The Utility of Whole Body 18F-FDG PET-CT in Diagnosing Isolated Cardiac Sarcoidosis: The Western Australian Cardiac Sarcoid Study

Giudicatti, L.; Marangou, James; Nolan, David; Dembo, L.; Baumwol, Jay; Dwivedi, Girish

doi:10.1016/j.hlc.2019.07.007

Cited by 28 publications

(27 citation statements)

References 11 publications

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“…Previous reports describe ICS as responsible for 25-65% of total CS Okada et al, 2018). More recent data using FDG-PET report a more modest prevalence for ICS (9% of total) (Giudicatti et al, 2020). Scarce data indicate that ICS presents with lower LVEF, more frequent VTs, and necessitate ICDs more frequently than CS with systemic sarcoidosis (Kron et al, 2015;Okada et al, 2018).…”

Section: Isolated Cardiac Sarcoidosismentioning

confidence: 97%

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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Section: Isolated Cardiac Sarcoidosismentioning

confidence: 97%

Cardiac sarcoidosis: diagnosis and management

Markatis¹,

Afthinos²,

Antonakis³

et al. 2020

Rev. Cardiovasc. Med.

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“…Whole Body FDG PET-CT in the Evaluation and Management of Cardiac Sarcoidosis and Isolated Cardiac Sarcoidosis high prevalence ranging from 29-52% of cases of CS [4]. It seems that in the absence of proper staging during the CS workup one may overestimate the cases of ICS.…”

Section: Short Communicationmentioning

confidence: 99%

“…It seems that in the absence of proper staging during the CS workup one may overestimate the cases of ICS. Giudicatti et al, looked into the impact of whole body FDG PET in assessing the true prevalence of ICS [4]. They found it to be much lower at about 9.4%.…”

Section: Short Communicationmentioning

confidence: 99%

Whole Body FDG PET-CT in the Evaluation and Management of Cardiac Sarcoidosis and Isolated Cardiac Sarcoidosis

Djekidel¹

2021

austinjdermatolog

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Introduction Sarcoidosis is a multisystem inflammatory disease defined histologically by the formation of non-caseating granulomas. Cardiac involvement can be seen in up to 5% of cases [1]. These patients are at a high risk for major cardiac events [1]. Diagnosing and monitoring Cardiac Sarcoidosis (CS) is not trivial but can be currently accomplished by a combination of cardiac MRI and cardiac FDG PET-CT scanning [2]. With appropriate patient preparation, cardiac FDG PET has a high sensitivity for detecting cardiac lesions but also extra-cardiac lesions and for monitoring the efficacy of treatment. Discussion Current standard clinical practice consists of acquiring dedicated, limited field of view cardiac FDG PET scans. This would cover the heart and immediately adjacent thoracic structures. Although this is of great value and used with great success to diagnose and monitor cardiac sarcoidosis, it fails to assess the patient’s disease in a holistic manner. Still with this limited field of view, several reports including ours have described a high rate of extra-cardiac findings. We reviewed a series of sixty-five PET-CT scans of 54 patients referred for CS evaluation. These were performed between September 2010 and April 2013 at Yale New Haven Hospital and we found extra-cardiac findings were present in 92.3% of scans (n=60). Overall disease distribution is summarized in (Table 1). Highlight some of these extra-cardiac findings (Figures 1-4). 52.3% of these patients were asymptomatic at the time of the scan. CS was diagnosed in 50.8% of patients (n=33). All the patients (100%) with CS had extra-cardiac findings. Additionally, extra-cardiac findings were present in 48.3% of the scans when there was no cardiac involvement. In our cohort, we had no cases of Isolated Cardiac Sarcoidosis (ICS).

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“…The reported prevalence of isolated CS varies widely with rates from 32 to 54%. 1,5,50,55,56,58 There are three main reasons for this variability. First, the heterogeneous nature of many of the cohorts.…”

Section: Isolated Csmentioning

confidence: 99%

“…57 Using this more precise definition of isolated CS: "active or inactive disease on 18 F-FDG PET-CT only in the myocardium and absence of sarcoidosis anywhere else including in hilar and/or mediastinal lymph nodes and no clinical evidence of skin or eye sarcoidosis," the rate of isolated CS has been described as 3.2 50 and 9.2%. 58 The new Japanese guidelines propose very similar criteria for the diagnosis for isolated CS (►Table 2). 48…”

Section: Isolated Csmentioning

confidence: 99%

Cardiac Sarcoidosis

Birnie

2020

Semin Respir Crit Care Med

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Approximately 5% of patients with sarcoidosis will have clinically manifest cardiac involvement presenting with one or more of ventricular arrhythmias, conduction abnormalities, and heart failure. It is estimated that another 20 to 25% of pulmonary/systemic sarcoidosis patients have asymptomatic cardiac involvement (clinically silent disease). Cardiac presentations can be the first (and/or an unrecognized) manifestation of sarcoidosis in a variety of circumstances. Immunosuppression therapy (usually with corticosteroids) has been suggested for the treatment of clinically manifest cardiac sarcoidosis (CS) despite minimal data supporting it. Positron emission tomography imaging is often used to detect active disease and guide immunosuppression. Patients with clinically manifest disease often need device therapy, typically with implantable cardioverter defibrillators (ICDs). The extent of left ventricular dysfunction seems to be the most important predictor of prognosis among patients with clinically manifest CS. In the current era of earlier diagnosis, modern heart failure treatment, and use of ICD therapy, the prognosis from CS is much improved. In a recent Finnish nationwide study, 10-year cardiac survival was 92.5% in 102 patients.

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The Utility of Whole Body 18F-FDG PET-CT in Diagnosing Isolated Cardiac Sarcoidosis: The Western Australian Cardiac Sarcoid Study

Cited by 28 publications

References 11 publications

Cardiac sarcoidosis: diagnosis and management

Cardiac sarcoidosis: diagnosis and management

Whole Body FDG PET-CT in the Evaluation and Management of Cardiac Sarcoidosis and Isolated Cardiac Sarcoidosis

Cardiac Sarcoidosis

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