseating granulomas. Sarcoidosis can affect any organ, predominantly the lungs, lymphatic system, skin and eyes. While 90% of patients with sarcoidosis have lung involvement, an estimated 5% of patients with sarcoidosis have clinically manifest cardiac sarcoidosis (CS), whereas approximately 25% have asymptomatic, clinically silent cardiac involvement verified by autopsy or imaging studies. CS can present with conduction disturbances, ventricular arrhythmias, heart failure or sudden cardiac death. Approximately 30% of 60-year-old patients presenting with unexplained high degree atrioventricular (AV) block or ventricular tachycardia are diagnosed with CS, therefore CS should be strongly considered in such patients. CS is the second leading cause of death among patients affected by sarcoidosis after pulmonary sarcoidosis, therefore its early recognition is important, because early treatment may prevent death from cardiovascular involvement. The establishment of isolated CS diagnosis sometimes can be quite difficult, when extracardiac disease cannot be verified. The other reason for the difficulty to diagnose CS is that CS is a chameleon of cardiology and it can mimic (completely or almost completely) different cardiac diseases, such as arrhythmogenic cardiomyopathy, giant cell myocarditis, dilated, restrictive and hypertrophic cardiomyopathies. In this review article we will discuss the current diagnosis and management of CS and delineate the potential difficulties and pitfalls of establishing the diagnosis in atypical cases of isolated CS.

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“…Nuclear imaging has become increasingly clinically relevant in diagnosing infections, specifically with the use of fluorodeoxyglucose (FDG) radiotracer with positron emission tomography (PET) [52,53]. The utility of PET has expanded far beyond its original oncological purpose to study various conditions, including infectious disease, inflammatory cardiological conditions, neurodegeneration, and nephritis [54][55][56][57][58][59][60][61]. FDG-PET is incredibly specific for detecting granulomatous and nodular inflammation, particularly at the early stages of disease burden.…”

Section: Diagnosismentioning

confidence: 99%

Acrophialophora: A Comprehensive Review of Clinical Guidelines and Diagnosis

Bhattaru¹,

Blanchard²,

Kunamneni³

et al. 2023

Cureus

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Acrophialophora is a saprotrophic genus of fungi found in both temperate and tropical regions. The genus is comprised of 16 species, with the subspecies A. fusispora and A. levis necessitating the most clinical concern. Acrophialophora is an opportunistic pathogen with a broad range of clinical manifestations; the fungus has been implicated in cases of fungal keratitis, lung infection, and brain abscess. Acrophialophora infection is particularly of concern for immunocompromised patients, who often present with a more severe disease course involving disseminated infection and may not exhibit typical symptoms. Early diagnosis and therapeutic intervention are critical to the successful clinical management of Acrophialophora infection. Guidelines for antifungal treatment have yet to be established, partially due to the lack of documented cases. Aggressive use of antifungal agents and long-term treatment is required, especially in immunocompromised patients and patients with systemic involvement, due to the potential for morbidity and mortality. In addition to outlining the rarity and epidemiology of the disease, this review provides an overview of the diagnosis and clinical management of Acrophialophora infection to facilitate an early diagnosis and appropriate interventions.

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Effect of Immunosuppressive Therapy and Biopsy Status in Monitoring Therapy Response in Suspected Cardiac Sarcoidosis

Cited by 15 publications

References 16 publications

Diagnosis and Management of Cardiac Sarcoidosis: A Scientific Statement From the American Heart Association

Diagnosis and Management of Cardiac Sarcoidosis: A Scientific Statement From the American Heart Association

Cardiac Sarcoidosis: A Comprehensive Clinical Review

Acrophialophora: A Comprehensive Review of Clinical Guidelines and Diagnosis

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