Evaluation and Management of Cardiac Sarcoidosis with Advanced Imaging

Shrivastav, Rishi; Hajra, Adrija; Shanmuganandan, Krishnan; Bandyopadhyay, Dhrubajyoti; Ranjan, Pragya; Fuisz, Anthon

doi:10.1016/j.hfc.2023.06.002

Cited by 6 publications

(5 citation statements)

References 57 publications

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“…Cardiac MRI can take images of the whole heart, mapping the structure and function of the myocardium. T2-weighted imaging can evaluate the degree of myocardial oedema, while late gadolinium enhancement (LGE) imaging can evaluate the presence of fibrosis [ 21 ]. In a study on MRI differentiating cardiac diseases, the results showed that the cardiac sarcoidosis group was mainly characterized by patchy 3-layer LGE ( p = 0.01), while the myocardial infarction group was commonly characterized by confluent transmural LGE ( p = 0.04) and vascular distribution ( p < 0.001).…”

Section: Diagnostic Value Of Imaging In Pulmonary Sarcoidosismentioning

confidence: 99%

Diagnostic Value of Imaging and Serological Biomarkers in Pulmonary Sarcoidosis

Li,

2024

ARM

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Sarcoidosis is a multisystem granulomatous disease of an unknown aetiology. It can exist in many organs. Pulmonary and intrathoracic lymph nodes are most commonly involved. Lung sarcoidosis is uncommon in Asia. However, due to the large population of our country and the development of bronchoscopy, percutaneous lung puncture, and other medical technologies, the number of pulmonary sarcoidosis patients is on the rise. Pulmonary sarcoidosis patients have no obvious symptoms in the early stage, and the clinical manifestations in the later stage may vary from person to person. Eventually, the disease progresses to life-threatening pulmonary fibrosis. Therefore, patients with pulmonary sarcoidosis should receive a timely diagnosis. In recent years, the imaging features and serologic biomarkers of pulmonary sarcoidosis have been continuously studied. The diagnostic value of imaging and serologic biomarkers for pulmonary sarcoidosis is summarized below.

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Section: Diagnostic Value Of Imaging In Pulmonary Sarcoidosismentioning

confidence: 99%

Diagnostic Value of Imaging and Serological Biomarkers in Pulmonary Sarcoidosis

Li,

2024

ARM

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“…47 Dentre as limitações deste exame, destacamos a contraindicação, ao relativa, em indivíduos com taxa de filtração glomerular < 30 mL/min/1,73 m 2 e a dificuldade de interpretação das imagens (devido à presença de artefatos) em indivíduos portadores de dispositivos cardíacos, como marcapasso e cardiodesfibrilador implantável, ainda que compatíveis com aparelhos de ressonância magnética. 48 Integrando os exames de imagem na avaliação do paciente com suspeita de sarcoidose cardíaca Quando se discute a abordagem diagnóstica ideal para indivíduos com suspeita de SC é imprescindível a distinção de pelo menos dois principais cenários: o dos indivíduos que já possuem o diagnóstico prévio de sarcoidose extracardíaca e os que não possuem. 44 Nos primeiros, qualquer sintoma cardiovascular ou alteração em ECG/ ecocardiograma, aumentam a probabilidade de que o miocárdio também seja acometido pela sarcoidose, indicando prosseguir a investigação…”

Section: Moure Et Al Sarcoidose Cardíaca: O Camaleão Da Cardiologiaunclassified

Sarcoidose Cardíaca: O Camaleão da Cardiologia

Moura,

Monteiro Neto,

Melo

et al. 2024

Arq Bras Cardiol: Imagem cardiovasc.

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A sarcoidose é uma doença granulomatosa multissistêmica de etiologia desconhecida, caracterizada pela formação de granulomas não caseosos em vários órgãos. O envolvimento cardíaco, importante causa de morbimortalidade nestes indivíduos, vem gerando interesse na cardiologia por ser uma causa de insuficiência cardíaca, bloqueios atrioventriculares e arritmias ventriculares de prognóstico reservado, mas que possuem tratamento específico com potencial de mudança da história natural desta condição. O grande desafio da sarcoidose cardíaca é o seu diagnóstico, uma vez que o método padrão ouro, a biópsia endomiocárdica, possui sensibilidade limitada devido à natureza focal da patologia. Desta forma, cabe aos métodos de imagem cardiovasculares o papel de nortear a maior parte dos diagnósticos de sarcoidose cardíaca. Neste cenário, o conhecimento sobre estes métodos, suas principais alterações e o seu uso racional são imprescindíveis para que esta doença de apresentação tão diversa possa ser diagnosticada. No eletrocardiograma e na ecocardiografia tem-se exames práticos e de ampla disponibilidade, no entanto com maior capacidade diagnóstica nos pacientes que apresentam a doença clinicamente manifesta. Já para a identificação das formas incipientes, muitas vezes silenciosas, é preciso lançar mão dos métodos de imagem avançada, como tomografia por emissão de pósitrons com o 18F-fluor-2-desoxiglicose e a ressonância magnética cardíaca, que identificam primordialmente indícios de atividade inflamatória ativa e sequelas cicatriciais, respectivamente. Apesar do avanço destes métodos de imagem, a carência de estudos comparando-os com o padrão ouro (a biópsia endomiocárdica) faz o que o diagnóstico da sarcoidose cardíaca ainda seja um grande desafio nos dias atuais.

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“…47 Regarding the limitations of this exam, we highlight the at least relative contraindication in patients with glomerular filtration rate < 30 mL/min/1.73 m 2 and the difficulties in image interpretation (due to the presence of artifacts) in patients with cardiac devices, such as pacemakers and implantable cardioverter defibrillators, even though they are compatible with magnetic resonance devices. 48 Integrating imaging exams in the assessment of patients with suspected CS When discussing the ideal diagnostic approach for individuals with suspected CS, it is essential to distinguish at least two main scenarios: patients who already have a previous diagnosis of extracardiac sarcoidosis and those who do not. 44 In the former case, any cardiovascular symptom or alteration on ECG/echocardiography increases the probability that the myocardium is also affected by sarcoidosis, indicating further investigation with CMR, generally followed by FDG-PET, and, in exceptional cases, endomyocardial biopsy 8 (Figure 3).…”

Section: Role Of Cardiac Magnetic Resonance Imagingmentioning

confidence: 99%

Cardiac Sarcoidosis: The Chameleon of Cardiology

De Moura,

Monteiro,

de Melo

et al. 2024

ABC Imagem Cardiovascular

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Sarcoidosis is a multisystemic granulomatous disease of unknown etiology, characterized by the formation of noncaseating granulomas in multiple organs. Cardiac involvement, an important cause of morbidity and mortality in these patients, has been generating interest in cardiology, because it is a cause of heart failure, atrioventricular blocks, and ventricular arrhythmias with unfavorable prognosis; however, there are specific treatments with the potential to change the natural history of this condition. The main challenge of cardiac sarcoidosis (CS) is diagnosis, given that the gold standard method of endomyocardial biopsy has limited sensitivity due to the focal nature of the pathology.Accordingly, cardiovascular imaging methods play the role of guiding most diagnoses of CS. In this scenario, knowledge about these methods, their main findings, and their rational use are essential to the diagnosis of this disease with such diverse presentations.Electrocardiogram and echocardiography are practical and widely available exams; however, they provide greater diagnostic capacity in patients with clinically manifest disease. On the other hand, to identify incipient forms, which are often silent, it is necessary to use advanced imaging methods, such as positron emission tomography with 18F-fluorodeoxyglucose and cardiac magnetic resonance, which primarily identify signs of active inflammatory activity and fibrosis, respectively. Despite the advances in these imaging methods, due to the lack of studies comparing them with the gold standard (endomyocardial biopsy), the diagnosis of CS currently remains a major challenge.

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Evaluation and Management of Cardiac Sarcoidosis with Advanced Imaging

Cited by 6 publications

References 57 publications

Diagnostic Value of Imaging and Serological Biomarkers in Pulmonary Sarcoidosis

Diagnostic Value of Imaging and Serological Biomarkers in Pulmonary Sarcoidosis

Sarcoidose Cardíaca: O Camaleão da Cardiologia

Cardiac Sarcoidosis: The Chameleon of Cardiology

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