Early detection of cardiac involvement in patients with sarcoidosis by a non-invasive method with ultrasonic tissue characterisation

Abstract

Objectives: To clarify the value of cycle dependent variation of myocardial integrated backscatter (CV-IB) analysis, which non-invasively measures acoustic properties of the myocardium, for early detection of cardiac involvement in patients with sarcoidosis. Methods: The study population consisted of 22 consecutive patients with biopsy proven sarcoidosis who did not have any abnormal findings on conventional two dimensional echocardiogram. Cardiac sarcoidosis was diagnosed by radionuclide testing including thallium-201 scintigraphy, gallium-67 scintigraphy, and cardiac fluorine-18-deoxyglucose positron emission tomography. The magnitude and delay of the CV-IB were analysed in the basal mid septum and the basal mid posterior wall of the left ventricle of all patients. Results: The patients were divided into two groups: 8 patients with cardiac involvement and 14 patients without cardiac involvement. In the basal septum, a major reduction in the magnitude (mean (SD) 1.8 (4.4) v 6.6 (1.3) , p = 0.012) and an increase in the time delay (1.3 (0.5) v 1.0 (0.1), p = 0.038) of CV-IB were observed in patients with cardiac sarcoidosis even in the absence of two dimensional echocardiographic abnormalities. The sensitivity for detecting cardiac involvement was such that the magnitude of CV-IB in the basal septum discriminated 75% of patients with cardiac sarcoidosis from those with non-cardiac sarcoidosis, whereas two dimensional echocardiographic parameters did not discriminate between these two groups. Conclusions: The CV-IB is decreased in the basal septum in patients with cardiac sarcoidosis even in the absence of two dimensional echocardiographic abnormalities. Analysis of CV-IB may be a useful method to detect early myocardial involvement in patients with sarcoidosis.

fQRS as a marker of granulomatous disease in patients presenting with ventricular tachycardia and normal left ventricular ejection fraction

“…2 Early stages of cardiac sarcoidosis may not be detected or show non-specific findings on echocardiography. 11,12 Moreover, SMVT can be the primary presentation of both sarcoidosis and tuberculosis. 13,14 Hence, granulomatous myocarditis related VT can be easily mistaken with idiopathic VT especially if no extracardiac manifestations of sarcoidosis are present.…”

Cardiac sarcoidosis: A review on the work-up and management

“…Rarely, signs of hypertrophic cardiomyopathy have been described. However, these findings are usually difficult to detect [16,17]. The echocardiographic abnormalities are directly related to the disease's stage and may be undetectable in its early phases.…”

Clinical Utility of FDG–PET and PET/CT in Non-malignant Thoracic Disorders

“…While 67 Ga scan and 99m Tc-methoxyisobutylisonitrile ( 99m Tc-MIBI) myocardial perfusion scintigraphy have been utilized for detection of myocardial involvement, they are relatively insensitive in the early stages of the disease, possibly delaying therapy which can pose substantial risks. Delayed-enhanced cardiac MRI and PET imaging are the most promising emerging diagnostic modalities in this setting, and the role of other non-invasive modalities like ultrasonic tissue characterization [7,8] and iodine-123-labeled 15-(p-iodophenyl)-3R,S-methylpentadecanoic acid scintigraphy [9] have also been investigated.…”