Low downstream event rate in patients without clinical cardiac sarcoidosis referred for cardiac FDG-PET imaging
Conclusion: In patients not meeting clinical criteria for CS and without extra-cardiac sarcoidosis, the overall event rate was similar between patients with and without abnormal FDG uptake. The overall low event rate suggests a potential lack of clinical utility in obtaining FDG PET imaging for all patients with non-ischemic cardiomyopathy to evaluate for CS. Future investigations are needed to determine if FDG PET imaging may be better targeted to certain subgroups of patients with non-ischemic cardiomyopathy.
ConclusionIn a large series of CS subjects, rates of ventricular arrhythmia and heart failure events remain high with no treatment regimen clearly associated with better outcome. Patients with cardiomyopathy at diagnosis were more likely to reach the composite endpoint.
Cardiac sarcoidosis (CS) is characterized histologically by the presence of noncaseating granulomas and manifests as conduction abnormality, ventricular arrhythmia and progressive heart failure. With advances in imaging techniques, CS is being increasingly recognized as an underlying cause of cardiomyopathy. To date, there are no randomized trials or published guidelines to direct treatment strategies in CS, specifically in regards to optimal immunosuppressive therapy. We sought to describe our experience using a combination of prednisone and mycophenolate mofetil (MMF) in the treatment of patients (pts) with CS.
ConclusionLeft ventricle MC is very rare. The dystrophic MC from ischemic origin is the most frequent. At long-term follow-up, 59% of MC had altered LVEF, it is more frequent (80%) in I-MC. The extent of LV MC was associated with high risk of cardiac death and ventricular arrhythmia.
This article focuses on the role of echocardiography and MRI in the diagnosis of these structural diseases. Cardiomyopathies with hypertrophic pattern (hypertrophic cardiomyopathy, restrictive cardiomyopathies, amyloidosis, Anderson-Fabry disease, and sarcoidosis), cardiomyopathies with dilated pattern, inflammatory cardiac diseases, and right ventricular arrhythmogenic cardiomyopathy are analyzed. Finally, anatomic predictors of arrhythmias and sudden cardiac death are discussed. Each paragraph is attended by clinical cases that are discussed on the electrocardiogram, after integrated with the anatomic, functional, and he...
ConclusionsRV or LV EMB can be performed safely during EP procedures and can assist with diagnosis, influencing management. EGM-guided EMB in patients presenting with scar-related VT was low yield for specific pathologies.
im KB Abstract Sarcoidosis is characterised by granulomatous inflammation in one or more organs, including the heart. Cardiac sarcoidosis generally has non-specific symptoms, and the disease is often diagnosed at a late stage. The condition is associated with cardiomyopathy and arrhythmia and may be fatal. PMID: 29460602 [PubMed - as supplied by publisher]
Conclusions Quantitative measures of extent and severity of perfusion–metabolism mismatch and coefficient of variation of FDG uptake provide an incremental prognostic advantage in patients undergoing FDG-PET for CS. These results support the use of a more detailed analysis of imaging findings, as is conventional in coronary artery disease.
Conclusions— CMR identified a likely pathogenesis for sudden cardiac arrest in nearly half of survivors in whom coronary artery disease had been excluded. One in 3 subjects had MACE; risk doubled in those with a CMR diagnosis and some CMR parameters—late gadolinium enhancement, left ventricular ejection fraction, and especially right ventricular ejection fraction—associated with prognosis.
Background— Recently, we reported that urinary 8-hydroxy-2'-deoxyguanosine (U-8-OHdG), an oxidative stress marker, reflected inflammatory activity in cardiac sarcoidosis (CS). Here, we investigated whether U-8-OHdG levels were associated with ventricular tachycardia (VT) in patients with CS. Methods and Results— This prospective cohort study enrolled 62 consecutive patients with CS, of whom 36 were diagnosed as having active CS based on abnormal 18F-flurodeoxyglucose accumulation in the heart on positron-emission tomography/computed tomography. The 36 patients with active CS were subdivided as having CS with s...
AbstractPurpose of ReviewVentricular arrhythmias (VAs) are a significant cause of morbidity and mortality in patients with cardiomyopathy (CM). This review focuses on ventricular tachycardia (VT) management in uncommon causes of heart disease, such as inflammatory and infiltrative CMs.Recent FindingsIntegration of advanced cardiac imaging modalities, such as cardiac magnetic resonance imaging (MRI) and positron emission tomography (PET), into diagnostic evaluation of patients with CM may unmask abnormal myocardial substrate in almost half of patients presenting with VAs. Stepwise approach to management of VAs in cardiac sa...