A new era of imaging for diagnosis and management of cardiac sarcoidosis: Hybrid cardiac magnetic resonance imaging and positron emission tomography

Ahluwalia, Monica; Pan, Stephen; Ghesani, Munir; Phillips, Lawrence M.

doi:10.1007/s12350-019-01770-4

Cited by 7 publications

(10 citation statements)

References 18 publications

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“…18 F-FDG-PET may be a more sensitive modality for acute inflammation, although specificity is less given possible background physiologic uptake of 18 F-FDG in the myocardium. 16 Since they evaluate different stages of disease progression within the myocardium, some have proposed a hybrid PET/CMR approach. 17 Several recent studies have incorporated the use of hybrid imaging into their clinical practice to diagnose and optimize medical treatment of active CS.…”

Section: Discussionmentioning

confidence: 99%

“…If the diagnosis of CS seems likely based on CMR findings, or if clinical suspicion remains high despite the lack of specific CMR findings, 18 F-FDG-PET is performed to evaluate for the presence and the degree of any ongoing active myocardial inflammation, as well as extracardiac involvement. 16 Glucocorticoid therapy remains the mainstay of treatment for active CS based on previous observational studies. 22 In addition, methotrexate has been the most studied glucocorticoid-sparing agent in treating CS and has shown efficacy in treating active CS in observational studies.…”

Section: Discussionmentioning

confidence: 99%

“…If no improvement is noted, then consideration is given to adding methotrexate, if not already done so, and considering third-line agents, with a preference to the TNF-α inhibitors infliximab or adalumimab. 16 In CS patients with high-degree conduction disorders, ICD implantation is to be considered according to the 2014 HRS Expert FIGURE 1. 18 F-flourodeoxyglucose uptake on positron emission tomography and late gadolinium enhancement on cardiac magnetic resonance of patients with cardiac sarcoidosis with primary RV involvement.…”

Section: Discussionmentioning

confidence: 99%

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Inflammatory Cardiomyopathy: Case-based Review on Clinical Presentation, Diagnosis, and Management

Lento

Pan

2020

Cardiology in Review

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Inflammatory cardiomyopathy is a broad term encompassing any disease leading to myocardial inflammation with associated cardiac dysfunction. While endomyocardial biopsy remains the gold standard for diagnosis, noninvasive imaging techniques, such as cardiac magnetic resonance imaging and positron emission tomography, have become powerful tools to facilitate the identification of underlying myocardial inflammation. This review presents a series of clinical cases with some common etiologies of inflammatory cardiomyopathy, including diagnosis and management.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Inflammatory Cardiomyopathy: Case-based Review on Clinical Presentation, Diagnosis, and Management

Lento

Pan

2020

Cardiology in Review

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“…Proposed clinical protocol for monitoring and treatment of cardiac sarcoidosis. Adapted with permission from Springer Nature from Ahluwalia et al 65 Copyright Springer Nature. All permission requests for this image should be made to the copyright holder.…”

Section: Treatmentmentioning

confidence: 99%

Sarcoid Heart Disease: Review of Current Knowledge

Jin

Gandrabur²,

Kim³

et al. 2021

Cardiology in Review

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Sarcoidosis is a granulomatous disease with the potential of multiple organ system involvement and its etiology remains unknown. Cardiac involvement is associated with worse clinical outcome, and has been reported to be 20–30% in white and as high as 58% in Japanese populations with sarcoidosis. Clinical manifestations of cardiac sarcoidosis highly depend on the extent and location of granulomatous inflammation. The most frequent presentations include heart block, tachyarrhythmia, or heart failure. Endomyocardial biopsy is the most specific diagnostic test, but has poor sensitivity due to often patchy involvement. The diagnosis of cardiac sarcoidosis remains challenging due to nonspecific imaging findings. Both 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) and cardiac magnetic resonance imaging can be used to evaluate cardiac sarcoidosis, but evaluate different stages of the disease process. FDG-PET detects metabolically active inflammatory cells while cardiac magnetic resonance imaging with late gadolinium enhancement reveals areas of myocardial necrosis and fibrosis. Aggressive therapy of symptomatic cardiac sarcoidosis is often sought due to the high risk of sudden death and/or progression to heart failure. Prednisone 20–40 mg a day is the recommended initial treatment. In refractory or severe cases, higher doses of prednisone, 1–1.5 mg/kg/d (or its equivalent) and addition of a steroid-sparing agent have been utilized. Methotrexate is added most commonly. Long-term improvement has been reported with the use of a combination of weekly methotrexate and prednisone versus prednisone alone. After initiation of treatment, a cardiac FDG-PET scan may be performed 2–3 months later to assess treatment response.

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“…1996-2004 In this issue of the Journal of Nuclear Cardiology, Ahluwalia et al present a case of a 49-year-old African American woman with pulmonary sarcoidosis and severe mitral regurgitation found to have cardiac sarcoid from tissue biopsy at time of valve replacement. 1 Left ventricular systolic function was poor by echocardiography and cardiac magnetic resonance imaging (CMR). There was no late gadolinium enhancement on CMR but on positron emission tomography (PET), which was obtained simultaneously with CMR (hybrid PET-CMR), and there was significant uptake of 18 F-FDG indicating active cardiac sarcoid.…”

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confidence: 99%

Hybrid positron emission tomography-Magnetic resonance imaging for cardiac sarcoid

Hage

2019

Journal of Nuclear Cardiology

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A new era of imaging for diagnosis and management of cardiac sarcoidosis: Hybrid cardiac magnetic resonance imaging and positron emission tomography

Cited by 7 publications

References 18 publications

Inflammatory Cardiomyopathy: Case-based Review on Clinical Presentation, Diagnosis, and Management

Inflammatory Cardiomyopathy: Case-based Review on Clinical Presentation, Diagnosis, and Management

Sarcoid Heart Disease: Review of Current Knowledge

Hybrid positron emission tomography-Magnetic resonance imaging for cardiac sarcoid

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