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Pubblicazioni recenti - cardiac sarcoidosis
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Long-Term Corticosteroid-Sparing Immunosuppression for Cardiac Sarcoidosis.
J Am Heart Assoc2019 Sep;8(18):e010952. doi: 10.1161/JAHA.118.010952.
Rosenthal David G, Parwani Purvi, Murray Tyler O, Petek Bradley J, Benn Bryan S, De Marco Teresa, Gerstenfeld Edward P, Janmohamed Munir, Klein Liviu, Lee Byron K, Moss Joshua D, Scheinman Melvin M, Hsia Henry H, Selby Van, Koth Laura L, Pampaloni Miguel H, Zikherman Julie, Vedantham Vasanth,
Abstract
Background Long-term corticosteroid therapy is the standard of care for treatment of cardiac sarcoidosis (CS). The efficacy of long-term corticosteroid-sparing immunosuppression in CS is unknown. The goal of this study was to assess the efficacy of methotrexate with or without adalimumab for long-term disease suppression in CS, and to assess recurrence and adverse event rates after immunosuppression discontinuation. Methods and Results Retrospective chart review identified treatment-naive CS patients at a single academic medical center who received corticosteroid-sparing maintenance therapy. Demographics, cardiac uptake of 18-fluorodeoxyglucose, and adverse cardiac events were compared before and during treatment and between those with persistent or interrupted immunosuppression. Twenty-eight CS patients were followed for a mean 4.1 (SD 1.5) years. Twenty-five patients received 4 to 8 weeks of high-dose prednisone (>30 mg/day), followed by taper and maintenance therapy with methotrexate±low-dose prednisone (low-dose prednisone, <10 mg/day). Adalimumab was added in 19 patients with persistently active CS or in those with intolerance to methotrexate. Methotrexate±low-dose prednisone resulted in initial reduction (88%) or elimination (60%) of 18-fluorodeoxyglucose uptake, and patients receiving adalimumab-containing regimens experienced improved (84%) or resolved (63%) 18-fluorodeoxyglucose uptake. Radiologic relapse occurred in 8 of 9 patients after immunosuppression cessation, 4 patients on methotrexate-containing regimens, and in no patients on adalimumab-containing regimens. Conclusions Corticosteroid-sparing regimens containing methotrexate with or without adalimumab is an effective maintenance therapy in patients after an initial response is confirmed. Disease recurrence in patients on and off immunosuppression support need for ongoing radiologic surveillance regardless of immunosuppression regimen.
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Cardiac sarcoidosis in a patient with testicular seminoma.
BMJ Case Rep2019 Sep;12(9):. doi: e229912.
Bhatti Prashan, Waight Michael, Bromage Daniel, Sado Daniel,
Abstract
Sarcoidosis is a multisystem disorder characterised by non-caseating granulomas that typically affect the lungs, skin and lymph nodes. Sarcoidosis has been associated with various cancers, and we describe the case of a patient with systemic sarcoidosis associated with testicular seminoma. This was originally diagnosed as stable sarcoid-like reaction. He subsequently presented with ventricular tachycardia. Cardiovascular MRI suggested cardiac sarcoidosis, which was confirmed by myocardial biopsy. This case highlights the association between some types of cancer and sarcoidosis. In addition, it highlights the importance of close follow-up for patients with a history of malignancy to monitor for sarcoid-like reactions and sarcoidosis, which are often difficult to differentiate clinically.
© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.
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Inflammasome Formation in Granulomas in Cardiac Sarcoidosis.
Circ Arrhythm Electrophysiol2019 Sep;12(9):e007582. doi: 10.1161/CIRCEP.119.007582.
Kron Jordana, Mauro Adolfo Gabriele, Bonaventura Aldo, Toldo Stefano, Salloum Fadi N, Ellenbogen Kenneth A, Abbate Antonio,
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Localized basal left ventricular dyssynchrony induced by manifest accessory pathway: Successful differentiation from cardiac involvement of sarcoidosis with administration of flecainide acetate.
J Electrocardiol2019 Sep;57():87-89. doi: S0022-0736(19)30607-7.
Tsuda Daisuke, Mori Shumpei, Yokota Shun, Izawa Yu, Shimoyama Shinsuke, Suzuki Masataka, Takahashi Yu, Toh Hiroyuki, Toba Takayoshi, Tanaka Hidekazu, Fujiwara Sei, Hirata Ken-Ichi,
Abstract
We present a patient with non-cardiac sarcoidosis complicated with manifest ventricular preexcitation. Initially, cardiac involvement of sarcoidosis was suspected from the echocardiographic findings showing localized hypokinesia at the left ventricular basal inferior wall. We, however, considered that the hypokinesia was a preexcitation-induced mechanical dyssynchrony rather than cardiac sarcoidosis, because polarities of the delta-waves indicated a left ventricular inferior accessory pathway. Temporal administration of oral flecainide acetate eliminated the basal left ventricular motion abnormality. Accordingly, we could successfully differentiate the mechanism of hypokinesia. In this context, we could rule out cardiac sarcoidosis, and initiation of glucocorticoid therapy was reasonably withheld.
Copyright © 2019 Elsevier Inc. All rights reserved.
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Mycophenolate mofetil as an alternative treatment in sarcoidosis.
Pulm Pharmacol Ther2019 Sep;58():101840. doi: S1094-5539(19)30188-9.
Papiris Spyros, Stagaki Eleni, Papadaki Georgia, Kolilekas Lykourgos, Korbila Ioanna, Apollonatou Vassiliki, Kallieri Maria, Gialafos Helias, Chatziioannou Sofia, Papaioannou Adriana I, Manali Effrosyni D,
Abstract
INTRODUCTION:
In sarcoidosis although no better drug therapy than corticosteroids (CS) has emerged, alternative immunosuppressive agents are used when indicated. Mycophenolate mofetil (MMF) presents rapid action, a considerable safety profile and absence of lung toxicity. Few data exist so far on its use in patients with sarcoidosis. This is a retrospective study on the effectiveness and safety of MMF in patients with sarcoidosis.
MATERIALS AND METHODS:
All patients with biopsy proven sarcoidosis treated for at least 1 year with MMF from 2008 to 2017 in our department are evaluated.
RESULTS:
Eight patients with both pulmonary and extrapulmonary disease are included in the analysis. During follow-up, symptoms and chest radiological findings improved in all. A statistically significant improvement of FEV and FVC is reported (p?=?0.010 and p?=?0.021 respectively). Cardiac and renal disease resolved during treatment while dermal disease significantly improved. MMF permitted CS dose reduction from 15.0 (10.0, 35.0) to 2.5 (0.0, 5.0) mg prednisolone (or equivalent), p?=?0.016. All patients but one, tolerated well MMF.
CONCLUSION:
MMF as an alternative drug in systemic sarcoidosis, proved safe and effective, permitting the reduction of the dose of oral CS and leading to clinical, functional and radiological improvement.
Copyright © 2019 Elsevier Ltd. All rights reserved.
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The Utility of Whole Body F-FDG PET-CT in Diagnosing Isolated Cardiac Sarcoidosis: The Western Australian Cardiac Sarcoid Study.
Heart Lung Circ2019 Aug;():. doi: S1443-9506(19)31368-X.
Giudicatti Lauren, Marangou James, Nolan David, Dembo Lawrence, Baumwol Jay, Dwivedi Girish,
Abstract
BACKGROUND:
It is reported that up to 29-52% of patients with cardiac sarcoidosis (CS) may have isolated cardiac sarcoidosis (ICS). The wide variation in prevalence may be related to the diagnostic methods for assessing extracardiac involvement. Whole-body F-fluorodeoxyglucose positron emission tomography-computed tomography (F-FDG PET-CT) imaging is a useful and increasingly used technique for screening for extracardiac involvement in cases of suspected ICS. This study aims to determine the rate of isolated cardiac involvement with clinically manifest CS using cardiac F-FDG PET-CT.
METHODS:
We performed a retrospective analysis of data in the West Australian Cardiac Sarcoid (WACaS) Database. After cardiologist review and workup, all cases of proven or probable CS, based on either current Heart Rhythm Society criteria for the diagnosis of CS or local expert consensus were included. Only patients who underwent whole body F-FDG PET-CT were included in the final analysis.
RESULTS:
Fifty-two (52) cases of CS were identified. Data on symptoms, imaging findings, treatment and outcomes were collected. Of the 42 patients who underwent diagnostic F-FDG PET-CT, 32 demonstrated changes consistent with CS. Of the 32, 69% were male, mean age 50 years at diagnosis. Only 3/32 (9.4%) patients had ICS. Pulmonary involvement occurred in 91% with varied involvement in other organs. The mean number of extracardiac sites at diagnosis was 2.2.
CONCLUSIONS:
This study demonstrates the utility of F-FDG PET-CT in diagnosing extracardiac organ involvement in cases of CS. With the use of this modality, ICS may be rarer than previously reported.
Copyright © 2019 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
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Infliximab for Refractory Cardiac Sarcoidosis.
Am J Cardiol2019 Aug;():. doi: S0002-9149(19)30955-5.
Harper Logan J, McCarthy Meghann, Neto Manuel L Ribeiro, Hachamovitch Rory, Pearson Karla, Bonanno Barbara, Shaia Josephine, Brunken Richard, Joyce Emer, Culver Daniel A,
Abstract
Cardiac sarcoidosis (CS) is frequently difficult to treat. Infliximab (IFX) is useful for extracardiac sarcoidosis, but its use in CS has been limited due to concerns about cardiotoxicity and an FDA blackbox warning about use in heart failure. We reviewed 36 consecutive patients treated with infliximab for CS refractory to standard therapies. IFX was initiated for patients with refractory dysrhythmias, moderate to severe cardiomyopathy, and evidence of persistent F-18 fluorodeoxyglucose uptake on positron emission tomography scan, despite standard therapies. We compared the prednisone dose, ejection fraction (EF), and dysrhythmias before and after IFX therapy. The prednisone-equivalent steroid dose decreased from a median of 20 mg at initiation of infliximab to 7.5 at 6 months and 5 mg at 12 months postinitiation of infliximab (p <0.001). In the 25 patients with serial EF measurements, no statistically significant difference was detected in EF (41% at baseline, 42% at 6 months). Of the 16 patients with serial dysrhythmia data, there was a trend toward reduction of percent of patients with ventricular tachycardia (VT), from 32% at baseline, to 22% at 6 months and 19% at 12 months (p?=?0.07). Adverse events were common, occurring in 6 of 36 patients, with 3 of 36 patients stopping infliximab for a prolonged period. In responder analysis, 24 patients improved in at least 1 of 3 outcome categories. In conclusion, infliximab may be useful for refractory cardiac sarcoidosis.
Copyright © 2019 Elsevier Inc. All rights reserved.
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[Pituitary sarcoidosis mimicking pituitary adenoma: case report and literature review].
Pan Afr Med J2019 ;33():92. doi: 10.11604/pamj.2019.33.92.17881.
Hassani Fahd Derkaoui, Fadli Mustapha, El Abbadi Najia,
Abstract
Isolated involvement of the hypothalamic-pituitary axis in patients with sarcoidosis is rare. Only a few cases have been reported in the literature. We report the clinical case of a 50-years old female patient who had undergone total thyroidectomy followed by replacement therapy because of goitre 4 years before. She complained of chronic headaches persisting for 6 months and resistant to all appropriate therapies, with concomitant decrease in visual acuity. Clinical examination showed optochiasmatic syndrome with extensive visual field defect and common oculomotor nerve palsy in the right eye with ptosis. Brain MRI objectified pathological process to the sellar region with heterogeneous tissue signal intensity extending to the pituitary stalk with thickening in the latter. Preoperative hormonal assessment showed mild thyrotropic deficiency. The patient underwent wide transnasal endoscopic transsphenoidal resection of fibrous and little bleeding tumor. Postoperative outcome was marked by the occurrence of diabetes insipidus and CSF fistula two days after surgery. Patient's outcome was good under medical treatment with spinal drainage. Thoracoabdominal CT scan and cardiac ultrasound were performed which showed no other site of occurrence of sarcoidosis. Dose of converting enzyme was normal. The patient received corticosteroid therapy for the treatment of systemic disease. Neurosarcoidosis is a criterion of poor prognosis in a patient with sarcoidosis. Hypothalamopituitary involvement is rare resulting in complications which are more frequent than those of other neurological and systemic disorders. This requires multidisciplinary long term management.
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Outcome of catheter ablation of supraventricular tachyarrhythmias in cardiac sarcoidosis.
Clin Cardiol2019 Sep;():. doi: 10.1002/clc.23263.
Willy Kevin, Dechering Dirk G, Wasmer Kristina, Köbe Julia, Bögeholz Nils, Ellermann Christian, Leitz Patrick, Reinke Florian, Frommeyer Gerrit, Eckardt Lars,
Abstract
BACKGROUND:
Sarcoidosis is a multisystem granulomatous disease of not sufficiently understood origin. Some patients develop cardiac involvement in course of the disease which is mostly responsible for adverse outcome. In addition to complications like high degree atrioventricular (AV) block or ventricular tachyarrhythmias, there is a certain percentage of patients developing atrial tachyarrhythmias. Data is limited and the role of catheter ablation uncertain. Therefore, we studied sarcoid patients who presented with supraventricular tachyarrhythmias.
HYPOTHESIS:
Treatment and ablation of supraventricular tachycardia could be hampered by inflammation in patients with cardiac sarcoidosis.
METHODS:
We enrolled 37 consecutive patients with cardiac sarcoidosis who presented with atrial tachyarrhythmias and underwent an electrophysiologic study over a period of 6?years (03/2013-04/2019). In total, 16 catheter ablations for atrial tachyarrhythmias were performed. Mean follow-up duration was 2.5?years.
RESULTS:
Most common ablation performed was cavo-tricuspid isthmus ablation for typical atrial flutter in seven patients (54%). Pulmonary vein isolation for treatment of atrial fibrillation (AF) was performed in five patients (38%). Two patients received slow-pathway modulation for treatment of recurrent atrioventricular nodal reentry tachycardia (AVNRT). All but two patients with AF had no clinical recurrence during follow-up. Two patients had recurrence of AF but still reported markedly improved european heart rhythm association (EHRA) class. Periprocedural safety was very high. There were no adverse events related to the ablation procedure. One patient died during follow-up in the presence of electrical storm.
CONCLUSION:
Catheter ablations of supraventricular tachycardias seem to be safe and effective in patients with cardiac sarcoidosis. Outcome is comparable to patients without inflammatory heart disease, although data from larger patient collectives are mandatory to make recommendations in this special entity.
© 2019 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc.
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Somatostatin receptor imaging by SPECT and PET in patients with chronic inflammatory disorders: a systematic review.
Eur J Nucl Med Mol Imaging2019 Aug;():. doi: 10.1007/s00259-019-04489-z.
Anzola Luz Kelly, Glaudemans Andor W J M, Dierckx Rudi A J O, Martinez F Andres, Moreno Sergio, Signore Alberto,
Abstract
OBJECTIVE:
To review the literature on the clinical application of radiolabeled somatostatin receptor scintigraphy (SRS) by SPECT and PET in adults with chronic inflammatory diseases.
RESEARCH DESIGN:
Systematic review of published observational studies between 1993 and 2017.
DATA COLLECTION AND ANALYSIS:
The Cochrane Central Register of Controlled Trials, MedLine, EMBASE, PubMed, Google Scholar, OVID, EBSCO, Scopus, and Web of Science were used to search for studies on the use of SRS in adults with chronic inflammatory diseases. A team of reviewers independently screened for eligible studies. Quality of evidence was assessed by QUADAS approach.
RESULTS:
Eligible papers included 38 studies. Studied populations were heterogeneous, and patients were classified according to the diagnosed disease: endothelial inflammation, rheumatoid arthritis, cardiac allograft rejection, granulomatous diseases, small vessel vasculitis, idiopathic pulmonary fibrosis, sarcoidosis, and thyroid exophthalmopathy. Because of many quality differences between studies, it was not possible to pool data, and a narrative synthesis is reported.
CONCLUSION:
Results highlight the value of SRS to detect active inflammation in several chronic inflammatory conditions, despite the bias related to the index test, showing lack of standardization of the scintigraphic technique and high variability of methods used to clinically evaluate inflammatory condition.
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Physical Activity in Patients with Sarcoidosis: The Role of Cardiac and Musculoskeletal Involvement.
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Pericardial Effusion in Systemic Sarcoidosis: A Rare Manifestation of Cardiac Sarcoid.
Heart Views;20(2):56-59. doi: 10.4103/HEARTVIEWS.HEARTVIEWS_117_18.
Peña-Garcia Jorge Isaac, Shaikh Sana Javeed, Villacis-Nunez Diana Sofia, Gurram Murali Krishna,
Abstract
We present a 65-year-old African American woman who was found to have pericardial effusion secondary to cardiac sarcoid. Pericardial effusion is a rare manifestation of cardiac sarcoid. All cases of sustemic sarcoid should be evaluated for cardiac involvement which can be difficult to detect.
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Quality of Life of Couples Living with Sarcoidosis.
Respiration2019 Aug;():1-10. doi: 10.1159/000501657.
Voortman Mareye, Hendriks Celine M R, Lodder Paul, Drent Marjolein, De Vries Jolanda,
Abstract
BACKGROUND:
Consequences of sarcoidosis are wide ranging, and the symptom burden has a great impact on patients' quality of life (QoL). However, the QoL of couples living with sarcoidosis has not yet been studied.
OBJECTIVES:
Our aim was to assess the QoL of couples living with sarcoidosis and to evaluate whether living with a partner with sarcoidosis influences the partner's QoL. Furthermore, we aimed to assess whether nonspecific symptoms (fatigue, cognitive failure, small fiber neuropathy (SFN)-related symptoms, depressive symptoms, and state/trait anxiety) predict QoL of partners as well as sarcoidosis patients.
METHOD:
Sarcoidosis outpatients, recruited at Maastricht University Medical Centre (n = 443), and their partners (n = 208) completed several questionnaires, including the World Health Organization QoL - BREF, Fatigue Assessment Scale, SFN screening list, and cognitive failure questionnaire.
RESULTS:
QoL of the partners as well as the sarcoidosis patients was reduced compared with healthy controls, especially regarding the physical health domain. All nonspecific symptoms studied, as well as perceived social support, predicted one or more QoL domains in the sarcoidosis patients, but these factors did not predict the QoL of their partners.
CONCLUSIONS:
The QoL of partners of sarcoidosis patients was reduced, although to a lesser extent than that of the patients. Although the nonspecific symptoms and perceived social support were related to the patients' QoL, this was not the case for the partners. In the management of sarcoidosis, it is important to focus not only on the patients but also on their partners.
© 2019 The Author(s) Published by S. Karger AG, Basel.
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Clinical Features and Histopathology of Cardiac Sarcoidosis with Refractory Heart Failure: An Autopsy Case.
Intern Med2019 Aug;():. doi: 10.2169/internalmedicine.3147-19.
Terasaki Fumio, Kuwabara Hiroko, Takeda Yoshihiro, Yamauchi Yohei, Fujita Shuichi, Nakamura Takahiro, Torii Ikuko, Hirose Yoshinobu, Hoshiga Masaaki,
Abstract
Treatment involving the insertion of an implantable cardioverter defibrillator and cardiac resynchronization therapy devices has markedly improved the prognosis of cardiac sarcoidosis. However, the prognosis remains poor in patients with advanced cardiac dysfunction or heart failure. We herein report the clinical course and histopathological findings of the autopsied heart of a patient with cardiac sarcoidosis with long-term refractory heart failure.
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Assessment of the 2017 AHA/ACC/HRS Guideline Recommendations for Implantable Cardioverter-Defibrillator Implantation in Cardiac Sarcoidosis.
Circ Arrhythm Electrophysiol2019 Sep;12(9):e007488. doi: 10.1161/CIRCEP.119.007488.
Kazmirczak Felipe, Chen Ko-Hsuan Amy, Adabag Selcuk, von Wald Lisa, Roukoz Henri, Benditt David G, Okasha Osama, Farzaneh-Far Afshin, Markowitz Jeremy, Nijjar Prabhjot S, Velangi Pratik S, Bhargava Maneesh, Perlman David, Duval Sue, Akçakaya Mehmet, Shenoy Chetan,
Abstract
BACKGROUND:
Implantable cardioverter-defibrillators are used to prevent sudden cardiac death in patients with cardiac sarcoidosis. The most recent recommendations for implantable cardioverter-defibrillator implantation in these patients are in the 2017 American Heart Association/American College of Cardiology/Heart Rhythm Society Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death. These recommendations, based on observational studies or expert opinion, have not been assessed. We aimed to assess them.
METHODS:
We performed a large retrospective cohort study of patients with biopsy-proven sarcoidosis and known or suspected cardiac sarcoidosis that underwent cardiovascular magnetic resonance imaging. Patients were followed for a composite end point of significant ventricular arrhythmia or sudden cardiac death. The discriminatory performance of the Guideline recommendations was tested using time-dependent receiver operating characteristic analyses. The optimal cutoff for the extent of late gadolinium enhancement predictive of the composite end point was determined using the Youden index.
RESULTS:
In 290 patients, the class I and IIa recommendations identified all patients who experienced the composite end point during a median follow-up of 3.0 years. Patients meeting class I recommendations had a significantly higher incidence of the composite end point than those meeting class IIa recommendations. Left ventricular ejection fraction (LVEF) >35% with >5.7% late gadolinium enhancement on cardiovascular magnetic resonance imaging was as sensitive as and significantly more specific than LVEF >35% with any late gadolinium enhancement. Patients meeting 2 class IIa recommendations, LVEF >35% with the need for a permanent pacemaker and LVEF >35% with late gadolinium enhancement >5.7%, had high annualized event rates. Excluding 2 class IIa recommendations, LVEF >35% with syncope and LVEF >35% with inducible ventricular arrhythmia, resulted in improved discrimination for the composite end point.
CONCLUSIONS:
We assessed the Guideline recommendations for implantable cardioverter-defibrillator implantation in patients with known or suspected cardiac sarcoidosis and identified topics for future research.
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Aetiologies and temporal trends of atrioventricular block in young patients: a 20-year nationwide study.
Europace2019 Aug;():. doi: euz206.
Rudbeck-Resdal Johnni, Christiansen Morten K, Johansen Jens B, Nielsen Jens C, Bundgaard Henning, Jensen Henrik K,
Abstract
AIMS:
To describe aetiologies and temporal trends in young patients with atrioventricular block (AVB).
METHODS AND RESULTS:
We identified all patients in Denmark, receiving their first pacemaker because of AVB before the age of 50?years between 1996 and 2015. Medical records were reviewed and clinical information and diagnostic work-up results were obtained to evaluate the aetiology. We used Poisson regression testing for temporal trends. One thousand and twenty-seven patients were identified, median age at time of implantation was 38 (interquartile range 25-45) years, 584 (56.9%) were male. The aetiologies were complications to cardiac surgery [n?=?157 (15.3%)], congenital AVB [n?=?93 (9.0%)], cardioinhibitory reflex [n?=?52 (5.0%)], congenital heart disease [n?=?43 (4.2%)], complication to radiofrequency ablation [n?=?35 (3.4%)], cardiomyopathy [n?=?31 (3.0%)], endocarditis [n?=?18 (1.7%)], muscular dystrophy [n?=?14 (1.4%)], ischaemic heart disease [n?=?14 (1.4%)], sarcoidosis [n?=?11 (1.1%)], borreliosis [n?=?9 (0.9%)], hereditary [n?=?6 (0.6%)], side-effect to antiarrhythmics [n?=?6 (0.6%)], planned His-ablation [n?=?5 (0.5%)], complication to alcohol septal ablation [n?=?5 (0.5%)], and other known aetiologies [n?=?11 (1.1%)]. The aetiology remained unknown in 517 (50.3%) cases. While the number of patients with unknown aetiology increased during the study period (P?
CONCLUSION:
In a nationwide cohort, the aetiology of AVB was identified in only half the patients younger than 50?years referred for first-time pacemaker implantation. The number of patients with unknown aetiology increased during the study period. These findings indicate need for better insight into aetiologies of AVB and improved diagnostic work-up guidelines.
© The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Imaging Cardiac Sarcoidosis With FLT-PET Compared With FDG/Perfusion-PET: A Prospective Pilot Study.
JACC Cardiovasc Imaging2019 Aug;():. doi: S1936-878X(19)30612-6.
Martineau Patrick, Pelletier-Galarneau Matthieu, Juneau Daniel, Leung Eugene, Nery Pablo B, de Kemp Rob, Beanlands Rob, Birnie David,
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Diagnostic Specificity of Basal Inferoseptal Triangular Late Gadolinium Enhancement for Identification of Cardiac Sarcoidosis.
JACC Cardiovasc Imaging2019 Aug;():. doi: S1936-878X(19)30623-0.
Kuo Ling, Han Yuchi, Mui David, Zhang Ying, Chahal Anwar, Schaller Robert D, Frankel David S, Marchlinski Francis E, Desjardins Benoit, Nazarian Saman,
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Letter by Birnie et al Regarding Article, "Diagnostic Accuracy of Advanced Imaging in Cardiac Sarcoidosis: Implications for the Diagnosis of Isolated Cardiac Sarcoidosis".
Circ Cardiovasc Imaging2019 Aug;12(8):e009614. doi: 10.1161/CIRCIMAGING.119.009614.
Birnie David H, Nery Pablo B, Beanlands Rob,
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