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Pubblicazioni recenti - cardiac sarcoidosis
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Arrhythmia and sarcoidosis: the role of myocardial tissue characterization to guide diagnosis and management.
Eur Heart J Cardiovasc Imaging2020 Mar;21(3):344. doi: 10.1093/ehjci/jez229.
Chatha Salman R, Chahal C Anwar A, Westwood Mark, Khanji Mohammed,
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Pericardial sarcoidosis presenting as PUO diagnosed on FDG PET CT scan.
Asia Ocean J Nucl Med Biol2020 ;8(1):74-78. doi: 10.22038/aojnmb.2019.38132.1255.
Vasantrao Solav Shrikant, Mahaveer Patil Abhijit, Vasant Savale Shailendra, Vishnu Salunke Deepak,
Abstract
Pyrexia of unknown origin (PUO) is a common problem in day-to-day practice. FDG PET CT is an established investigation that aids in identifying the cause of PUO. Due to its high sensitivity PET detects an occult hypermetabolic focus in the body where CT helps in anatomical localization, vascularity, enhancement characteristics of the lesion detected on PET. It helps to differentiate benign versus malignant cause and target biopsy. Tuberculosis, lymphoma, pyelonephritis, thyroiditis appear hypermetabolic on FDG PET CT. Pericardial sarcoidosis is rare and not reported in literature as a cause of PUO. Presented here is a case of PUO secondary to pericardial granulomatosis diagnosed on PET CT. Cardiac MRI also helps in better tissue characterization and associated myocardial involvement of sarcoidosis. Histology confirmed the diagnosis of pericardial sarcoidosis in this case.
© 2020 mums.ac.ir All rights reserved.
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Outcome of implantable cardioverter defibrillator in cardiac sarcoidosis: a systematic review and meta-analysis.
J Interv Card Electrophysiol2020 Feb;():. doi: 10.1007/s10840-020-00705-1.
Halawa Ahmad, Jain Rahul, Turagam Mohit K, Kusumoto Fred M, Woldu Henok G, Gautam Sandeep,
Abstract
PURPOSE:
Cardiac sarcoidosis is a multisystem inflammatory disorder characterized by ventricular arrhythmias. Implantable cardioverter defibrillator (ICD) is used to prevent sudden cardiac death.
METHODS:
We performed literature search for studies that addressed the outcome and complications of ICD in Cardiac Sarcoidosis (CS). Multiple search sites were reviewed from January 1, 2000 until December 1, 2018. We then performed a meta-analysis using a random effects model. Two investigators independently extracted the data and assessed studies' quality.
RESULTS:
Ten studies with 585 patients qualified for the analysis. In the pooled analysis, 57% were male with mean left ventricular ejection fraction (LVEF) of 38.4%. Appropriate and inappropriate ICD treatments (AT and IAT) were reported in 39% and 15% of patients respectively over mean follow-up period of 25 months and mortality rate of 8%. A sub-analysis of four studies indicated that patients with appropriate therapy did not differ from the rest of CS population in LVEF% (mean difference (MD)?=?-?7.37%, 95% confidence interval (CI) -?16.89 to 2.15, p?=?0.12), age (MD?=?-?3.87 years, 95% CI -?10.19 to 2.46, p?=?0.23), primary prevention (range difference (RD)?=?-?0.11, 95% CI -?0.31 to 0.10, p?=?0.31) or secondary prevention indication (RD?=?0.09, 95% CI -?0.12 to 0.3, p?=?0.37). High degree AV block was more common in patients with AT (RD?=?0.07, 95% CI 0.00 to 0.14 p?=?0.05).
CONCLUSIONS:
ICD placement in CS is associated with high incidence of both appropriate and inappropriate therapy. High degree AV block appears to be predictive of appropriate ICD therapy.
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Extending the Role of Cardiac Magnetic Resonance in Sarcoidosis Risk Stratification: Editorial for "Regional Myocardial Remodeling Characteristics Correlates With Cardiac Events in Sarcoidosis".
J Magn Reson Imaging -
Acute exacerbation of idiopathic pulmonary fibrosis: International survey and call for harmonisation.
Eur Respir J2020 Feb;():. doi: 1901760.
Kreuter Michael, Polke Markus, Walsh Simon L F, Krisam Johannes, Collard Harold R, Chaudhuri Nazia, Avdeev Sergey, Behr Jürgen, Calligaro Gregory, Corte Tamera, Flaherty Kevin, Funke-Chambour Manuela, Kolb Martin, Kondoh Yasuhiro, Maher Toby M, Molina Maria Molina, Morais Antonio, Moor Catharina C, Morisset Julie, Pereira Carlos, Quadrelli Silvia, Selman Moises, Tzouvelekis Argyrios, Valenzuela Claudia, Vancheri Carlo, Vicens-Zygmunt Vanesa, Wälscher Julia, Wuyts Wim, Wijsenbeek Marlies, Cottin Vincent, Bendstrup Elisabeth,
Abstract
AIM:
Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) is an often deadly complication of IPF. No focused international guidelines for the management of AE-IPF exist. The aim of this international survey was to assess the global variability in prevention, diagnostic and treatment strategies for AE-IPF.
MATERIAL AND METHODS:
Pulmonologists with ILD expertise were invited to participate in a survey designed by an international expert panel.
RESULTS:
509 pulmonologists from 66 countries responded. Significant geographical variability in approaches to manage AE-IPF was found. Common preventive measures included antifibrotic drugs and vaccination. Diagnostic differences were most pronounced regarding use of KL-6 and viral testing, while HRCT, BNP and D-Dimer are generally applied. High dose steroids are widely administered (94%); the use of other immunosuppressant and treatment strategies is highly variable. Very few (4%) responders never use immunosuppression. Antifibrotic treatments are initiated during AE-IPF by 67%. Invasive ventilation or extracorporeal membrane oxygenation are mainly used as a bridge to transplantation. Most physicians educate patients comprehensively on the severity of AE-IPF (82%) and consider palliative care (64%).
CONCLUSION:
Approaches to the prevention, diagnosis and treatment of AE-IPF vary worldwide. Global trials and guidelines to improve the prognosis of AE-IPF are needed.
Copyright ©ERS 2020.
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Breaking hearts and taking names: A case of sarcoidosis related effusive-constrictive pericarditis.
Respir Med2020 Jan;163():105879. doi: S0954-6111(20)30019-6.
Valentin Ramon, Keeley Ellen C, Ataya Ali, Gomez-Manjarres Diana, Petersen John, Arnaoutakis George J, Drew Peter, Barnes Matt, Patel Divya C,
Abstract
INTRODUCTION:
Pericardial involvement of sarcoidosis is a rare cause for acute heart failure, and usually occurs as a result of the development of a pericardial effusion leading to cardiac tamponade. Even rarer still, is the manifestation of constrictive pericarditis. We report a case of sarcoidosis with lung, pleural, and pericardial involvement with effusive-constrictive pericarditis leading to cardiac tamponade.
CASE PRESENTATION:
A 34-year-old Caucasian man presented for evaluation of a history of worsening exertional dyspnea, edema, and weight loss. A high-resolution chest computed tomography showed diffuse pulmonary nodules with upper lobe predominance and in a perilymphatic distribution; large right pleural effusion; and large pericardial effusion with pericardial thickening. A transthoracic echocardiogram demonstrated early tamponade physiology for which a pericardial drain was placed. After removal of the drain he developed cardiogenic shock from cardiac tamponade attributed to the reaccumulation of a pericardial effusion and urgent pericardial window was performed. Serial echocardiography was concerning for organization and localization of the pericardial fluid. Cardiac magnetic resonance imaging demonstrated a significant reduction in pericardial slippage between the parietal and visceral layers around the heart collectively suggestive of constrictive pericarditis. Confirmation of effusive-constrictive pericarditis was noted on right heart catheterization. He then underwent pericardiectomy, which on histopathologic evaluation demonstrated non-necrotizing granulomas, thus confirming pericardial involvement of sarcoidosis.
CONCLUSIONS:
We report a case demonstrating unique manifestations of sarcoidosis; effusive-constrictive pericarditis presenting with acute congestive heart failure.
Copyright © 2020 Elsevier Ltd. All rights reserved.
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Sarcoidosis diagnosis and treatment in Sweden: A register-based assessment of variations by region and calendar period.
Respir Med2020 Jan;161():105846. doi: S0954-6111(19)30360-9.
Rossides Marios, Kullberg Susanna, Eklund Anders, Grunewald Johan, Arkema Elizabeth V,
Abstract
BACKGROUND:
In Sweden, sarcoidosis prevalence varies geographically, but it is unclear whether diagnosis and treatment patterns vary by geographical area and calendar period. We sought to investigate differences in sarcoidosis diagnosis and treatment by healthcare region and calendar period using nationwide register data.
METHODS:
We included 4777 adults who had at least two ICD-coded visits for sarcoidosis in the National Patient Register (2007-2012). We compared patterns of healthcare use (visits and medication dispensations), and data on sarcoidosis diagnosis and treatment spanning two years before to two years after diagnosis stratified by healthcare region and calendar period at diagnosis.
RESULTS:
Compared to other regions, individuals diagnosed in Stockholm were younger, more likely female, and had a higher education level. In all regions, there was an increase in healthcare use at least six months before sarcoidosis diagnosis with small variation among regions. Most patients were diagnosed in pulmonary and internal medicine outpatient clinics, but compared to the national average more patients were diagnosed in rheumatology in the West and ophthalmology and cardiology in the South. Corticosteroid dispensations at diagnosis varied widely by region (48% in the South/Southeast vs. 30% in Stockholm/North). Demographic factors could not explain these differences. We found no differences by calendar period.
CONCLUSION:
Our findings suggest a six-month delay in sarcoidosis diagnosis irrespective of region. The observed regional variation likely reflects differences in diagnosis and treatment patterns. Stakeholders should ensure diagnosis and treatment recommendations are closely followed.
Copyright © 2019 Elsevier Ltd. All rights reserved.
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Myocardial Positron Emission Tomography for Evaluation of Cardiac Sarcoidosis: Specialized Protocols for Better Diagnosis.
J Cardiovasc Imaging2020 Jan;():. doi: 10.4250/jcvi.2019.0103.
Hwang In Chang, Bang Ji In, Yoon Yeonyee E, Lee Won Woo,
Abstract
Sarcoidosis is a multisystemic granulomatous disease of unknown etiology with various clinical presentations depending on the organs involved. Since cardiac sarcoidosis (CS) portends a higher risk of morbidity and mortality, early diagnosis and aggressive medical treatment are essential to improve the prognosis. 18F-Fluorodeoxyglucose (FDG) positron emission tomography (PET) has emerged as an important tool with practical advantages in assessing disease activity and monitoring the treatment response in patients with CS. While it has high sensitivity, it also has great variability in specificity, probably due to normal physiologic myocardial FDG uptake, which interferes with the evaluation and follow-up of CS using FDG-PET. This review details the technical aspects of FDG-PET imaging for evaluating and diagnosing CS, assessing disease activity, and monitoring therapeutic response.
Copyright © 2020 Korean Society of Echocardiography.
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Proliferation imaging with C-4DST PET/CT for the evaluation of cardiac sarcoidosis, compared with FDG-PET/CT given a long fasting preparation protocol.
J Nucl Cardiol2020 Feb;():. doi: 10.1007/s12350-020-02069-5.
Minamimoto Ryogo, Hotta Masatoshi, Hiroe Michiaki, Awaya Toru, Nakajima Kazuhiko, Okazaki Osamu, Yamashita Hiroyuki, Kaneko Hiroshi, Hiroi Yukio,
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Atypical presentation of cardiac sarcoidosis: role of multimodality imaging and review of literature.
BMJ Case Rep2020 Feb;13(2):. doi: e232047.
Bhandare Deepti, Kottam Anupama,
Abstract
Cardiac sarcoidosis (CS) is challenging to determine, consequently is under-recognised in clinical practice. The accurate prevalence of CS is possibly underestimated due to unspecific symptoms, subclinical illness and the dearth of universally accepted diagnostic criteria. Totally, non-invasive diagnosis of CS was proposed in 2015 by the Japanese Ministry of Health and Welfare using positron emission tomography and cardiac MRI findings as major criteria and substituting histological verification. We present a case of a 60-year-old woman with pulmonary sarcoidosis presenting with progressively worsening palpitations and recurrent syncope. Her initial evaluation at another hospital facility revealed normal cardiac testing. A detailed evaluation with echocardiography and cardiac MRI helped us arrive at the diagnosis of CS, which resulted in appropriate treatment and resolution of symptoms. We discuss CS in general, the clinical disease, diagnostic algorithms, latest guidelines and management.
© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.
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Granuloma in the Explanted Lungs: Infectious Causes and Impact on Post- lung Transplant Mycobacterial Infection.
Transpl Infect Dis2020 Feb;():e13262. doi: 10.1111/tid.13262.
Kabbani D, Kozlowski H N, Cervera C, Chaparro C, Singer L, Rotstein C, Keshavjee S, Husain S,
Abstract
INTRODUCTION:
The significance of granuloma in explanted lungs of lung transplant recipients (LTR) on the development of post-transplant mycobacterial infection is unclear.
METHODS:
A retrospective review comparing LTRs and heart-lung transplant (H-LTR) recipients with granuloma in the explanted lungs between 2000 and 2012 (excluding those LTRs with granuloma due to sarcoidosis) and LTRs or H-LTRs without granuloma. Patients were followed for 2 years post-transplant.
RESULTS:
144 LTRs and 4 H-LTRs with granulomas (75 necrotizing and 73 non-necrotizing) and a comparator cohort of 144 LTRs and 4 H-LTRs without granuloma were analyzed. In LTRs with granulomas, identification of infectious organisms was more common by histopathology (35 AFB and 22 fungal) compared to cultures (6 NTM and 7 fungal) taken around time of the transplant. LTRs with granulomas were more likely to have pre-transplant non-tuberculous mycobacteria (NTM) infection compared to LTRs without granuloma; p<0.01. In the multivariate analysis, having granuloma or positive mycobacterial cultures at time of transplant were associated with increased risk of post-transplant mycobacterial infection (HR=1.8 95% CI [1.024-3.154]; p= 0.041 and HR=2.083 95% CI [1.011-4.292]; p= 0.047). Although there was a trend toward increase mycobacterial disease in those with granulomas p= 0.056, there was no difference in survival post transplantation between those with or without granuloma in the explanted lung; p= 0.886.
CONCLUSION:
The presence of granuloma in the explanted lungs of LTRs or positive mycobacterial cultures at time of transplant are associated with an increased risk of mycobacterial infection post-transplant.
This article is protected by copyright. All rights reserved.
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2020 vision: New insights on hypoxia imaging to assess cardiac and extra-cardiac active inflammatory sarcoidosis.
J Nucl Cardiol2020 Feb;():. doi: 10.1007/s12350-020-02032-4.
Schwartz Ronald G, Vidula Himabindu,
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[Update Sarcoidosis].
Dtsch Med Wochenschr2020 Feb;145(3):175-180. doi: 10.1055/a-0847-9588.
Pfeifer Michael, Lepiorz Marc,
Abstract
Sarcoidosis is a systemic granulomatous disease whose etiology has not yet been clarified. Generally, sarcoidosis is a benign disease, but recent studies have shown that the number of chronic progressive diseases is greater than previously thought. Diagnosis is based on the clinical picture and radiological imaging. In recent years, FDG-PET has become more and more important for the determination of activity and, together with MRI of the heart, for the diagnosis of cardiac manifestation. Furthermore, the indication for immunosuppressive treatment must be determined individually for each patient and depends on the severity of the symptoms and organ disorders. In addition to corticosteroids as the first choice, other immunosuppressants such as methotrexate and TNFalpha blockers have been established as stepwise approach.
© Georg Thieme Verlag KG Stuttgart · New York.
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Sarcoidosis presenting as cardiac tamponade: a case report.
Acta Clin Belg2020 Jan;():1-5. doi: 10.1080/17843286.2020.1724429.
Verdickt Sébastien, De Man Filip, Haine Emmanuel, Van Cleemput Johan,
Abstract
A 62-year-old man without medical history presented with a cardiac tamponade due to a voluminous sterile hemorrhagic exudate. Hypermetabolic mediastinal lymph nodes were found on a PET-CT and pathological analysis revealed non-necrotizing granulomatous adenitis, a finding compatible with sarcoidosis. Steroids were started with rapid clinical improvement and complete resolution of the pericardial effusion.Although pericardial effusions are occasionally seen in cardiac sarcoidosis, symptomatic pericardial involvement with evolution to a tamponade is rare. Our patient is the 7th described case of a sarcoidosis presenting as a tamponade.
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The effects of pharmacological interventions on quality of life and fatigue in sarcoidosis: a systematic review.
Eur Respir Rev2020 Mar;29(155):. doi: 190057.
Vis Roeland, van de Garde Ewoudt M W, Grutters Jan C, Korenromp Ingrid H E,
Abstract
AIMS:
Many sarcoidosis patients experience a reduction in health-related quality of life (HRQoL) and a majority of patients report fatigue. Historically, drug trials in sarcoidosis have focused on changes in chest radiographs, lung function parameters and biomarkers, while HRQoL and fatigue have not been the main outcomes examined. We performed a systematic review of the literature to evaluate the existing evidence on the effects of pharmacological interventions on HRQoL and fatigue outcomes.
METHODS:
The systematic search was performed in Medline and Embase and yielded 15 records covering seven randomised controlled trials and seven single-arm open label studies, which were included in a qualitative synthesis (the results of one study were included in two publications). 12 studies evaluated immunosuppressive and/or immunomodulatory therapies and two studies evaluated stimulants.
RESULTS:
Nine out of the 14 studies observed positive treatment effects from the interventions on HRQoL and/or fatigue, exceeding the minimal important difference. The risk of bias was generally high with only three studies rated as having a low risk of bias. The results suggest a potential for improvement in HRQoL and/or fatigue in patients with active disease who are either untreated or treated but not yet fully stabilised or therapy refractory.
CONCLUSION:
More randomised, double-blind and placebo-controlled trials are needed to expand the evidence base on these important outcome parameters.
Copyright ©ERS 2020.
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Imaging cardiac sarcoidosis and infiltrative diseases: diagnosis and therapeutic response.
Q J Nucl Med Mol Imaging2020 Jan;():. doi: 10.23736/S1824-4785.20.03235-5.
Elwazir Mohamed Y, Bois John P, Abouezzeddine Omar F, Chareonthaitawee Panithaya,
Abstract
Infiltrative heart disease is an encompassing term referring to different pathological entities that involve infiltration of the myocardium by either abnormal substances or inflammatory cells. These infiltrates can impair cellular function, induce necrosis and fibrosis, or otherwise disrupt myocardial architecture resulting in a wide spectrum of structural and functional impairment. Depending on the specific disorder and stage of disease, patients may present with minimal cardiac abnormalities, or may have findings of advanced restrictive and/or dilated cardiomyopathy. Furthermore, patients may often be misdiagnosed with more common conditions such as hypertensive, hypertrophic or ischemic cardiomyopathies. Correlation of cardiac findings with clinical, serologic or pathologic data is critical in many of these conditions. While cardiac involvement may be detected by echocardiography, other imaging modalities such as cardiac magnetic resonance (CMR), single-photon emission computed tomography (SPECT), or positron emission tomography (PET) provide additional critical diagnostic, prognostic and therapeutic information. Advanced imaging modalities also provide quantitative data that can further risk stratify patients, monitor disease progression, and guide management. In this review we provide an overview of infiltrative heart disease from an imaging perspective, with a particular focus on cardiac sarcoidosis (CS) and cardiac amyloidosis (CA).
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The Multi-modality Cardiac Imaging Approach to Cardiac Sarcoidosis.
Curr Med Imaging Rev2019 ;15(1):10-20. doi: 10.2174/1573405614666180522074320.
Ricci Fabrizio, Mantini Cesare, Grigoratos Chrysanthos, Bianco Francesco, Bucciarelli Valentina, Tana Claudio, Mastrodicasa Domenico, Caulo Massimo, Donato Aquaro Giovanni, Raffaele Cotroneo Antonio, Gallina Sabina,
Abstract
BACKGROUND:
Sarcoidosis is a multisystem granulomatous disease with a neglected but high prevalence of life-threatening cardiac involvement.
DISCUSSION:
The clinical presentation of Cardiac Sarcoidosis (CS) depends upon the location and extent of the granulomatous inflammation, with left ventricular free wall the most common location followed by interventricular septum. The lack of a diagnostic gold standard and the unpredictable risk of sudden cardiac death pose serious challenges for the validation of accurate and effective screening test and the management of the disease. In the last few years advanced cardiac imaging modalities such as Cardiac Magnetic Resonance (CMR) and Positron Emission Tomography (PET) have significantly improved our knowledge and understanding of CS, and have also contributed in risk stratification, assessment of inflammatory activity and therapeutic monitoring of the disease.
CONCLUSION:
In this review, we will discuss the state of the art in the diagnosis of CS focusing on the role and importance of multi-modality cardiac imaging.
Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.
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FDG-PET Scan in Sarcoidosis: Clinical and Imaging Indications.
Curr Med Imaging Rev2019 ;15(1):4-9. doi: 10.2174/1573405614666180626120832.
Maccarone Marica T,
Abstract
BACKGROUND:
Sarcoidosis is an unknown etiology multisystem inflammatory disease in which noncaseating granulomas (a collections of inflammatory cells) form and grow in various organs, involving predominantly lungs, intrathoracic lymph node, skin and eyes. It most commonly affects patients between 20 and 40 years old of age but it could be observed at any age (female predominance; rare in Asians).
DISCUSSION:
The areas of the body usually affected by sarcoidosis are lungs, skin, or lymph nodes; pulmonary and mediastinal involvement is seen in over of 90% of patients. Less commonly eyes, liver, heart, and brain are involved. Any organ, however, can be affected. Early diagnosis of sarcoidosis can be difficult due to few signs and symptoms in its early stages, and when disease does occur, it may mimic other pathologies, and is made up with chest X-ray, Computed Tomography (CT)-High Resolution CT (HRCT), gallium scans. Fluoro-Deoxy Glucose- Positron Emission Tomography (FDG-PET) is another useful tool to assess the extent of disease and has a potential to evaluate the clinical management of patients responding or not to the treatment.
CONCLUSION:
In this review, we would summarize in brief the clinical indications of PDG-PET in sarcoidosis and report the imaging features of the main organs involved in this disease.
Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.
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Bone Marrow-Derived Mesenchymal Stromal Cells (MSCs) Modulate the Inflammatory Character of Alveolar Macrophages from Sarcoidosis Patients.
J Clin Med2020 Jan;9(1):. doi: E278.
McClain Caldwell Ian, Hogden Christopher, Nemeth Krisztian, Boyajian Michael, Krepuska Miklos, Szombath Gergely, MacDonald Sandra, Abshari Mehrnoosh, Moss Joel, Vitale-Cross Lynn, Fontana Joseph R, Mezey Eva,
Abstract
Sarcoidosis is a devastating inflammatory disease affecting many organs, especially the lungs and lymph nodes. Bone marrow-derived mesenchymal stromal cells (MSCs) can "reprogram" various types of macrophages towards an anti-inflammatory phenotype. We wanted to determine whether alveolar macrophages from sarcoidosis subjects behave similarly by mounting an anti-inflammatory response when co-cultured with MSCs. Fifteen sarcoidosis and eight control subjects underwent bronchoscopy and bronchoalveolar lavage (BAL). Unselected BAL cells (70-94% macrophages) were isolated and cultured with and without MSCs from healthy adults. Following stimulation of the cultured cells with lipopolysaccharide, the medium was removed to measure interleukin 10 and tumor necrosis factor alpha (IL-10 and TNF-?). In two additional sarcoidosis subjects, flow cytometry was used to study intracellular cytokines and surface markers associated with alveolar macrophages to confirm the results. Unselected BAL cells from sarcoidosis subjects co-cultured with MSCs showed a reduction in TNF-? (pro-inflammatory M1) and an increase in IL-10 (anti-inflammatory M2) in 9 of 11 samples studied. Control subject samples showed few, if any, differences in cytokine production. Unselected BAL cells from two additional patients analyzed by flow cytometry confirmed a switch towards an anti-inflammatory state (i.e., M1 to M2) after co-culture with MSCs. These results suggest that, similarly to other macrophages, alveolar macrophages also respond to MSC contacts by changing towards an anti-inflammatory phenotype. Based on our results, we hypothesize that mesenchymal stromal cells applied to the airways might alleviate lung inflammation and decrease steroid need in patients with sarcoidosis.
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Diagnostic and predictive value of speckle tracking echocardiography in cardiac sarcoidosis.
BMC Cardiovasc Disord2020 Jan;20(1):21. doi: 10.1186/s12872-019-01323-0.
Di Stefano Cristina, Bruno Giulia, Arciniegas Calle Maria C, Acharya Gayatri A, Fussner Lynn M, Ungprasert Patompong, Cooper Leslie T, Blauwet Lori A, Ryu Jay H, Pellikka Patricia A, Carmona Porquera Eva M, Villarraga Hector R,
Abstract
BACKGROUND:
Sarcoidosis is a systemic granulomatous disease that may affect the myocardium. This study evaluated the diagnostic and prognostic value of 2-dimensional speckle tracking echocardiography in cardiac sarcoidosis (CS).
METHODS:
Eighty-three patients with extracardiac, biopsy-proven sarcoidosis and definite/probable diagnosis of cardiac involvement diagnosed from January 2005 through December 2016 were included. Strain parameters in early stages of CS, in a subgroup of 23 CS patients with left ventricular ejection fraction (LVEF) within normal limits (LVEF>?52% for men: >?54% for women, mean value: 57.3%?±?3.8%) and no wall motion abnormalities was compared with 97 controls (1:4) without cardiac disease. LV and right ventricular (RV) global longitudinal (GLS), circumferential (GCS), and radial (GRS) strain and strain rate (SR) analyses were performed with TomTec software and correlated with cardiac outcomes (including heart failure and arrhythmias). This study was approved by the Mayo Clinic Institutional Review Board, and all patients gave informed written consent to participate.
RESULTS:
Mean age of CS patients was 53.6?±?10.8?years, and 34.9% were women. Mean LVEF was 43.2%?±?12.4%; LV GLS, -?12.4%?±?3.7%; LV GCS, -?17.1%?±?6.5%; LV GRS, 29.3%?±?12.8%; and RV wall GLS, 14.6%?±?6.3%. In the 23 patients with early stage CS with normal LVEF and RV systolic function, strain parameters were significantly reduced when compared with controls (respectively: LV GLS, -?15.9%?±?2.5% vs -?18.2%?±?2.7% [P?=?.001]; RV GLS, -?16.9%?±?4.5% vs -?24.1%?±?4.0% [P? -?14%).
CONCLUSION:
Reduced strain values in the LV GLS and RV GLS can be used in the diagnostic algorithm in patients with suspicion of cardiac sarcoidosis. These values also correlate with adverse cardiovascular events.
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