Pubblicazioni recenti - cardiac sarcoidosis
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Diagnosis and Management of Cardiac Sarcoidosis: A Scientific Statement From the American Heart Association.
Circulation2024 Apr;():. doi: 10.1161/CIR.0000000000001240.
Cheng Richard K, Kittleson Michelle M, Beavers Craig J, Birnie David H, Blankstein Ron, Bravo Paco E, Gilotra Nisha A, Judson Marc A, Patton Kristen K, Rose-Bovino Leonie, ,
Abstract
Cardiac sarcoidosis is an infiltrative cardiomyopathy that results from granulomatous inflammation of the myocardium and may present with high-grade conduction disease, ventricular arrhythmias, and right or left ventricular dysfunction. Over the past several decades, the prevalence of cardiac sarcoidosis has increased. Definitive histological confirmation is often not possible, so clinicians frequently face uncertainty about the accuracy of diagnosis. Hence, the likelihood of cardiac sarcoidosis should be thought of as a continuum (definite, highly probable, probable, possible, low probability, unlikely) rather than in a binary fashion. Treatment should be initiated in individuals with clinical manifestations and active inflammation in a tiered approach, with corticosteroids as first-line treatment. The lack of randomized clinical trials in cardiac sarcoidosis has led to treatment decisions based on cohort studies and consensus opinions, with substantial variation observed across centers. This scientific statement is intended to guide clinical practice and to facilitate management conformity by providing a framework for the diagnosis and management of cardiac sarcoidosis.
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Reversible complete atrioventricular block caused by aortic bicuspid valve calcification with severe aortic stenosis: a case report.
Eur Heart J Case Rep2024 Apr;8(4):ytae173. doi: ytae173.
Yamauchi Shuichiro, Kondo Hidekazu, Fukuda Tomoko, Miyamoto Shinji, Takahashi Naohiko,
Abstract
BACKGROUND:
The aetiology of secondary complete atrioventricular blocks includes ischaemia, cardiac sarcoidosis, electrolyte imbalance, drug use, rheumatic fever, and infections such as Lyme disease and endocarditis. Diagnosis is important since some of these causes are reversible. Although several studies have reported on aortic valve calcification causing complete atrioventricular blocks, no study has described improvement of complete atrioventricular blocks by removal of the calcification.
CASE SUMMARY:
A 42-year-old man with syncope had a Mobitz type II atrioventricular block, an alternating bundle branch block, and severe aortic stenosis. We identified a 10?s paroxysmal complete atrioventricular block with pre-syncope and performed pacemaker implantation. Electrocardiography-gated computed tomography confirmed that the calcification had reached the muscular septum. F-fluorodeoxyglucose-positron emission tomography (FDG-PET) revealed significant FDG uptake with high CT value of calcification in basal interventricular septum. The calcification in the septum was removed carefully, and aortic valve replacement was performed. The atrioventricular conduction capacity improved post-surgery. During the 1-year follow-up, the patient reported dramatic improvement in exercise capacity. We also noted an improvement of
DISCUSSION:
Complete atrioventricular blocks occur in patients with aortic stenosis accompanied by severe calcification of the aortic valve, which are visualized comprehensively by echocardiography. Electrocardiography-gated computed tomography and FDG-PET enabled detailed evaluation of the extent of calcification and pre- and post-operative tissue inflammation. Hence, we suspected that the calcification in the septum was causing complete atrioventricular block. Moreover, clinicians should recognize that aortic valve calcification with aortic stenosis can cause complete atrioventricular blocks.
© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.
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Surgical management of intramedullary cervical spinal sarcoidosis complicated by transient unilateral weakness: A case report.
Surg Neurol Int2024 ;15():76. doi: 76.
Saade Aziz, Denwood Hayley M, Tannoury Tony, Tannoury Chadi,
Abstract
BACKGROUND:
Sarcoidosis, a multisystem inflammatory non-caseating granulomatous disease, can present with neurologic lesions in up to 10% of patients.
CASE DESCRIPTION:
A 57-year-old male presented with three months of worsening upper extremity radicular pain associated with dysmetria, hyperreflexia, bilateral Hoffman's, and positive Babinski signs. The contrast magnetic resonance imaging (MRI) showed a diffuse T2 signal hyperintensity and T1-enhancing 2.5 cm lesion extending sagittally between C4 and C6. The cerebrospinal fluid analysis showed a high protein level and lymphocytic pleocytosis. A cardiac positron emission tomography scan was consistent with the diagnosis of cardiac sarcoidosis. With the diagnosis of multisystemic/probable neurosarcoidosis, the patient was unsuccessfully treated with intravenous methylprednisolone, followed by infliximab. Due to severe cord compression/myelopathy, a C3-C6 laminectomy and C3-C7 posterior spinal fusion were performed. Postoperatively, the patient developed a transient right-sided hemiparesis. Over nine postoperative months, the patient had four relapses of transient repeated episodes of paresis, although follow-up cervical MRI scans revealed adequate cord decompression with a stable intramedullary hyperintense lesion.
CONCLUSION:
Patients with neurosarcoidosis respond unpredictably to surgical decompression and require prolonged medical care, which is often unsuccessful.
Copyright: © 2024 Surgical Neurology International.
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Sarcoidosis presenting as multiple osseous lesions.
Proc (Bayl Univ Med Cent)2024 ;37(3):489-492. doi: 10.1080/08998280.2024.2325322.
Riaz Maryam, Jha Swastika,
Abstract
Sarcoidosis is a multisystem inflammatory condition presenting with the formation of noncaseating granulomas. These granulomas can be found in nearly every organ of the body, but in 90% of cases the lungs are involved. Osseous manifestations are seen in only 3% to 13% of cases and are typically seen alongside the more common pulmonary manifestations. These lesions can be misdiagnosed as metastatic cancer so biopsy, along with clinical correlation and exclusion of other diseases, is necessary to make the diagnosis. Most patients with primary osseous sarcoidosis remain asymptomatic but routine monitoring is necessary to identify progression to lesion growth, cardiac manifestations, and respiratory involvement.
Copyright © 2024 Baylor University Medical Center.
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Decreased serpin C1 in extracellular vesicles predicts response to methotrexate treatment in patients with pulmonary sarcoidosis.
Respir Res2024 Apr;25(1):166. doi: 166.
Kraaijvanger Raisa, Janssen Bonás Montse, Grutters Jan C, Paspali Ioanna, Veltkamp Marcel, de Kleijn Dominique P V, van Moorsel Coline H M,
Abstract
BACKGROUND:
Sarcoidosis is a systemic granulomatous disease of unknown etiology primarily affecting the lungs. Treatment is needed when disease symptoms worsen and organ function deteriorates. In pulmonary sarcoidosis, prednisone and methotrexate (MTX) are the most common anti-inflammatory therapies. However, there is large inter-patient variability in response to treatment, and predictive response markers are currently lacking.
OBJECTIVE:
In this study, we investigated the predictive potential of biomarkers in extracellular vesicles (EVs) isolated from biobanked serum of patients with pulmonary sarcoidosis stored prior to start of therapy.
METHODS:
Protein concentrations of a four-protein test panel of inflammatory proteins were measured in a discovery (n?=?16) and replication (n?=?129) cohort of patients with sarcoidosis and 47 healthy controls. Response to therapy was defined as an improvement of the absolute score of >?5% forced vital capacity (FVC) and/or?>?10% diffusion lung of carbon monoxide (DLCO) after 24?weeks compared to baseline (before treatment).
RESULTS:
Serum protein levels differed between EV fractions and serum, and between sarcoidosis cases and controls. Serpin C1 concentrations in the low density lipid particle EV fraction were lower at baseline in the group of patients with a good response to MTX treatment in both the discovery cohort (p?=?0.059) and in the replication cohort (p?=?0.032). EV Serpin C1 showed to be a significant predictor for response to treatment with MTX (OR 0.4; p?=?0.032).
CONCLUSION:
This study shows that proteins isolated from EVs harbor a distinct signal and have potential as new predictive therapy response biomarkers in sarcoidosis.
© 2024. The Author(s).
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Sarcoidosis-Associated Pulmonary Hypertension.
J Clin Med2024 Apr;13(7):. doi: 2054.
Israël-Biet Dominique, Pastré Jean, Nunes Hilario,
Abstract
Sarcoidosis-associated pulmonary hypertension (SAPH) is a very severe complication of the disease, largely impacting its morbidity and being one of its strongest predictors of mortality. With the recent modifications of the hemodynamic definition of pulmonary hypertension (mean arterial pulmonary pressure >20 instead of
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Molecular Imaging of Heart Failure: An Update and Future Trends.
Semin Nucl Med2024 Apr;():. doi: S0001-2998(24)00028-X.
Saraste Antti, Ståhle Mia, Roivainen Anne, Knuuti Juhani,
Abstract
Molecular imaging can detect and quantify pathophysiological processes underlying heart failure, complementing evaluation of cardiac structure and function with other imaging modalities. Targeted tracers have enabled assessment of various cellular and subcellular mechanisms of heart failure aiming for improved phenotyping, risk stratification, and personalized therapy. This review outlines the current status of molecular imaging in heart failure, accompanied with discussion on novel developments. The focus is on radionuclide methods with data from clinical studies. Imaging of myocardial metabolism can identify left ventricle dysfunction caused by myocardial ischemia that may be reversible after revascularization in the presence of viable myocardium. In vivo imaging of active inflammation and amyloid deposition have an established role in the detection of cardiac sarcoidosis and transthyretin amyloidosis. Innervation imaging has well documented prognostic value in predicting heart failure progression and arrhythmias. Tracers specific for inflammation, angiogenesis and myocardial fibrotic activity are in earlier stages of development, but have demonstrated potential value in early characterization of the response to myocardial injury and prediction of cardiac function over time. Early detection of disease activity is a key for transition from medical treatment of clinically overt heart failure towards a personalized approach aimed at supporting repair and preventing progressive cardiac dysfunction.
Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.
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Highlights 2023.
Radiol Cardiothorac Imaging2024 Apr;6(2):e240020. doi: 10.1148/ryct.240020.
Aquino Gilberto J, Mastrodicasa Domenico, Alabed Samer, Abohashem Shady, Wen Lingyi, Gill Ritu R, Bardo Dianna M E, Abbara Suhny, Hanneman Kate,
Abstract
publishes novel research and technical developments in cardiac, thoracic, and vascular imaging. The journal published many innovative studies during 2023 and achieved an impact factor for the first time since its inaugural issue in 2019, with an impact factor of 7.0. The current review article, led by the trainee editorial board, highlights the most impactful articles published in the journal between November 2022 and October 2023. The review encompasses various aspects of coronary CT, photon-counting detector CT, PET/MRI, cardiac MRI, congenital heart disease, vascular imaging, thoracic imaging, artificial intelligence, and health services research. Key highlights include the potential for photon-counting detector CT to reduce contrast media volumes, utility of combined PET/MRI in the evaluation of cardiac sarcoidosis, the prognostic value of left atrial late gadolinium enhancement at MRI in predicting incident atrial fibrillation, the utility of an artificial intelligence tool to optimize detection of incidental pulmonary embolism, and standardization of medical terminology for cardiac CT. Ongoing research and future directions include evaluation of novel PET tracers for assessment of myocardial fibrosis, deployment of AI tools in clinical cardiovascular imaging workflows, and growing awareness of the need to improve environmental sustainability in imaging. Coronary CT, Photon-counting Detector CT, PET/MRI, Cardiac MRI, Congenital Heart Disease, Vascular Imaging, Thoracic Imaging, Artificial Intelligence, Health Services Research © RSNA, 2024.
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A Case of Cardiomyopathy Associated with CD36 Deficiency: Role of F-Fluorodeoxyglucose Positron Emission Tomography in the Diagnosis.
Intern Med2024 Apr;():. doi: 10.2169/internalmedicine.3253-23.
Fujita Shuichi, Terasaki Fumio, Morishima Itsuro, Hoshiga Masaaki,
Abstract
We herein report a patient with type I CD36 deficiency. The patient was initially suspected of having isolated cardiac sarcoidosis based on the presence of non-sustained ventricular tachycardia, delayed myocardial enhancement on magnetic resonance imaging (MRI), and diffuse accumulation of F-fluorodeoxyglucose (F-FDG) on cardiac positron emission tomography (PET). Our findings suggest that the diagnosis of cardiomyopathy associated with CD36 deficiency is often missed, highlighting the importance of a differential diagnosis of isolated cardiac sarcoidosis.
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Intense 68Ga-OncoFAP Uptake as a New Promising Diagnostic Biomarker in Cardiac Sarcoidosis.
Clin Nucl Med2024 Apr;():. doi: 10.1097/RLU.0000000000005214.
Ventura David, Schäfers Michael, Yilmaz Ali, Eckardt Lars, Korthals Dennis,
Abstract
A 72-year-old man revealed typical findings of cardiac sarcoidosis on cardiovascular MRI. However, 18F-FDG PET showed no hypermetabolism. Therefore, immunosuppression was not initiated. After 2 years, ventricular arrhythmias and heart failure worsened. 68Ga-fibroblast activation protein inhibitor PET was initiated to evaluate potential adverse remodeling due to progressive myocardial fibrosis. A second 18F-FDG PET still revealed no hypermetabolism, and the patient received an implanted cardioverter defibrillator after electrophysiological risk stratification. We present a case of intense fibroblast activation despite a missing 18F-FDG uptake (mismatch).
Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
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Atypical chemokine receptor 4 (ACKR4/CCX-CKR): A comprehensive exploration across physiological and pathological landscapes in contemporary research.
Cell Biochem Funct2024 Apr;42(3):e4009. doi: 10.1002/cbf.4009.
Naser Israa Habeeb, Hamza Asia Ali, Alhili Ahmed, Faisal Ahmed Naser, Ali Mohammed Shnain, Kadhim Noor Abdulaala, Suliman Muath, Alshahrani Mohammad Y, Alawadi Ahmed,
Abstract
Atypical chemokine receptor 4 (ACKR4), also known as CCX-CKR, is a member of the chemokine receptor family that lacks typical G protein signaling activity. Instead, ACKR4 functions as a scavenger receptor that can bind and internalize a wide range of chemokines, influencing their availability and activity in the body. ACKR4 is involved in various physiological processes, such as immune cell trafficking and the development of thymus, spleen, and lymph nodes. Moreover, ACKR4 has been implicated in several pathological conditions, including cancer, heart and lung diseases. In cancer, ACKR4 plays a complex role, acting as a tumor suppressor or promoter depending on the type of cancer and the stage of the disease. For instance, ACKR4 may inhibit the growth and metastasis of breast cancer, but it may also promote the progression of hepatocellular carcinoma and gastric cancer. In inflammatory situations, ACKR4 has been found to modulate the recruitment and activation of immune cells, contributing to the pathogenesis of diseases such as myocardial infraction and pulmonary sarcoidosis. The study of ACKR4 is still ongoing, and further research is needed to fully understand its role in different physiological and pathological contexts. Nonetheless, ACKR4 represents a promising target for the development of novel therapeutic strategies for various diseases.
© 2024 John Wiley & Sons Ltd.
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The Significance of Parametric Mapping in Advanced Cardiac Imaging.
Cardiol Rev2024 Apr;():. doi: 10.1097/CRD.0000000000000695.
Khachatoorian Yeraz, Fuisz Anthon, Frishman William H, Aronow Wilbert S, Ranjan Pragya,
Abstract
Cardiac magnetic resonance imaging has witnessed a transformative shift with the integration of parametric mapping techniques, such as T1 and T2 mapping and extracellular volume fraction. These techniques play a crucial role in advancing our understanding of cardiac function and structure, providing unique insights into myocardial tissue properties. Native T1 mapping is particularly valuable, correlating with histopathological fibrosis and serving as a marker for various cardiac pathologies. Extracellular volume fraction, an early indicator of myocardial remodeling, predicts adverse outcomes in heart failure. Elevated T2 relaxation time in cardiac MRI indicates myocardial edema, enabling noninvasive and early detection in conditions like myocarditis. These techniques offer precise insights into myocardial properties, enhancing the accuracy of diagnosis and prognosis across a spectrum of cardiac conditions, including myocardial infarction, autoimmune diseases, myocarditis, and sarcoidosis. Emphasizing the significance of these techniques in myocardial tissue analysis, the review provides a comprehensive overview of their applications and contributions to our understanding of cardiac diseases.
Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
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Arrhythmic Manifestations and Outcomes of Definite and Probable Cardiac Sarcoidosis.
Heart Rhythm2024 Apr;():. doi: S1547-5271(24)02326-9.
Sykora Daniel, Rosenbaum Andrew N, Churchill Robert A, Kim B Michelle, Elwazir Mohamed Y, Bois John P, Giudicessi John R, Bratcher Melanie, Young Kathleen A, Ryan Sami M, Sugrue Alan M, Killu Ammar M, Chareonthaitawee Panithaya, Kapa Suraj, Deshmukh Abhishek J, Abou Ezzeddine Omar F, Cooper Leslie T, Siontis Konstantinos C,
Abstract
BACKGROUND:
The 2014 HRS consensus statement defines histological (definite) and clinical (probable) diagnostic categories of cardiac sarcoidosis (CS), but few studies have compared their arrhythmic phenotypes and outcomes.
OBJECTIVE:
Evaluate the electrophysiologic/arrhythmic phenotype and outcomes of patients with definite and probable CS.
METHODS:
We analyzed the arrhythmic/electrophysiologic phenotype in a single-center North American cohort of 388 patients (median age 56 years, 39% female) diagnosed with definite (n=58) or probable (n=330) CS (2000-2022). The primary composite outcome was survival to first ventricular tachycardia/fibrillation (VT/VF) or sudden cardiac death (SCD). Key secondary outcomes were also assessed.
RESULTS:
At index evaluation, in situ cardiac implantable electronic devices and antiarrhythmic drug use were more common in definite CS. At median follow-up 3.1 years, the primary outcome occurred in 22 (38%) definite and 127 (38%) probable CS patients (log-rank p=0.55). In multivariable analysis, only higher 18F-FDG SUV myocardium:SUV blood pool ratio (HR 1.09 [95% CI 1.03, 1.15], p=0.003, per 1 unit increase) was associated with the primary outcome. During follow-up, definite CS patients had higher burden of device-treated VT/VF events (mean 2.86 vs 1.56 per patient-year) and higher rate of progression to heart transplant/left ventricular assist device implantation, but no difference in all-cause mortality compared to probable CS patients.
CONCLUSION:
Definite and probable CS patients had similarly high risks of first sustained VT/VF/SCD and all-cause death though definite CS patients had a higher overall arrhythmic burden. Both CS diagnostic groups as defined by the 2014 HRS criteria require an aggressive approach to prevent arrhythmic complications.
Copyright © 2024. Published by Elsevier Inc.
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CHARACTERISTICS AND OUTCOMES OF HOSPITALISED PATIENTS WITH HEART FAILURE AND SARCOIDOSIS: A PROPENISTY-MATCHED ANALYSIS OF THE NATIONWIDE READMISSIONS DATABASE 2010-2019.
Am J Med2024 Apr;():. doi: S0002-9343(24)00206-7.
Ahmed Raheel, Sawatari Hiroyuki, Amanullah Khadija, Okafor Joseph, Wafa Syed Emir Irfan, Deshpande Saurabh, Ramphul Kamleshun, Ali Isma, Khanji Mohammed, Mactaggart Sebastian, AbouEzzeddine Omar, Kouranos Vasilis, Sharma Rakesh, Somers Virend K, Mohammed Selma F, Chahal C Anwar A,
Abstract
BACKGROUND:
Sarcoidosis is associated with a poor prognosis. There is a lack of data examining the outcomes and readmission rates of sarcoidosis patients with heart failure (SwHF) and without heart failure (SwoHF). We aimed to compare the impact of non-ischemic heart failure on outcomes and readmissions in these two groups.
METHODS:
The US Nationwide Readmission Database was queried from 2010-2019 for SwHF and SwoHF patients identified using the International Classification of Diseases, Ninth and Tenth Editions. Those with ischemic heart disease were excluded, and both cohorts were propensity matched for age, gender, and Charlson Comorbidity Index (CCI). Clinical characteristics, length of stay, adjusted healthcare-associated costs, 90-day readmission and mortality were analyzed.
RESULTS:
We identified 97,961 hospitalized patients (median age 63 years, 37.9% male) with a diagnosis of sarcoidosis (35.9% SwHF vs. 64.1% SwoHF). On index admission, heart failure patients had higher prevalences of atrioventricular block (3.3% vs. 1.4%, p
CONCLUSION:
SwHF is associated with higher rates of arrhythmia at index admission, as well as greater hospital cost, readmission and mortality rates compared to those without heart failure.
Copyright © 2024. Published by Elsevier Inc.
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Impact of Sarcoidosis on In-hospital Outcomes Among Patients with Atrial Fibrillation: A Nationwide Readmissions Database Analysis.
J Innov Card Rhythm Manag2024 Mar;15(3):5782-5785. doi: 10.19102/icrm.2024.15035.
Tan Min Choon, Ang Qi Xuan, Yeo Yong Hao, San Boon Jian, Ibrahim Ramzi, Ng Sze Jia, Tan Jian Liang, Walia Jasjit, Suleiman Addi, Correia Joaquim,
Abstract
Sarcoidosis is a disease that involves multiple organs, including the cardiovascular system. While cardiac sarcoidosis has been increasingly recognized, the impact of sarcoidosis on atrial fibrillation (AF) is not well established. This study aimed to analyze the impact of sarcoidosis on in-hospital outcomes among patients who were admitted for a primary diagnosis of AF. Using the all-payer, nationally representative Nationwide Readmissions Database, our study included patients aged ?18 years who were admitted for AF between 2017-2020. We stratified the cohort into two groups depending on the presence of sarcoidosis diagnosis. The in-hospital outcomes were assessed between the two groups via propensity score analysis. A total of 1031 (0.27%) AF patients with sarcoidosis and 387,380 (99.73%) AF patients without sarcoidosis were identified in our analysis. Our propensity score analysis of 1031 (50%) patients with AF and sarcoidosis and 1031 (50%) patients with AF but without sarcoidosis revealed comparable outcomes in early mortality (1.55% vs. 1.55%, = 1.000), prolonged hospital stay (9.51% vs. 9.70%, = .874), non-home discharge (7.95% vs. 9.89%, = .108), and 30-day readmission (13.29% vs. 13.69%, = .797) between the two groups. The cumulative cost of hospitalization was also similar in both groups ($12,632.25 vs. $12,532.63, = .839). The in-hospital adverse event rates were comparable in both groups. Sarcoidosis is not a risk factor for poorer in-hospital outcomes following AF admission. These findings provide valuable insights into the effectiveness of the current guideline for AF management in patients with concomitant sarcoidosis and AF.
Copyright: © 2024 Innovations in Cardiac Rhythm Management.
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Sequential 18F-fluorodeoxyglucose positron emission tomography imaging in cardiac sarcoidosis: Editorial Comment for a manuscript entitled: 'Role of serial 18FDG-PET in determining the therapeutic efficacy of immunosuppression and clinical outcome in patients with cardiac sarcoidosis'.
J Nucl Cardiol2024 Apr;():101860. doi: 10.1016/j.nuclcard.2024.101860.
Sperry Brett W, Vuppala Suchith,
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Organ involvement in newly diagnosed sarcoidosis patients in the Netherlands: The first large European multicentre prospective study.
Respir Med2024 Apr;226():107608. doi: 10.1016/j.rmed.2024.107608.
Van Woensel Julie, Koopman Bart, Schiefer Mart, van Kan Coen, Janssen Marlou T F H, Ramiro Sofia, Magro-Checa César, Landewé Robert Bm, de Kruif Martijn D, Bresser Paul, Mostard Rémy L M,
Abstract
BACKGROUND:
Clinical presentation and prevalence of organ involvement is highly variable in sarcoidosis and depends on ethnic, genetic and geographical factors. These data are not extensively studied in a Dutch population.
AIM:
To determine the prevalence of organ involvement and the indication for systemic immunosuppressive therapy in newly diagnosed sarcoidosis patients in the Netherlands.
METHODS:
Two large Dutch teaching hospitals participated in this prospective cohort study. All adult patients with newly diagnosed sarcoidosis were prospectively included and a standardized work-up was performed. Organ involvement was defined using the WASOG instrument.
RESULTS:
Between 2015 and 2020, a total of 330 patients were included, 55% were male, mean age was 46 (SD 14) years. Most of them were white (76%). Pulmonary involvement including thoracic lymph node enlargement was present in 316 patients (96%). Pulmonary parenchymal disease was present in 156 patients (47%). Ten patients (3%) had radiological signs of pulmonary fibrosis. Cutaneous sarcoidosis was present in 74 patients (23%). Routine ophthalmological screening revealed uveitis in 29 patients (12%, n = 256)). Cardiac and neurosarcoidosis were diagnosed in respectively five (2%) and six patients (2%). Renal involvement was observed in 11 (3%) patients. Hypercalcaemia and hypercalciuria were observed in 29 (10%) and 48 (26%, n = 182) patients, respectively. Hepatic involvement was found in 6 patients (2%). In 30% of the patients, systemic immunosuppressive treatment was started at diagnosis.
CONCLUSIONS:
High-risk organ involvement in sarcoidosis is uncommon at diagnosis. Indication for systemic immunosuppressive therapy was present in a minority of patients.
Copyright © 2024 Elsevier Ltd. All rights reserved.
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Peri-Operative Outcomes Associated With the Placement of Implantable Cardioverter-Defibrillators in Patients With Sarcoidosis: A Nationwide Database Analysis.
Cureus2024 Mar;16(3):e55589. doi: e55589.
Singireddy Shreyas, Edusa Samuel,
Abstract
Rationale Sarcoidosis with cardiac involvement can be associated with serious life-threatening arrhythmias and an increased risk of sudden cardiac death. Implantable cardiac defibrillators (ICDs) have been used for primary and secondary prevention of sudden death in patients with cardiac sarcoidosis (CS). Post-ICD placement complications have been shown to be higher in patients with CS. However, data comparing postoperative ICD complications among sarcoidosis patients with the general population is limited. Here, we evaluated the association of postoperative complications with implantable cardioverter-defibrillators in sarcoidosis. Methods Using the NIS database, we identified cases of adults aged ? 18 years undergoing surgical placement of implantable cardioverter-defibrillators between 2010 and 2019. Using ICD-9 and ICD-10 codes, we identified patients with sarcoidosis. In all statistical analyses, we applied weights provided by HCUP to produce results representative of national estimates. We compared categorical and continuous covariates in the baseline characteristics using the chi-square test and analysis of variance, respectively. We employed multivariable logistic and linear regression to compare binomial and continuous outcomes to assess differences in mortality rates. Results We analyzed 114073 patients during the study period. Of these, 1012 (0.9%) had sarcoidosis and were found to be significantly younger and female compared to patients without sarcoidosis (56.4 ±11.5 years vs. 65.6 ± 13.9 years, p
Copyright © 2024, Singireddy et al.
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Aneurysm After Stereotactic Body Radiation Therapy in a Patient With Cardiac Sarcoidosis.
JACC Clin Electrophysiol2024 Mar;():. doi: S2405-500X(24)00157-9.
John Leah A, Bredfeldt Jeremy, Mannan Zariyat, Patino Carlos, Divakaran Sanjay, Mak Raymond, Sauer William H, Zei Paul, Tedrow Usha B,
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Utility of new FDG-PET/CT guidelines for diagnosing cardiac sarcoidosis in patients with implanted cardiac pacemakers for atrioventricular block.
Sci Rep2024 Apr;14(1):7825. doi: 7825.
Tanabe Subaru, Nakano Yusuke, Ando Hirohiko, Fujimoto Masanobu, Onishi Tomohiro, Ohashi Hirofumi, Kuno Shimpei, Naito Kazuhiro, Waseda Katsuhisa, Takahashi Hiroshi, Suzuki Yasushi, Fukuta Motoyuki, Amano Tetsuya,
Abstract
Diagnosing cardiac sarcoidosis (CS), especially in isolated cases, is challenging, particularly due to the limitations of endomyocardial biopsy, leading to potential undiagnosed cases in pacemaker-implanted patients. This study aims to provide real world findings to support new guideline for CS using 18F-fluoro-deoxyglucose positron-emission tomography computed tomography (FDG-PET/CT) which give a definite diagnosis of isolated CS (iCS) without histological findings. We examined consecutive patients with cardiac pacemakers for atrioventricular block (AV-b) attending our outpatient pacemaker clinic. The patients underwent periodical follow-up echocardiography and were divided into two groups according to echocardiographic findings: those with suspected CS and those without suspected CS. Patients suspected of having nonischemic cardiomyopathy underwent FDG-PET/CT for CS diagnosis. We investigated the utility of the new guideline for CS using FDG-PET/CT. Among the 272 patients enrolled, 97 patients were implanted with cardiac pacemakers for AV-b. Twenty-two patients were suspected of having CS during a median observation period of 5.4 years after pacemaker implantation. Of these, one did not consent, and nine of 21 cases (43%) were diagnosed with definite CS according to the new guidelines. Five of these nine patients were diagnosed with iCS using FDG-PET/CT. The number of patients diagnosed with definite CS using the new guidelines tended to be approximately 2.3 times that of the conventional criteria (p?=?0.074). Three of the nine patients underwent steroid treatment. The composite outcome, comprising all-cause death, heart failure hospitalization, and a substantial reduction in left ventricular ejection fraction, were significantly lower in patients receiving steroid treatment compared to those without steroid treatment (p?=?0.048). The utilization of FDG-PET/CT in accordance with the new guidelines facilitates the diagnosis of CS, including iCS, resulting in approximately 2.3 times as many diagnoses of CS compared to the conventional criteria. This guideline has the potential to support the early identification of iCS and may contribute to enhancing patient clinical outcomes.
© 2024. The Author(s).
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