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[18F]FDG-PET in Cardiac Sarcoidosis: a single-centre study in a southern European population
Session:
CO 07 - Miocardiopatias Infiltrativas
Speaker:
João Borges Rosa
Congress:
CPC 2021
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.2 Myocardial Disease – Epidemiology, Prognosis, Outcome
Session Type:
Comunicações Orais
FP Number:
---
Authors:
João Borges Rosa; Manuel Oliveira-Santos; Rodolfo Silva; José Paulo de Almeida; Lino Gonçalves; Gracinda Costa; Maria João Vidigal Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Background:</strong> Cardiac sarcoidosis (CS) is clinically diagnosed in 5% of patients with sarcoidosis and is associated with poor prognosis. However, imaging studies suggest higher prevalence, up to 55%, with worldwide variation. Growing evidence highlights the role of <sup>18</sup>F-fluorodeoxyglucose positron emission tomography ([<sup>18</sup>F]FDG-PET) in non-invasive diagnosis and follow-up. We aimed to evaluate the prevalence and clinical manifestations of CS, diagnosed through [<sup>18</sup>F]FDG-PET, in a southern European population. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> We retrospectively assessed all patients evaluated with [<sup>18</sup>F]FDG-PET for sarcoidosis screening between 2009 and 2020, and selected those with a histological diagnosis of extracardiac sarcoidosis. We collected data on clinical manifestations, cardiac magnetic resonance (CMR) results, and mortality outcomes and compared those with and without cardiac involvement. We applied the criteria for the diagnosis of CS from Heart Rhythm Society.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> Of the 400 patients screened with [<sup>18</sup>F]FDG-PET, 128 had a histological diagnosis of extracardiac sarcoidosis (54.7% females, mean age 51.0±14.2 years). None underwent endomyocardial biopsy. Ten patients had a pattern of [<sup>18</sup>F]FDG uptake consistent with CS defined as diffuse (n=5), focal (n=3), and focal on diffuse (n=2). Of the 128 patients, 14 also underwent CMR, which identified 2 subjects with positive findings in both modalities and 3 additional patients: focal (n=1), multifocal mid-wall (n=2), focal mid-wall (n=2), and multifocal subepicardial (n=1) delayed gadolinium enhancement. Overall, 13 patients (10.2%) fulfilled the criteria for probable CS (53.8% female, mean age 56.2±12.6 years), all with multiorgan involvement, mostly lung and lymph nodes (each 92%), followed by skin and central nervous system (each 15%). Median left ventricle ejection fraction was 62% [55-65] and there were cardiac manifestations of CS in 6 patients (46%): sick sinus syndrome (n=2), complete heart block (n=1), frequent premature ventricular complexes (n=1), ventricular tachycardia plus heart failure (n=1), and bifascicular block plus heart failure (n=1). Eleven patients (85%) with probable CS were medicated with immunosuppressant drugs: corticosteroids (n=9), methotrexate (n=4), and azathioprine (n=2). Four patients with previous [<sup>18</sup>F]FDG screening were revaluated after treatment, each showing no cardiac uptake. After a mean follow-up of 4.0±1.0 years, mortality was three-fold higher in patients with cardiac involvement, despite the absence of statistical significance (15% vs. 5%, P=0.151).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions:</strong> In this single-centre study, 10.2% of the patients with proven extracardiac sarcoidosis were diagnosed with CS, of whom 54% were clinically asymptomatic. Cardiac imaging with [<sup>18</sup>F]FDG-PET plays an important role by improving diagnostic yield and monitoring response to therapy, while CMR is still underused. </span></span></p>
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