Utility of N-13 Ammonia and F-18 Fluorodeoxyglucose Cardiac Positron Emission Tomography in Assessing Regional Prevalence of Cardiac Sarcoidosis

1575Background: Sarcoidosis is a multisystem disease of unknown etiology. The prevalence of clinically evident cardiac involvement is about 5%, though this may be an underestimation given the difficulties of diagnosing cardiac sarcoidosis (CS). Only 40% of patients with CS diagnosed at autopsy have the diagnosis made during their lifetime. Cardiac PET is an excellent tool for diagnosis and follow up of CS patients. Little is known of the regional myocardial involvement of CS. In the current series, we utilize PET to determine the most commonly sarcoid-afflicted myocardium regions. Methods: 45 patients (mean age 54 +/- 8.4, 69% male) had studies positive for CS with N-13 NH3/FDG PET/CT (N=99 total scans). Patients adhered to a standardized protocol, undergoing a 24 hour fast from carbohydrates, plus unfractionated heparin intravenously (10-50IU/kg) 15 minutes prior to FDG injection. Scans were obtained 90 minutes after FDG injection. All patients underwent rest N-13 NH3 perfusion imaging prior to administering FDG. Perfusion-metabolism mismatch defects and mean SUV for involved segments in the 17 segment model were determined using INVIA 4DM software. Presence of sarcoid was determined using the perfusion-metabolism mismatch defect criteria. Percentage of cardiac sarcoidosis was calculated per segment (1-17 individually), and per segment group [basal region (segments 1-6), middle region (segments 7-12), and distal region (segments 13-17)]. Results: Of the sarcoid-positive scan...
Source: Journal of Nuclear Medicine - Category: Nuclear Medicine Authors: Tags: Cardiovascular Clinical Science Poster Session Source Type: research

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ConclusionIn this limited patient study, PET/CT and PET/MR provided similar diagnostic data for18F-FDG uptake, and the concurrent acquisition of MR images provided further insight into the disease process.
Source: Journal of Nuclear Cardiology - Category: Nuclear Medicine Source Type: research
Conclusion: The pathology discovered after many years indicates the need for an expanded involvement of specialists in primary and dynamic examination of patients with sarcoidosis.
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Sarcoidosis and other granulomatous ILD/DPLD Source Type: research
AbstractBackgroundThere is no identified level of FDG uptake in cardiac sarcoidosis (CS) associated with increased risk of arrhythmias, conduction disease, heart failure, or death. We aim to utilize standardized uptake value (SUV) quantitation and localization to identify patients at increased risk of cardiac events.Methods and ResultsF18-FDG PET/CT with MPI was used in CS diagnosis (N = 67). Mean and max SUV were measured and grouped as basal, mid, and apical disease. Post-scan ventricular tachycardia, AICD placement, complete heart block, pacemaker placement, atrial fibrillation, heart failure, and cardiac-...
Source: Journal of Nuclear Cardiology - Category: Nuclear Medicine Source Type: research
Endomyocardial biopsy (EMB) is routinely performed for cardiac transplant monitoring. Moreover, it can be a useful tool in the diagnostic work-up of myocarditis, cardiomyopathies, drug toxicity, unexplained arrhythmias, heart involvement in systemic disease, and to diagnose cardiac masses. Pathologic evaluation of EMB represents the gold standard in specific disorders, including myocarditis and cardiac involvement by amyloidosis and sarcoidosis. To increase the diagnostic yield of the procedure, multiple myocardial samples should be obtained, and processed in a fully-equipped laboratory, with access to immunohistochemical/...
Source: Diagnostic Histopathology - Category: Pathology Authors: Tags: Mini-symposium: Cardiovascular pathology Source Type: research
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.
Source: European Journal of Heart Failure - Category: Cardiology Authors: Tags: Research Article Source Type: research
AbstractPurpose of ReviewTo review the clinical features of acute myocarditis, including its fulminant presentation, and present a pragmatic approach to the diagnosis and treatment, considering indications of American and European Scientific Statements and recent data derived by large contemporary registries.Recent FindingsPatients presenting with acute uncomplicated myocarditis (i.e., without left ventricular dysfunction, heart failure, or ventricular arrhythmias) have a favorable short- and long-term prognosis: these findings do not support the indication to endomyocardial biopsy in this clinical scenario. Conversely, pa...
Source: Current Cardiology Reports - Category: Cardiology Source Type: research
Abstract BACKGROUND: Sarcoidosis is an increasingly recognized multi-systemic condition. Cardiac sarcoidosis is associated with ventricular arrhythmias and higher mortality rates. Little epidemiological data is available regarding the disease and associated ventricular arrhythmias. METHODS: Data from the National Inpatient Sample (NIS) database 2012-2014, were reviewed. Discharges associated with sarcoidosis were identified as the target population using relevant ICD-9-CM codes. Primary outcome was a diagnosis of ventricular tachycardia (VT) in the sarcoidosis population. Secondary outcomes include rate of ve...
Source: Cardiology Journal - Category: Cardiology Authors: Tags: Cardiol J Source Type: research
Cardiac sarcoidosis is a significant cause of morbidity and mortality in patients with sarcoidosis. Cardiac manifestations of disease are largely dependent on the region of inflammation and subsequent fibrosis and scar. Although atrial arrhythmias occur in approximately one-third of patients with cardiac sarcoidosis, sinus node dysfunction is rare. Bhaskaran et  al (DOI: https://doi.org/10.1016/j.hrcr.2018.06.014) described a case of a 42-year-old previously healthy patient who presented with symptomatic sinus bradycardia with intermittent junctional bradycardia and sinus pauses up to 8 seconds with intermittent episo...
Source: Heart Rhythm - Category: Cardiology Authors: Tags: EP News Source Type: research
Authors: Kiko T, Yoshihisa A, Kanno Y, Yokokawa T, Abe S, Miyata-Tatsumi M, Misaka T, Oikawa M, Kobayashi A, Ishida T, Takeishi Y Abstract Sarcoidosis is a systemic granulomatous disease including heart (cardiac sarcoidosis, CS). It has recently been reported that isolated CS, which presenting primarily cardiac symptoms without clinical evidence of sarcoid involvement in other organs. Diagnostic and prognostic biomarkers of CS, especially in isolated CS, have not yet been established.We studied plasma levels of angiotensin-converting enzyme (ACE), soluble interleukin-2 receptor (sIL-2R), B-type natriuretic peptide ...
Source: International Heart Journal - Category: Cardiology Tags: Int Heart J Source Type: research
Authors: Ho JS, Chilvers ER, Thillai M Abstract INTRODUCTION: Sarcoidosis is a multisystem granulomatous disease predominantly affecting the lungs, with increased risk of cardiovascular disease, pulmonary hypertension and cardiac sarcoidosis (CS), the latter due to direct granuloma infiltration. Sarcoidosis is often managed by chest physicians who need to understand the diagnostic pathways and initial management plans for patients with cardiac involvement. Areas covered: The most serious consequence of CS is sudden cardiac death due to ventricular tachyarrhythmias or complete atrioventricular block. Additional comp...
Source: Expert Review of Respiratory Medicine - Category: Respiratory Medicine Tags: Expert Rev Respir Med Source Type: research
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