Cardiac Sarcoidosis Underlies Idiopathic Dilated Cardiomyopathy  Importance of Mediastinal Lymphadenopathy in Differential Diagnosis

Otsuka, Keijiro; Terasaki, Fumio; Eishi, Yoshinobu; Shimomura, Hiroaki; Ogura, Yasuharu; Horii, Taiko; Isomura, Tadashi; Suma, Hisayoshi; Kitaura, Yasushi

doi:10.1253/circj.71.1937

Cited by 23 publications

(4 citation statements)

References 21 publications

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“…Otsuka and colleagues reported the results of chest computed tomographic (CT) imaging in a series of 8 patients who underwent left ventriculoplasty for idiopathic dilated cardiomyopathy and were found to have evidence of CS on pathologic inspection of the resected myocardium. 27 On retrospective review of the CT imaging, all 8 patients had enlarged mediastinal LN. In their 2011 study, Kandolin et al 8 reported the results of mediastinal LN biopsies in 12 patients with suspected CS.…”

Section: Introductionmentioning

confidence: 99%

Isolated cardiac sarcoidosis: A focused review of an under-recognized entity

Okada

Bravo

Vita

et al. 2018

Journal of Nuclear Cardiology

132

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There is accumulating evidence for the existence of a phenotype of isolated cardiac sarcoidosis (ICS), or sarcoidosis that only involves the heart. In the absence of biopsy-confirmed cardiac sarcoidosis (CS), existing diagnostic criteria require the presence of extra-cardiac sarcoidosis as an inclusion criterion for the diagnosis of CS. Consequently, in the absence of a positive endomyocardial biopsy, ICS is not diagnosable by current guidelines. Therefore, there is uncertainty regarding the epidemiology, pathobiology, clinical characteristics, prognosis, and optimal treatment of ICS. This review will summarize the available data related to the prevalence and prognosis of ICS and will discuss challenges surrounding the diagnosis and management of this under-recognized entity.

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Section: Introductionmentioning

confidence: 99%

Isolated cardiac sarcoidosis: A focused review of an under-recognized entity

Okada

Bravo

Vita

et al. 2018

Journal of Nuclear Cardiology

132

View full text Add to dashboard Cite

show abstract

“…By obvious reasons, the access to lymphoid tissue in patients with coronary artery disease was very limited not allowing us to include a larger number of patients or to collect more lymph nodes per patients. Based on the literature, upper mediastinal lymph nodes receive drainage from the heart whereas it is not clear from where internal mammary artery lymph nodes, used in this study, collect blood [34]. Thus, it is a potential limitation that the lymph nodes investigated may not directly be connected to the heart, although there are several connections across the highly dynamic lymph node network.…”

Section: Discussionmentioning

confidence: 99%

Lymphocyte Subpopulations in Lymph Nodes and Peripheral Blood: A Comparison between Patients with Stable Angina and Acute Coronary Syndrome

Backteman

Andersson

Dahlin³

et al. 2012

PLoS ONE

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ObjectiveAtherosclerosis is characterized by a chronic inflammatory response involving activated T cells and impairment of natural killer (NK) cells. An increased T cell activity has been associated with plaque instability and risk of acute cardiac events. Lymphocyte analyses in blood are widely used to evaluate the immune status. However, peripheral blood contains only a minor proportion of lymphocytes. In this study, we hypothesized that thoracic lymph nodes from patients with stable angina (SA) and acute coronary syndrome (ACS) might add information to peripheral blood analyses.MethodsPeripheral blood and lymph nodes were collected during coronary by-pass surgery in 13 patients with SA and 13 patients with ACS. Lymphocyte subpopulations were assessed by flow cytometry using antibodies against CD3, CD4, CD8, CD19, CD16/56, CD25, Foxp3, CD69, HLA-DR, IL-18 receptor (R) and CCR4.ResultsLymph nodes revealed a lymphocyte subpopulation profile substantially differing from that in blood including a higher proportion of B cells, lower proportions of CD8+ T cells and NK cells and a 2-fold higher CD4/CD8 ratio. CD4+CD69+ cells as well as Foxp3+ regulatory T cells were markedly enriched in lymph nodes (p<0.001) while T helper 1-like (CD4+IL-18R+) cells were more frequent in blood (p<0.001). The only significant differences between ACS and SA patients involved NK cells that were reduced in the ACS group. However, despite being reduced, the NK cell fraction in ACS patients contained a significantly higher proportion of IL-18R+ cells compared with SA patients (p<0.05).ConclusionThere were several differences in lymphocyte subpopulations between blood and lymph nodes. However, the lymphocyte perturbations in peripheral blood of ACS patients compared with SA patients were not mirrored in lymph nodes. The findings indicate that lymph node analyses in multivessel coronary artery disease may not reveal any major changes in the immune response that are not detectable in blood.

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“…In patients in whom clinically isolated CS is suspected, chest CT scan with contrast for better assessment of adenopathy and advanced cardiac imaging should be performed. 10,39,42 Performing CMR and FDG-PET scans should be considered because many believe performing both imaging modalities increases the diagnostic yield with the potential to reveal extracardiac disease and to guide for biopsies. Also, performing both tests can be used to assess the stage of the disease, fibrotic or inflammatory.…”

Section: Clinically Isolated Csmentioning

confidence: 99%

Ten Questions Cardiologists Should Be Able to Answer About Cardiac Sarcoidosis: Case-Based Approach and Contemporary Review

et al. 2021

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Sarcoidosis is an inflammatory multisystemic disease of unknown etiology characterized by the formation of noncaseating epithelioid cell granulomas. Cardiac sarcoidosis might be life-threatening and its diagnosis and treatment remain a challenge nowadays. The aim of this review is to provide an updated overview of cardiac sarcoidosis and, through 10 practical clinical questions and real-life challenging case scenarios, summarize the main clinical presentation, diagnostic criteria, imaging findings, and contemporary treatment.

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Cardiac Sarcoidosis Underlies Idiopathic Dilated Cardiomyopathy Importance of Mediastinal Lymphadenopathy in Differential Diagnosis

Cited by 23 publications

References 21 publications

Isolated cardiac sarcoidosis: A focused review of an under-recognized entity

Isolated cardiac sarcoidosis: A focused review of an under-recognized entity

Lymphocyte Subpopulations in Lymph Nodes and Peripheral Blood: A Comparison between Patients with Stable Angina and Acute Coronary Syndrome

Ten Questions Cardiologists Should Be Able to Answer About Cardiac Sarcoidosis: Case-Based Approach and Contemporary Review

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