JCS 2016 Guideline on Diagnosis and Treatment of Cardiac Sarcoidosis　― Digest Version ―

Terasaki, Fumio; Azuma, Arata; Anzai, Toshihisa; Ishizaka, Nobukazu; Ishida, Yoshiteru; Isobe, Mitsuaki; Inomata, Takayuki; Ishibashi‐Ueda, Hatsue; Eishi, Yoshinobu; Kitakaze, Masafumi; Kusano, Kengo; Sakata, Yasushi; Shijubo, Noriharu; Tsuchida, Akihito; Tsutsui, Hiroyuki; Nakajima, Takahito; Nakatani, Satoshi; Horii, Taiko; Yazaki, Yoshikazu; Yamaguchi, Etsuro; Yamaguchi, Tetsuo; Ide, Tomomi; Okamura, Hideo; Kato, Yasuchika; Goya, Masahiko; Sakakibara, Mamoru; Soejima, Kyoko; Nagai, Toshiyuki; Nakamura, Hiroshi; Noda, Takashi; Hasegawa, Takuya; Morita, Hideaki; Ohe, Tohru; Kihara, Yasuki; Saito, Yoshihiko; Sugiyama, Yukihiko; Morimoto, Shin-ichiro; Yamashina, Akira

doi:10.1253/circj.cj-19-0508

Cited by 296 publications

(402 citation statements)

References 280 publications

(205 reference statements)

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“…ICD implantation is recommended for patients with an LVEF of <35% ( 6 , 7 ). As the present patient experienced sustained VT, the use of an ICD was a Class I recommendation according to various treatment guidelines for CS ( 1 , 2 , 8 ). As her left ventricular systolic dysfunction progressed during pharmacotherapy, as shown by the reduction in the LVEF to <35%, we should also have considered using cardiac resynchronization therapy (CRT), which is a Class IIb recommendation ( 1 , 2 ).…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, our patient's 18 F-FDG PET findings at the time of relapse showed abnormal tracer accumulation only in the heart, with no tracer accumulation in lymph nodes or lungs. If her latest 18 F-FDG PET findings had been examined by physicians who only had information on her history, she would have been diagnosed with isolated CS ( 1 , 2 , 12 ). The normal blood levels of ACE and sIL-2R shown at the time of relapse may have been associated with this condition.…”

Section: Discussionmentioning

confidence: 99%

“…Corticosteroids are widely used as first-line immunosuppressants for patients with CS. Corticosteroid therapy should be considered for patients with CS who have high-grade atrioventricular block, ventricular arrhythmias, or cardiac dysfunction ( 1 , 2 ). Although no placebo-controlled, prospective studies have been reported, clinical experience in patients showing improvement in clinical findings after starting corticosteroids has suggested their benefits.…”

Section: Introductionmentioning

confidence: 99%

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A Patient with Cardiac Sarcoidosis in Whom an Abnormal Myocardial Uptake of Fluorine-18 Fluorodeoxyglucose and Sustained Ventricular Tachycardia Recurred 3.5 Years after Discontinuing Oral Corticosteroid Therapy

et al. 2020

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We herein report a woman diagnosed with cardiac sarcoidosis (CS) based on the presence of epithelioid granulomas in non-cardiac organs and clinical findings including sustained ventricular tachycardia (VT) and cardiac dysfunction. She stopped oral corticosteroid after 4 years of treatment, and an abnormal myocardial uptake of fluorine-18 fluorodeoxyglucose and sustained VT recurred 3.5 years later. There is no consensus concerning whether or not corticosteroid therapy should be discontinued in the treatment of CS. As a relapse of sarcoidosis-related inflammation may be associated with life-threatening arrhythmia, some patients should continue corticosteroid therapy, even at low doses.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A Patient with Cardiac Sarcoidosis in Whom an Abnormal Myocardial Uptake of Fluorine-18 Fluorodeoxyglucose and Sustained Ventricular Tachycardia Recurred 3.5 Years after Discontinuing Oral Corticosteroid Therapy

et al. 2020

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“…A lower socioeconomic status has been asso- Table 1. Japanese cardiac sarcoidosis and Heart Rhythm Society guidelines (Birnie et al, 2014;Terasaki et al, 2019).…”

Section: Epidemiologymentioning

confidence: 99%

Cardiac sarcoidosis: diagnosis and management

Markatis¹,

Afthinos²,

Antonakis³

et al. 2020

Rev. Cardiovasc. Med.

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Sarcoidosis is a chronic inflammatory disease of unknown etiology characterized by multi-organ involvement. Endorgan disease consists of granulomatous inflammation, which if left untreated or not resolved spontaneously, leads to permanent fibrosis and end-organ dysfunction. Cardiac involvement and fibrosis in sarcoidosis occur in 5-10% of cases and is becoming increasingly diagnosed. This is due to increased clinical awareness among clinicians and new diagnostic modalities, since magnetic resonance imaging and positron-emission tomography are emerging as "gold standard'' tools replacing endomyocardial biopsy. Despite this progress, isolated cardiac sarcoidosis is difficult to differentiate from other causes of arrhythmogenic cardiomyopathy. Cardiac fibrosis leads to congestive heart failure, arrhythmias and sudden cardiac death. Immunosuppressives (mostly corticosteroids) are used for the treatment of cardiac sarcoidosis. Implantable devices like a cardioverter-defibrillator may be warranted in order to prevent sudden cardiac death. In this article current trends in the pathophysiology, diagnosis and management of cardiac sarcoidosis will be reviewed focusing on published research and latest guidelines. Lastly, a management algorithm is proposed.

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“…From April 2019 to January 2020, 18 F-FDG-PET/CT was performed in 24 consecutive patients for suspected CS or known CS, and their clinical records were reviewed to identify patients for analysis. The inclusion criterion was diagnosis of CS according to the Japanese Society of Sarcoidosis and Other Granulomatous Disorders guidelines [17]. Patients with a history or coexistence of other cardiac disorders were excluded.…”

Section: Study Design and Patient Selectionmentioning

confidence: 99%

Clinical Value of Patlak Ki Images Extracted From Dynamic 18F-FDG PET/CT For Evaluation of The Relationships Between Disease Activity and Clinical Events in Cardiac Sarcoidosis

Nakajo

Ojima

Kawakami

et al. 2020

Preprint

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Background: Cardiac sarcoidosis (CS) has a poor prognosis because of frequent complication of atrioventricular block, ventricular tachycardia and congestive heart failure. Qualitative or quantitative 18F-FDG PET/CT has been used for diagnosing or assessing the disease activity of CS. However, the association between 18F-FDG myocardial uptake and clinical presentations in CS has not yet been clarified, and it is unknown if Patlak Ki images (Ki images) extracted from dynamic 18F-FDG-PET/CT are useful for evaluating the disease activity or clinical events in CS patients. In this context, this study was performed to investigate the usefulness of SUV and Patlak Ki images extracted from dynamic 18F-FDG-PET/CT for evaluating the risk of severe clinical events (SCEs) in CS. Methods: The SUV and Ki myocardial images were generated from 30 dynamic 18F-FDG-PET/CT scans of 21 CS patients including those with cardiac dysfunction and arrhythmic events. SUV parameters and Ki parameters (Ki max, Ki mean, Ki volume) were measured for positive myocardial lesions. The Mann–Whitney U-test or Fisher’s exact test was used appropriately to assess differences between quantitative variables or compare categorical data. The association between each quantitative parameter and presence of SCEs was analyzed by logistic regression analysis.Results: The SUV and Ki mages both were rated as positive in 19 scans and negative in 11 scans with the same incidence of SCEs which were significantly higher in positive than negative scans [cardiac dysfunction: 78.9% (15/19) vs. 27.2% (3/11), p=0.009; arrhythmic events: 65.5% (10/19) vs. 0% (0/11), p=0.004]. In 19 positive scans, neither SUV nor Ki parameters were significantly different between scans of patients with cardiac dysfunction (n=15) and those without (n=4) (p>0.05, each), whereas the three Ki parameters were significantly higher in scans for patients with arrhythmic events (n=10) than in those without (n=9) (p<0.05, each). Logistic regression analysis showed that the Ki volume alone was significantly associated with the risk of arrhythmic events (Odds ratio: 1.11, p=0.047).Conclusion: Patlak Ki images may add value to SUV images for evaluating the risk of SCEs in CS patients.

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JCS 2016 Guideline on Diagnosis and Treatment of Cardiac Sarcoidosis　― Digest Version ―

Cited by 296 publications

References 280 publications

A Patient with Cardiac Sarcoidosis in Whom an Abnormal Myocardial Uptake of Fluorine-18 Fluorodeoxyglucose and Sustained Ventricular Tachycardia Recurred 3.5 Years after Discontinuing Oral Corticosteroid Therapy

A Patient with Cardiac Sarcoidosis in Whom an Abnormal Myocardial Uptake of Fluorine-18 Fluorodeoxyglucose and Sustained Ventricular Tachycardia Recurred 3.5 Years after Discontinuing Oral Corticosteroid Therapy

Cardiac sarcoidosis: diagnosis and management

Clinical Value of Patlak Ki Images Extracted From Dynamic 18F-FDG PET/CT For Evaluation of The Relationships Between Disease Activity and Clinical Events in Cardiac Sarcoidosis

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JCS 2016 Guideline on Diagnosis and Treatment of Cardiac Sarcoidosis ― Digest Version ―

Cited by 296 publications

References 280 publications

A Patient with Cardiac Sarcoidosis in Whom an Abnormal Myocardial Uptake of Fluorine-18 Fluorodeoxyglucose and Sustained Ventricular Tachycardia Recurred 3.5 Years after Discontinuing Oral Corticosteroid Therapy

A Patient with Cardiac Sarcoidosis in Whom an Abnormal Myocardial Uptake of Fluorine-18 Fluorodeoxyglucose and Sustained Ventricular Tachycardia Recurred 3.5 Years after Discontinuing Oral Corticosteroid Therapy

Cardiac sarcoidosis: diagnosis and management

Clinical Value of Patlak Ki Images Extracted From Dynamic 18F-FDG PET/CT For Evaluation of The Relationships Between Disease Activity and Clinical Events in Cardiac Sarcoidosis

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JCS 2016 Guideline on Diagnosis and Treatment of Cardiac Sarcoidosis　― Digest Version ―