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Pubblicazioni recenti - cardiac sarcoidosis
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Cardiac sarcoidosis: Presentation of three cases.
Med Clin (Barc)2022 Dec;():. doi: S0025-7753(22)00590-5.
López Caleya Juan Francisco, Rodríguez Vega Sara, Fonseca Aizpuru Eva María,
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Clinical Outcomes of Radiologic Relapse in Patients With Cardiac Sarcoidosis Under Immunosuppressive Therapies.
Am J Cardiol2022 Nov;188():24-29. doi: 10.1016/j.amjcard.2022.10.048.
Kaneta Kohei, Takahama Hiroyuki, Tateishi Emi, Irie Yuki, Moriuchi Kenji, Amano Masashi, Okada Atsushi, Amaki Makoto, Kiso Keisuke, Kanzaki Hideaki, Kusano Kengo, Yasuda Satoshi, Izumi Chisato,
Abstract
Although nuclear imaging can detect cardiac involvement of cardiac sarcoidosis (CS), including subclinical states, little is known about the prevalence and outcomes of radiologic relapse under prednisolone (PSL) therapy. This study aimed to investigate the clinical characteristics and outcomes in patients with radiologic relapse. A total of 80 consecutive patients with CS whose disease activity on nuclear imaging decreased at least once after initiation of immunosuppressive therapy were identified through a retrospective chart review. Radiologic relapse of CS was diagnosed using F-fluoro-2-deoxyglucose positron emission tomography or gallium-67 scintigraphy. Composite adverse events were defined as at least 1 of the following: all-cause death, hospitalization for heart failure, or lethal arrhythmia. During the follow-up period (median 2.9 years), radiologic relapse was observed in 31 patients (38.8% of overall patients) at 30 months (median) after immunosuppressive therapy initiation. After radiologic relapse was detected, all patients were treated with intensified immunosuppressive therapies (increasing PSL, n = 26 [83.9%], adding other immunosuppressive therapies to PSL, n = 5 [16.1%]). There were no differences in occurrences of composite adverse events in patients with and patients without radiologic relapse. Radiologic relapse under immunosuppressive therapy was observed in many patients with CS, but it was not associated with clinical outcomes under intensified immunosuppressive therapy.
Copyright © 2022 Elsevier Inc. All rights reserved.
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UEDA Heart Awards for 2022.
Int Heart J2022 ;63(6):1217. doi: 10.1536/ihj.63-6_UEDA.
Abstract
We are pleased to announce that the following 3 articles have been selected for the UEDA Heart Awards for the Year 2022.FIRST PLACEChronic HDAC6 Activation Induces Atrial Fibrillation Through Atrial Electrical and Structural Remodeling in Transgenic MiceYohei Sawa, Naoko Matsushita, Sachiko Sato, Nanae Ishida, Maki Saito, Atsushi Sanbe, Yoshihiro Morino, Eiichi Taira, Mami Obara, Masamichi HiroseInt Heart J 2021; 62 (3): 616-626.SECOND PLACEA Novel Titin Truncation Variant Linked to Familial Dilated Cardiomyopathy Found in a Japanese Family and Its Functional Analysis in Genome-Edited Model CellsKayoko Hirayama-Yamada, Natsuko Inagaki, Takeharu Hayashi, Akinori KimuraInt Heart J 2021; 62 (2): 359-366.THIRD PLACECytokine Signaling and Matrix Remodeling Pathways Associated with Cardiac Sarcoidosis Disease Activity Defined Using FDG PET ImagingBryan D. Young, Hannah Moreland, Kelsie E. Oatmen, Lisa A. Freeburg, Zartashia Shahab, Erica Herzog, Edward J. Miller, Francis G. SpinaleInt Heart J 2021; 62 (5): 1096-1105.
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Serial assessment of cardiac involvement in sarcoidosis by delayed F-fluorodeoxyglucose PET/CT.
J Nucl Cardiol2022 Nov;():. doi: 10.1007/s12350-022-03151-w.
Aikawa Tadao, Manabe Osamu, Ibe Tatsuro, Oyama-Manabe Noriko,
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Comparison of cardiac magnetic resonance imaging and fluorodeoxyglucose positron emission tomography in the assessment of cardiac sarcoidosis: Meta-analysis and systematic review.
J Nucl Cardiol2022 Nov;():. doi: 10.1007/s12350-022-03129-8.
Adhaduk Mehul, Paudel Bishow, Khalid Muhammad Umar, Ashwath Mahi, Mansour Shareef, Liu Kan,
Abstract
AIM:
Fluorine-18 fluorodeoxyglucose-positron emission tomography (FDG-PET) and cardiac magnetic resonance (CMR) are frequently used advanced cardiac imaging to diagnose cardiac sarcoidosis (CS). We conducted a meta-analysis and systematic review to compare diagnostic parameters of FDG-PET and CMR in the diagnosis of cardiac sarcoidosis (CS).
METHODS:
We searched PubMed, EMBASE, and Scopus databases from their inception to 9/30/2021 with search terms "cardiac sarcoidosis" AND "cardiac magnetic resonance imaging" AND "positronemission tomography". We extracted patient characteristics, results of the FDG-PET and CMR, and adverse outcomes from the included studies. Adverse outcomes served as a reference standard for the evaluation of FDG-PET and CMR.
RESULTS:
We included 4 studies in the meta-analysis which provided adverse outcomes and all patients underwent FDG-PET and CMR. There were 237 patients, 60.3% male, and ages ranged from 50-53 years. There were 45 events in 237 patients from four studies included in the meta-analyses. The pooled sensitivity (95% confidence interval-CI) and specificity (CI) of CMR in predicting an adverse event were 0.94 (0.79-0.98) and 0.49 (0.40-0.59), respectively. The pooled sensitivity (CI) and specificity (CI) of FDG-PET in predicting an adverse event were 0.51 (0.26-0.75) and 0.60 (0.35-0.81), respectively.
CONCLUSION:
CMR was more sensitive but less specific than FDG-PET in predicting adverse events; however, the study population and definition of a positive test need to be considered while interpreting the results.
© 2022. The Author(s) under exclusive licence to American Society of Nuclear Cardiology.
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Unusual Forms of Pulmonary Hypertension.
Heart Fail Clin2023 Jan;19(1):25-33. doi: 10.1016/j.hfc.2022.08.021.
Parente Yuri de Deus Montalverne, Fernandes da Silva Natalia, Souza Rogerio,
Abstract
There are several forms of pulmonary hypertension that can be considered unusual not solely due to their prevalence but also due to their geographic distribution. The aim of this review is to highlight some of these forms, most of them classified within group 5 of the current pulmonary hypertension classification. This review also discusses on schistosomiasis-associated pulmonary hypertension, a prevalent form of pulmonary hypertension mostly limited to developing countries.
Copyright © 2022 Elsevier Inc. All rights reserved.
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Evaluation and Catheter Ablation of Ventricular Arrhythmias in Cardiac Sarcoidosis.
J Clin Med2022 Nov;11(22):. doi: 6718.
Ezzeddine Fatima M, Tan Nicholas, Siontis Konstantinos C,
Abstract
Ventricular arrhythmias are a common clinical manifestation in patients with cardiac sarcoidosis (CS) and other arrhythmogenic inflammatory cardiomyopathies (AIC). The management of sustained ventricular arrhythmias in these patients presents unique challenges. Current therapies include immunosuppressive, antiarrhythmic agents, and catheter ablation. Significant progress has been made in deciphering the importance of patient selection for ablation, systematic preablation evaluation, and optimal ablation timing, as well as ablation approaches and techniques. In this overview, we discuss the evaluation and management of ventricular arrhythmias in patients with CS, focusing on catheter ablation, which has evolved into an effective approach in reducing the burden of ventricular arrhythmias in these patients in the context of multifaceted treatment along with medical therapies.
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A Review Pertaining to SARS-CoV-2 and Autoimmune Diseases: What Is the Connection?
Life (Basel)2022 Nov;12(11):. doi: 1918.
Kocivnik Nina, Velnar Tomaz,
Abstract
Coronavirus disease 2019 (COVID-19) is an infectious viral disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). It is known that infection with SARS-CoV-2 can lead to various autoimmune and autoinflammatory diseases. There are few reports in the literature on the association between SARS-CoV-2 and autoimmune diseases, and the number of reports has been increasing since 2020. Autoimmune diseases and SARS-CoV-2 infections are intertwined in several ways. Both conditions lead to immune-mediated tissue damage, the immune response is accompanied by the increased secretion of inflammatory cytokines and both conditions can be treated using immunomodulatory drugs. Patients with certain autoimmune diseases, such as systemic lupus erythematosus, rheumatoid arthritis, type 1 diabetes, cardiac sarcoidosis, idiopathic pulmonary fibrosis, autoimmune hepatitis, multiple sclerosis and others, are more susceptible to SARS-CoV-2 infection, either because of the active autoimmune disease or because of the medications used to treat it. Conversely, SARS-CoV-2 infection can also cause certain autoimmune diseases. In this paper, we describe the development of autoimmune diseases after COVID-19 and the recovery from COVID-19 in people with autoimmune diseases.
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Online mindfulness-based cognitive therapy for fatigue in patients with sarcoidosis (TIRED): a randomised controlled trial.
Lancet Respir Med2022 Nov;():. doi: S2213-2600(22)00387-3.
Kahlmann Vivienne, Moor Catharina C, van Helmondt Sanne J, Mostard Rémy L M, van der Lee Marije L, Grutters Jan C, Wijsenbeek Marlies S, Veltkamp Marcel,
Abstract
BACKGROUND:
Sarcoidosis-associated fatigue is highly prevalent and is often reported as the most burdensome symptom of sarcoidosis. Management of fatigue is challenging, and evidence-based therapies are lacking. In this TIRED trial, we aimed to assess the effects of a 12-week online mindfulness-based cognitive therapy (eMBCT) on fatigue.
METHODS:
This study was a prospective, open-label, multicentre randomised controlled trial, conducted at three centres in the Netherlands. Eligible patients were 18 years or older, had stable sarcoidosis, and a score of more than 21 points on the Fatigue Assessment Scale (FAS). Patients were randomised into either the eMBCT or the control group. Participants completed patient-reported outcome measures at baseline, after intervention (T1), and 12 weeks after completion of eMBCT (T2). The primary outcome was the change in FAS score at T1 in the eMBCT group compared with the control group, assessed with the independent students't test in all patients who started the study. Secondary outcomes included within-group difference in FAS score at T1 and T2, between-group difference in FAS score at T2, and changes in the Hospital Anxiety and Depression Scale, the Freiburg Mindfulness Inventory-Short Form, and the Kings Sarcoidosis Questionnaire. The study was registered at the Netherlands Trial Register, NL7816.
FINDINGS:
Between June 5, 2019, and Oct 28, 2021, 99 patients were randomly assigned to the eMBCT (n=52) or the control (n=47) groups. Six patients withdrew consent after psychological screening before the start of eMBCT. Baseline FAS score was similar in both groups (34·57 [SD 6·07] for 46 patients in the eMBCT group and 35·51 [4·65] for 47 patients in the control group). Mean change in FAS score at T1 was -4·53 (SD 5·77; p
INTERPRETATION:
12 week eMBCT improves fatigue, anxiety, depression, mindfulness, and health status in patients with sarcoidosis-associated fatigue.
FUNDING:
Dutch Sarcoidosis Patient Association (Sarcoidose.nl).
TRANSLATION:
For the Dutch translation of the summary see Supplementary Materials section.
Copyright © 2022 Elsevier Ltd. All rights reserved.
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Comparison of LGE quantitation methods in cardiac sarcoidosis to predict clinical outcomes.
Int J Cardiovasc Imaging2022 Nov;():. doi: 10.1007/s10554-022-02751-4.
Benjamin Mina M, Shah Parth, Munir Muhammad S, Kinno Menhel, Syed Mushabbar A,
Abstract
We sought to investigate the optimal method of quantifying late gadolinium enhancement (LGE) in cardiac sarcoidosis (CS) using cardiac magnetic resonance imaging (MRI). We retrospectively studied 53 patients with CS. LGE quantitation was performed using (a) semi-automated segmentation using Signal Threshold versus Reference Mean (STRM) cutoffs of >?2, > 3 and >?5 standard deviations (SD); (b) full-width-half-max (FWHM) method and (c) manual segmentation (MS) of affected myocardial segments. Primary outcome was a composite of cardiovascular death and ventricular tachyarrhythmia (VTA). A multivariate regression analysis was performed comparing the techniques adjusting for age, gender, NYHA class and LVEF. Mean age was 56.3?±?12 years, 71.6% males, 66% white. Mean LVEF was 45.1% ± 14.7%. Over median follow-up of 28.1 months, 2 patients had cardiac death (3.7%) and 8 (15.1%) had VTA. On multivariate analysis, MS, > 2SD, > 3SD, > 5SD and FWHM had OR of 1.39 [CI 1.04-1.79], 1.09 [CI 0.99-1.21], 1.15 [CI 1.03-1.29], 1.16 [CI 1.04-1.27] and 1.08 [CI 0.96-1.21], respectively, for predicting the composite outcome. ROC curve analysis showed MS to have the highest AUC 0.89 followed by 0.81 for >?3SD and > ?5SD, 0.75 for >?2SD and lowest 0.69 for FWHM method. Reproducibility was lower for manual method (ICC 0.7) than for >?3SD (ICC 0.991) and >?5SD (ICC 0.997). CS quantitation of LGE with MS or semi-automated quantitation with STRM?>?3SD or >?5SD was significantly associated with the composite outcome of cardiac death and VTA. Semi-automated quantitation with STRM?>?3SD provided the best combination of accuracy and reproducibility.
© 2022. The Author(s), under exclusive licence to Springer Nature B.V.
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Myocardial Involvement in Systemic Autoimmune Rheumatic Diseases.
Rheum Dis Clin North Am2023 Feb;49(1):45-66. doi: 10.1016/j.rdc.2022.08.002.
Zagouras Alexia A, Tang W H Wilson,
Abstract
Systemic autoimmune rheumatic diseases (SARDs) are defined by the potential to affect multiple organ systems, and cardiac involvement is a prevalent but often overlooked sequela. Myocardial involvement in SARDs is medicated by macrovascular disease, microvascular dysfunction, and myocarditis. Systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, eosinophilic granulomatosis with polyangiitis, and sarcoidosis are associated with the greatest risk of myocardial damage and heart failure, though myocardial involvement is also seen in other SARDs or their treatments. Management of myocardial involvement should be disease-specific. Further research is required to elucidate targetable mechanisms of myocardial involvement in SARDs.
Copyright © 2022 Elsevier Inc. All rights reserved.
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Recurrent small bowel obstruction as a rare presentation of undiagnosed sarcoidosis.
BMJ Case Rep2022 Nov;15(11):. doi: e252486.
Naumann Ashton A, Rodriguez Vanessa I, Shychuk Andrew,
Abstract
Sarcoidosis is an immune-mediated inflammatory disorder with unknown aetiology that is marked by non-caseating granulomas in affected organs. Pulmonary sarcoidosis is the most common manifestation, but gastrointestinal involvement, particularly in the small bowel, is exceedingly rare. While symptom-driven treatment guidelines that are steroid based are well established for pulmonary and few extrapulmonary manifestations (ie, cardiac, neurologic, renal), gastrointestinal sarcoidosis treatment is largely extrapolation with optimal management under investigation. Additionally, few works document small bowel obstruction related to small bowel sarcoidosis. We present a case of short-interval recurrent small bowel obstruction in a man in his sixties that revealed newly diagnosed sarcoidosis with suspected small bowel involvement who never underwent steroid therapy. The patient exhibited gastrointestinal symptoms, despite asymptomatic pulmonary disease and a course of prednisone may have reduced his risk of recurrence. We also review suggested gastrointestinal sarcoidosis treatment and surveillance guidelines with focus on the small bowel.
© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.
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Semiquantitative evaluation of Ga-DOTANOC uptake in the normal myocardium: establishment of reference values.
J Nucl Cardiol2022 Nov;():. doi: 10.1007/s12350-022-03135-w.
Kaushik Prateek, Patel Chetan, Chandra Khangembam Bangkim, Kumar Suraj, Gupta Priyanka, Ojha Vineeta, Bal Chandrasekhar,
Abstract
BACKGROUND:
To ascertain presence of physiological uptake and derive standardized uptake values (SUV) of Ga-DOTANOC in normal myocardium and establish reference values.
METHODS AND RESULTS:
Dedicated cardiac Ga-DOTANOC PET/CT studies of patients referred for evaluation of cardiac sarcoidosis (CS) or myocarditis and found to be normal on visual assessment and on cardiac MRI were analyzed semiquantitatively. The studies were acquired 45-60 minutes after intravenous injection of 111-185 MBq of Ga-DOTANOC. Myocardial SUV normalized to lean body mass (SUVlbm) values for septum, anterior wall, proximal lateral wall, distal lateral wall, inferior wall, and apical region were 1.12?±?.39, 1.09?±?.42, 1.26?±?.49, 1.16?±?.40, 1.23?±?.39, and 1.05?±?.40, respectively. Myocardial SUVlbm-to-blood pool SUV_lbm ratios were calculated for each region and 95th percentile values of these ratios were considered the upper limit of normal. 95th percentile values of myocardial SUVlbm-to-blood pool SUV_lbm ratio for the corresponding regions were 1.70, 1.70, 2.00 1.95, 2.05, and 1.70, respectively.
CONCLUSION:
There can be physiological uptake of Ga-DOTANOC in normal myocardium and the reference values of semiquantitative parameters established in this study may be employed as a corroborative tool for visual assessment in patients undergoing Ga-DOTANOC PET/CT for suspected CS or myocarditis.
© 2022. The Author(s) under exclusive licence to American Society of Nuclear Cardiology.
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Ventricular Tachycardia in Granulomatous Myocarditis: Role of Catheter Ablation.
Card Electrophysiol Clin2022 Dec;14(4):701-707. doi: 10.1016/j.ccep.2022.08.001.
Saggu Daljeet Kaur, Yalagudri Sachin D, Subramanian Muthiah, Atreya Auras R, Narasimhan Calambur,
Abstract
Granulomatous myocarditis is an inflammatory disease of the myocardium, characterized by lymphocytic infiltration with characteristic granuloma formation. Although a host of disease processes can elicit myocardial granulomas, two common entities are cardiac sarcoidosis and cardiac tuberculosis. Cardiac arrhythmias in this condition are frequent and management of ventricular arrhythmias can be challenging, especially in those with drug-refractory ventricular tachycardia and electrical storm. In this review, we highlight the role of catheter ablation for ventricular tachycardia and optimal patient selection for catheter ablation, based on cardiac imaging.
Copyright © 2022 Elsevier Inc. All rights reserved.
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A 60-Year-Old Woman with a 6-Week History of Shortness of Breath and Intermittent Chest Pain Due to Chronic Thromboembolic Pulmonary Disease Undetected by Computed Tomography Pulmonary Angiography (CTPA) and Diagnosed by Ventilation-Perfusion Imaging.
Am J Case Rep2022 Nov;23():e938041. doi: 10.12659/AJCR.938041.
Yanagisawa Yuuki, Hassan Ibrahim Wissam, Kumar Narendra, Cooper John,
Abstract
BACKGROUND Chronic thromboembolic pulmonary disease (CTEPD) is the persistent occlusion of pulmonary arteries resulting from 1 or more thrombo-emboli. Its presentation is often non-specific, with exertional dyspnea and fatigue, yet if left undiagnosed risks of chronic thromboembolic pulmonary hypertension and right-sided cardiac failure can ensue. Computed tomography pulmonary angiography (CTPA) and ventilation/perfusion (V/Q) imaging are most commonly utilized for investigating CTEPD. This report is of a 60-year-old woman with a 6-week history of breathlessness and intermittent chest pain due to CTEPD, undetected by CTPA and diagnosed by V/Q imaging. CASE REPORT A 60-year-old woman presented with a 6-week history of breathlessness, intermittent chest pain, and reduced mobility. Her past medical history included chronic obstructive pulmonary disease, pulmonary sarcoidosis, and obesity. Screening tests for infective and ischemic cardiac etiologies were unremarkable. A calculated Wells score was 6, making CTEPD the main differential diagnosis, and she was commenced on therapeutic dose anticoagulation. A CTPA performed on day 2 of admission showed no evidence of acute thromboembolic pulmonary disease or CTEPD. Instead, V/Q scintigraphy on day 6 revealed a perfusion mismatch in the right lung apex, consistent with CTEPD. The patient improved clinically and was discharged on long-term apixaban. CONCLUSIONS A negative CTPA does not necessarily exclude CTEPD. The sensitivity of CTPA for CTEPD is lower than that of V/Q imaging, and can hence lead to false-negative results, as this case highlights. When there is a high clinical suspicion for CTEPD but a negative CTPA study, V/Q imaging should always be undertaken.
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Cardiovascular CT, MRI, and PET/CT in 2021: Review of Key Articles.
Radiology2022 Dec;305(3):538-554. doi: 10.1148/radiol.221181.
Tzimas Georgios, Ryan David T, Murphy David J, Leipsic Jonathon A, Dodd Jonathan D,
Abstract
This review focuses on three key noninvasive cardiac imaging modalities-cardiac CT angiography (CTA), MRI, and PET/CT-and summarizes key publications in 2021 relevant to radiologists in clinical practice. Although this review focuses primarily on articles published in , important studies from other major journals are included to highlight "must-know" articles in the field of cardiovascular imaging. Cardiac CTA has been established as the first-line test for patients with stable chest pain and no known coronary artery disease, and its value remains central to the assessment of surgical or transcatheter aortic valve replacement. Artificial intelligence continues to evolve in a number of applications in cardiovascular disease. In cardiac MRI studies, 2021 has seen an emphasis on nonischemic cardiomyopathies, valvular heart disease, and COVID-19 disease cardiac manifestations and the authors highlight the key articles on these topics. A section featuring the increasing role of cardiac PET/CT in the assessment of cardiac sarcoidosis and prosthetic valves is also provided.
© RSNA, 2022.
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A review of the challenges, learnings and future directions of home handheld spirometry in interstitial lung disease.
Respir Res2022 Nov;23(1):307. doi: 307.
Maher Toby M, Schiffman Courtney, Kreuter Michael, Moor Catharina C, Nathan Steven D, Axmann Judit, Belloni Paula, Bengus Monica, Gilberg Frank, Kirchgaessler Klaus-Uwe, Wijsenbeek Marlies S,
Abstract
BACKGROUND:
Patients with interstitial lung disease (ILD) require regular physician visits and referral to specialist ILD clinics. Difficulties or delays in accessing care can limit opportunities to monitor disease trajectory and response to treatment, and the COVID-19 pandemic has added to these challenges. Therefore, home monitoring technologies, such as home handheld spirometry, have gained increased attention as they may help to improve access to care for patients with ILD. However, while several studies have shown that home handheld spirometry in ILD is acceptable for most patients, data from clinical trials are not sufficiently robust to support its use as a primary endpoint. This review discusses the challenges that were encountered with handheld spirometry across three recent ILD studies, which included home spirometry as a primary endpoint, and highlights where further optimisation and research into home handheld spirometry in ILD is required. Rate of decline in forced vital capacity (FVC) as measured by daily home handheld spirometry versus site spirometry was of primary interest in three recently completed studies: STARLINER (NCT03261037), STARMAP and a Phase II study of pirfenidone in progressive fibrosing unclassifiable ILD (NCT03099187). Unanticipated practical and technical issues led to problems with estimating FVC decline. In all three studies, cross-sectional correlations for home handheld versus site spirometry were strong/moderate at baseline and later timepoints, but longitudinal correlations were weak. Other issues observed with the home handheld spirometry data included: high within-patient variability in home handheld FVC measurements; implausible longitudinal patterns in the home handheld spirometry data that were not reflected in site spirometry; and extreme estimated rates of FVC change.
CONCLUSIONS:
Home handheld spirometry in ILD requires further optimisation and research to ensure accurate and reliable FVC measurements before it can be used as an endpoint in clinical trials. Refresher training, automated alerts of problems and FVC changes, and patient support could help to overcome some practical issues. Despite the challenges, there is value in incorporating home handheld spirometry into clinical practice, and the COVID-19 pandemic has highlighted the potential for home monitoring technologies to help improve access to care for patients with ILD.
© 2022. The Author(s).
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Hybrid PET/MRI in Infection and Inflammation: An Update About the Latest Available Literature Evidence.
Semin Nucl Med2023 Jan;53(1):107-124. doi: 10.1053/j.semnuclmed.2022.10.005.
Kirienko Margarita, Erba Paola A, Chiti Arturo, Sollini Martina,
Abstract
PET/MRI has been reported to be promising in the diagnosis and evaluation of infection and inflammation including brain disorders, bone and soft tissue infections and inflammations, cardiovascular, abdominal, and systemic diseases. However, evidence came out manly from anecdotal cases or small cohorts. The present review aimed to update the latest available evidence about the role of PET/MRI in infection and inflammation. The search (January, 1 2018-July, 8 2022) on PubMed produced 504 results. Sixty-five articles were selected and included in the qualitative synthesis. The number of publications on PET/MRI in the 3 years 2018-2020 was comparable, while it increased in 2021 and 2022 (from 11 to 17 and 15, respectively). [F]FDG and Ga-DOTA-FAPI-04 were the most frequently used (42/65) and innovative radiopharmaceuticals, respectively. [F]fluoride (9/65), translocator protein (TSPO)-targeted PET agents (6/65), CXCR4 receptor targeting tracer and ?-amyloid plaques binding radiopharmaceuticals (2/65 and 2/65, respectively) were also used. Most PET/MRI studies in the period 2018-2022 focused on inflammation (55/65), and cardiovascular diseases represented the most frequent field of interest (30/65), also when considering each year singularly. An increasing trend in bone and joint publications was observed in the considered period (12/65). Other topics included neurology (11/65), inflammatory bowel disease (8/65), and other (4/65). PET/MRI technology demonstrated to be useful in infection and inflammation, being superior to each single modality and/or facilitating diagnosis in a number of conditions (eg, cardiac sarcoidosis, myocarditis, endocarditis), and/or allowing to provide insightful information about disease biology and apply innovative radiopharmaceuticals (eg, neurology, atherosclerosis). Publications focused on PET/MRI in large vessel vasculitis and aortic diseases include both diagnostic and discovery objectives. The current review corroborates the potential of PET/MRI - combining in a single examination the high soft tissue contrast, high resolution, and functional information of MRI, with molecular data provided by PET technology - to positively impact on the management of infectious diseases and inflammatory conditions.
Copyright © 2022 Elsevier Inc. All rights reserved.
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Treating Myocardial Inflammation in Cardiac Sarcoidosis: Why, With What, and for How Long?
JACC Cardiovasc Imaging2022 Nov;15(11):1956-1959. doi: 10.1016/j.jcmg.2022.07.016.
Blankstein Ron, Divakaran Sanjay,
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Effect of Immunosuppressive Therapy and Biopsy Status in Monitoring Therapy Response in Suspected Cardiac Sarcoidosis.
JACC Cardiovasc Imaging2022 Nov;15(11):1944-1955. doi: 10.1016/j.jcmg.2022.05.015.
Rojulpote Chaitanya, Bhattaru Abhijit, Jean Christopher, Adams Sarah L, Patel Vandan, Vidula Mahesh K, Selvaraj Senthil, Dubroff Jacob, Peyster Eliot, Clancy Caitlin B, Patterson Karen, Marchlinski Francis E, Rossman Milton, Goldberg Lee, Bravo Paco E,
Abstract
BACKGROUND:
Patients with suspected cardiac sarcoidosis frequently undergo fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) imaging to assess disease activity at baseline and after treatment initiation.
OBJECTIVES:
This study investigated the effect of immunosuppressive therapy and biopsy status to achieve complete treatment response (CTR), partial treatment response (PTR), or no response (NR) on myocardial FDG-PET/CT.
METHODS:
This study analyzed 83 patients with suspected cardiac sarcoidosis (aged 53 ± 1.8 years, 71% were male, 69% were White, 61% had a history of biopsy-confirmed sarcoidosis) who were treatment naive, had evidence of myocardial FDG at baseline, and underwent repeat PET imaging after treatment initiation. CTR was graded visually, and PTR/NR were measured both visually and quantitatively using the total glycolytic activity. Patients were also evaluated for the occurrence of death, sustained ventricular arrhythmias, and heart failure admissions.
RESULTS:
Overall, 59 patients (71%) achieved CTR/PTR (30%/41%) at follow-up scan (P = 0.04). Total glycolytic activity and visual estimate of PTR/NR had excellent agreement (? = 0.86 [95% CI: 0.72-0.99]; P
CONCLUSIONS:
Among patients with suspected sarcoidosis and evidence of myocardial inflammation, treatment response by serial FDG-PET was variable, but a favorable response was more common when using moderate-to-high intensity prednisone dose. Biopsy-proven individuals and those with preserved systolic function were less likely to experience adverse outcomes during follow-up.
Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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