Prevalence of newly diagnosed sarcoidosis in patients with ventricular arrhythmias: a cardiac magnetic resonance and 18F
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ORIGINAL PAPER
Prevalence of newly diagnosed sarcoidosis in patients with ventricular arrhythmias: a cardiac magnetic resonance and 18F‑FDG cardiac PET study Kalie Y. Kebed1 · Spencer V. Carter2 · Erin Flatley3 · R. Parker Ward4 · Joshua D. Moss3 · Daniel E. Appelbaum5 · Amita Singh4 · Roberto M. Lang4 · Roderick Tung4 · Amit R. Patel4 Received: 11 August 2020 / Accepted: 26 October 2020 © Springer Nature B.V. 2020
Abstract Cardiac sarcoidosis (CS) is known to be associated with ventricular tachycardia (VT); however, most investigations to date have focused on patients with known extra-cardiac sarcoidosis. The presence of CS is typically evaluated using 18F-fluorodeoxyglucose (18F-FDG) uptake on cardiac positron emission tomography (PET) or late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR). In this study, we sought to determine the prevalence of primary CS and the relationship between myocardial 18F-FDG uptake and LGE in patients with VT without known sarcoidosis. We retrospectively identified 67 patients without known sarcoidosis or active ischemic heart disease (i.e. significant ischemic disease that had not been previously revascularized) referred for both CMR and PET for evaluation of VT. Standard cine- and LGE- CMR and cardiac PET protocols were used. Myocardial LGE was defined as signal intensity > 5 SDs above the mean signal intensity of normal myocardium. Cardiac PET images were considered positive if there was focal myocardial 18F-FDG uptake having greater activity than the left ventricular blood pool. 45 patients (67%) had LGE, while only 4 (6%) had myocardial FDG uptake. Nine percent of patients with LGE had FDG-uptake while none without LGE did, and 10% of the cohort had indeterminate FDG uptake presumably from poor dietary preparation. Of those with both FDG uptake and LGE, 3/4 ultimately received a clinical diagnosis of CS. 4.5% of patients without previously known sarcoidosis or active ischemic heart disease presenting with VT have newly diagnosed CS. Detection of CS can be increased using a CMR first approach followed by cardiac PET for patients with non-ischemic LGE. Keywords Cardiac sarcoidosis · Late gadolinium enhancement · 18F-fluorodeoxyglucose · Cardiac positron emission tomography · Ventricular tachycardia
* Amit R. Patel [email protected] Spencer V. Carter [email protected] 1
United Heart and Vascular, St. Paul, MN, USA
2
Department of Internal Medicine, University of Chicago, Chicago, USA
3
Department of Medicine, Division of Cardiology, University of California San Francisco, San Francisco, USA
4
Department of Medicine, Section of Cardiology, University of Chicago Medicine, 5758 S. Maryland Avenue, MC 9067, Chicago, IL 60637, USA
5
Department of Radiology, University of Chicago, Chicago, USA
Abbreviations CMR Cardiac magnetic resonance CS Cardiac sarcoidosis EF Ejection fraction ICD Implantable cardioverter-defibrillator LGE Late gadolinium enhancement LV Left ventricle, left ventricular NSVT Non-sustained ventricular tachy
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