The usefulness of delayed enhancement magnetic resonance imaging for diagnosis and evaluation of cardiac function in patients with cardiac sarcoidosis

Matoh, Fumitaka; Satoh, Hiroshi; Shiraki, Katsunori; Odagiri, Keiichi; Saitoh, Takeji; Urushida, Tsuyoshi; Katoh, Hideki; Takehara, Yasuo; Sakahara, Harumi; Hayashi, Hideharu

doi:10.1016/j.jjcc.2008.03.002

Cited by 53 publications

(30 citation statements)

References 33 publications

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“…In accordance with other studies subepicardial LGE was almost exclusively found in patients with peri-/myocarditis [1,11] , while sarcoidosis another known disease with subepicardial enhancement and a cardiac involvement of 50% [20] did not show a specific pattern in our study [8,11] . However, as only 2 patients suffered from sarcoidosis in our study a detailed analysis of LGE pattern was not possible.…”

Section: Discussionsupporting

confidence: 93%

“…Late gadolinium enhancement (LGE) is a substantial part of CMR and is highly valued in both differentiating between ischemic and non-ischemic myocardial disease as shown by various studies [1][2][3][4][5][6][7][8][9][10][11] as well as identifying primary or secondary cardiomyopathy. LGE uses extracellular paramagnetic, Gadolinium-based contrast agents and reflects edema, myocyte necrosis or fibrosis of different etiologies.…”

Section: Introductionmentioning

confidence: 99%

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Spectra and appearance of late gadolinium enhancement in magnetic resonance imaging of non-ischemic myocardial disease - from pattern to diagnosis

Heilmaier

Franzen

Naßenstein

et al. 2014

IJDI

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Objective: Value of late gadolinium enhancement (LGE) in diagnosis of ischemic disorders in cardiac magnetic resonance is well-known. The purpose of the present paper was to describe more details and characteristics of LGE patterns arising in several non-ischemic myocardial diseases. Methods:Cardiac MRI was performed in 1,905 patients at a 1.5-T MR system and showed LGE with 1,646/1,905 demonstrating LGE patterns or other diagnostic criteria (e.g. laboratory results, ECG, coronary angiography findings) regarded typical for ischemic heart disease. The remaining 259/1,905 patients revealed LGE related to non-ischemic myocardial disease. Two experts (radiologists and/or cardiologist) qualitatively described LGE pattern in consensus reading with regard to its site (left or right ventricle), extent (subendocardial, midmyocardial, subepicardial, transmural, pericardial), segment (according to the 17-segment model of left ventricle (LV)), distribution (streaky, patchy, punctual, spotty, crescent, diffuse), and intensity (weak, moderate, strong). Thereafter, results were correlated to final diagnosis based on synopsis of clinical features, laboratory results, ECG, biopsy, or other imaging procedures. Results:In 250/259 patients (96.5%) only the LV was affected by LGE, most frequently midmyocardial (166/259). In most cases this was due to peri-/myocarditis (especially if of weak-moderate intensity), while a weaker, streaky or spotty LGE basal or lateral pointed to HCM (39/166) and streaky and lateral to DCM (20/166). A midmyocardial, patchy LGE in segment 3 and 5 was caused by Fabry's disease (6x). In case of a transmural, spotty or patchy pattern LGE pointed to HCM, if intensity was weak-moderate, or to peri-/myocarditis, when LGE was moderate-strong. In addition to that, subepicardial LGE in basal segments with patchy, streaky, or spotty distribution and moderate intensity was also due to peri-/myocarditis, while it was located midventricular, spotty and weak in TASH (transcoronary ablation of septum hypertrophy). Conclusions: SeveralLGE patterns point to certain non-ischemic myocardial diseases and thereby might facilitate and confine differential diagnosis and might be useful in biopsy planing.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Spectra and appearance of late gadolinium enhancement in magnetic resonance imaging of non-ischemic myocardial disease - from pattern to diagnosis

Heilmaier

Franzen

Naßenstein

et al. 2014

IJDI

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“…Recently, use of late gadolinium enhancement and T2-weighted MRI and 18F-fluorodeoxyglucose positron emission tomography for the detection of occult granuloma sites and residual sarcoidosis activity was reported. 18,19 Combined use of these multimodality techniques with gallium uptake may enhance prediction of corticosteroid effectiveness for VT recurrence. Late gadolinium enhancement MRI might have contributed to identification of patients requiring epicardial access.…”

Section: Study Limitationsmentioning

confidence: 99%

Systematic Treatment Approach to Ventricular Tachycardia in Cardiac Sarcoidosis [RETRACTED]

Naruse

Sekiguchi

Nogami

et al. 2014

Circ: Arrhythmia and Electrophysiology

114

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Background— Fatal arrhythmia is commonly observed in cardiac sarcoidosis, but clinical effects of a systematic treatment approach are still uncertain. This study sought to describe both clinical and electrophysiological characteristics and outcomes of systematic treatment approach to ventricular tachycardia (VT) associated with cardiac sarcoidosis. Methods and Results— We enrolled 37 consecutive patients (11 men; age, 56±11 years) with a diagnosis of sustained VT associated with cardiac sarcoidosis. Clinical effects of a systematic treatment approach including medical therapy (both steroid and antiarrhythmic agents), in association with radiofrequency catheter ablation, were evaluated. All patients received antiarrhythmic agents, and 34 received steroid therapy. During a 39-month follow-up, 23 (62%) patients were free from any VT episodes with medical therapy. Multivariable Cox regression analyses revealed that the absence of gallium-67 myocardial uptake was an independent predictor for VT recurrence (hazard ratio, 7.51; 95% confidence interval, 1.65–34.26; P <0.01). Fourteen patients who experienced VT recurrences even while on drug therapy underwent radiofrequency catheter ablation. Electrophysiological study revealed that the mechanisms of VTs could be classified into 2 subgroups: Purkinje-related or scar-related VT. The QRS duration of VT was narrower in Purkinje-related than in scar-related VTs (157±23 versus 183±22 ms; P <0.05). After a 33-month follow-up subsequent to the radiofrequency catheter ablation, 6 of 14 patients experienced VT recurrence. The number of VTs sustained during electrophysiological study was higher in the patients with VT recurrence than in those without (3.7±1.4 versus 1.9±0.8; P <0.01). Conclusions— A systematic treatment approach to cardiac sarcoidosis with VT successfully suppressed VT recurrences in the majority of patients studied.

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“…Ohira et al have shown that cardiac MRI has a better specificity, but a lower sensitivity than FDG-PET [33]. The value of MRI in evaluation of the prognosis of the disease is directly dependent on the degree of myocardial involvement [6,34,35]. Since a powerful magnetic field may affect defibrillator settings, MRI is not safe for patients with pacemakers and implantable defibrillators and is not recommended in those cases [36].…”

Section: Discussionmentioning

confidence: 99%

Cardiac sarcoidosis: A review on the work-up and management

et al. 2012

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AbstractSarcoidosis is a multisystem granulomatous disease of unknown etiology and with variable presentation. Skin, lymph nodes, lungs, eyes and the central nervous system are mostly involved. Cardiac sarcoidosis (CS) is a rare condition with clinical manifestations in about 5% of patients. Since it increases the risk of acute cardiac failure, ventricular arrhythmia, conduction disturbances and even sudden death, it aggravates markedly the prognosis. The early diagnosis of CS is difficult, requiring the use of diagnostic tools such as electrocardiographic monitoring, two-dimensional echocardiography, radionuclide scan, cardiac magnetic resonance imaging, positron emission tomography and endomyocardial biopsy. Once the diagnosis of CS is established, there is a need for early corticosteroids treatment, with or without immunosuppressive therapy, to prevent deterioration of cardiac function. In patients with refractory ventricular tachyarrhythmia, markedly reduced left ventricular ejection fraction and high risk of sudden death, prophylactic insertion of a pacemaker or implantable defibrillator is recommended. We had the opportunity to treat a patient with CS and to review the currently accepted diagnostic and treatment approach.

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The usefulness of delayed enhancement magnetic resonance imaging for diagnosis and evaluation of cardiac function in patients with cardiac sarcoidosis

Abstract: DE-MRI is useful to diagnose the cardiac involvement of sarcoidosis and to evaluate cardiac function. It is likely that the distribution of DE in mid- to epi-myocardium is the characteristic of cardiac sarcoidosis, and the larger DE area may be correlated with poor LV function.

Cited by 53 publications

References 33 publications

Spectra and appearance of late gadolinium enhancement in magnetic resonance imaging of non-ischemic myocardial disease - from pattern to diagnosis

Spectra and appearance of late gadolinium enhancement in magnetic resonance imaging of non-ischemic myocardial disease - from pattern to diagnosis

Systematic Treatment Approach to Ventricular Tachycardia in Cardiac Sarcoidosis [RETRACTED]

Cardiac sarcoidosis: A review on the work-up and management

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