Pubblicazioni recenti - cardiac sarcoidosis

• Sarcoidosis: rarely a single system disorder.
  Breathe (Sheff)

  2020 Dec;16(4):200207. doi: 10.1183/20734735.0207-2020.
  
  Mannes Katrin, Thomas Paul S,
  
  Abstract
  
  Sarcoidosis is a systemic disease with a number of extrapulmonary manifestations, rarely limited to a single system. The objective of this review is to provide a overview of the systemic features of sarcoidosis and their surveillance. Sarcoidosis is disease that can affect any organ system, resulting in a number of complications that can cause significant morbidity and mortality, including ophthalmological and cardiac complications. A number of investigations play a role in identifying manifestations of sarcoidosis. Respiratory physicians have an important role to play in identifying complications and monitoring patients with sarcoidosis, as they may be the first to encounter them.
  
  Copyright ©ERS 2020.
  
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• Re-entrant ventricular tachycardia as a complication of ablation of idiopathic ventricular premature beats from the right outflow tract: a case report.
  Eur Heart J Case Rep

  2020 Dec;4(6):1-7. doi: 10.1093/ehjcr/ytaa434.
  
  Tran Van Nam, Rotman Samuel, Carroz Patrice, Pruvot Etienne,
  
  Abstract
  
  Background:
  We report an unusual case of non-sustained ventricular tachycardia (NSVT) from the epicardial part of the right ventricular outflow tract (RVOT).
  
  Case summary:
  A 37-year-old woman who underwent in 2006 an ablation for idiopathic ventricular premature beats (VPBs) from the RVOT presented with pre-syncopal NSVT in 2016. A cardiac workup showed no coronary disease, normal biventricular function, and no enhancement on cardiac magnetic resonance imaging. A metabolic positron emission tomography scan excluded inflammation. Biopsies revealed normal desmosomal proteins. An endocardial mapping revealed an area of low voltage potential (<0.5?mV) at the antero-septal aspect of the RVOT corresponding to the initial site of ablation from 2006. Activation mapping revealed poor prematurity and pace-mapping showed unsatisfactory morphologies in the RVOT, the left ventricle outflow tract and the right coronary cusp. An epicardial map revealed a low voltage area at the antero-septal aspect of the RVOT with fragmented potentials opposite to the endocardial scar. Pace-mapping demonstrated perfect match. An NSVT was induced and local electrocardiogram showed mid-diastolic potentials. Ablation was applied epicardially and endocardially without any complication. The patient was arrhythmia free at 4-year follow-up.
  
  Discussion:
  Cardiac workup allowed to exclude specific conditions such as arrhythmogenic cardiomyopathy, tetralogy of Fallot, sarcoidosis, or myocarditis as a cause for NSVT from the RVOT. The epi and endocardial map showed residual scar subsequent to the first ablation which served as substrate for the re-entrant NSVT. This is the first case which describes NSVT from the epicardial RVOT as a complication from a previous endocardial ablation for idiopathic VPB.
  
  © The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.
  
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• Management of Cardiac Sarcoidosis in 2020.
  Arrhythm Electrophysiol Rev

  2020 Dec;9(4):182-188. doi: 10.15420/aer.2020.09.
  
  Gilotra Nisha, Okada David, Sharma Apurva, Chrispin Jonathan,
  
  Abstract
  
  Sarcoidosis is an inflammatory granulomatous disease that can affect any organ. Up to one-quarter of patients with systemic sarcoidosis may have evidence of cardiac involvement. The clinical manifestations of cardiac sarcoidosis (CS) include heart block, atrial arrhythmias, ventricular arrhythmias and heart failure. The diagnosis of CS can be challenging given the patchy infiltration of the myocardium but, with the increased availability of advanced cardiac imaging, more cases of CS are being identified. Immunosuppression with corticosteroids remains the standard therapy for the acute inflammatory phase of CS, but there is an evolving role of steroid-sparing agents. In this article, the authors provide an update on the diagnosis of CS, including the role of imaging; review the clinical manifestations of CS, namely heart block, atrial and ventricular arrhythmias and heart failure; discuss updated management strategies, including immunosuppression, electrophysiological and heart failure therapies; and identify the current gaps in knowledge and future directions for cardiac sarcoidosis.
  
  Copyright © 2020, Radcliffe Cardiology.
  
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• Cardiac MRI in autoimmune diseases: where are we now?
  Curr Cardiol Rev

  2021 Jan;():. doi: 10.2174/1573403X16666210108104236.
  
  Vallianou Natalia G, Geladari Eleni, Panagopoulos Fotis, Kalantzi Maria,
  
  Abstract
  
  Cardiovascular magnetic resonance imaging (CMR) allows the early diagnosis of various cardiovascular pathophysiologic phenomena in autoimmune diseases. Preliminary studies suggest that CMR holds a promising role in initiating the necessary changes in anti-rheumatic and cardiac treatment among patients with autoimmune diseases and cardiovascular diseases (CVD). It is widely known that the presence of late gadolinium enhancement (LGE) has been related to worse cardiovascular prognosis. CMR has been documented to be the most valuable tool for diagnosis and risk prediction of cardiac involvement in a sarcoidosis population, while in SLE, the gap between clinical and autopsy diagnosis of myocardial disease could be narrowed with the implementation of CMR. In different connective tissue diseases, including SLE, LGE has been demonstrated to be present, early after the initial diagnosis of SLE. Considering that CMR including LGE identifies more patients with silent myocardial disease in SLE and other connective tissue diseases than echocardiography, CMR should be the preferred imaging modality, especially in the era of modern techniques with a broader availability and expertise. In this review, we summarize the major indications, advantages and limitations of the use of CMR among patients with autoimmune disorders.
  
  Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.
  
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• Twirling around the block-A complex case of cardiac sarcoidosis.
  Heart Rhythm

  2021 Jan;18(1):151-153. doi: S1547-5271(20)30848-1.
  
  Cheung Christopher C, Sarcon Annahita, Belhassen Bernard, Scheinman Melvin,
  
  
  
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• Unusual Overlapping Cardiac Sarcoidosis and Long-QT Type 3 Induced Ventricular Fibrillation.
  Intern Med

  2021 ;60(1):85-89. doi: 10.2169/internalmedicine.5018-20.
  
  Nishikawa Tatsuya, Aiba Takeshi, Ueda Nobuhiko, Nakajima Kenzaburo, Yamada-Inoue Yuko, Kamakura Tsukasa, Wada Mitsuru, Yamagata Kenichiro, Ishibashi Kohei, Tateishi Emi, Kiso Keisuke, Ikeda Yoshihiko, Ishibashi-Ueda Hatsue, Miyamoto Koji, Nagase Satoshi, Noda Takashi, Kusano Kengo,
  
  Abstract
  
  A 54-year-old woman had been resuscitated after ventricular fibrillation and her electrocardiogram showed a QT prolongation (QTc=510 ms), and genetic screening revealed a missense variant, R1644C, in the SCN5A gene. She was therefore diagnosed with congenital long-QT syndrome (LQTS) type 3. However, the patient had left ventricular dysfunction, and based on the findings of cardiac magnetic resonance imaging, positron emission tomography and pathological examinations, she was diagnosed with cardiac sarcoidosis. Although both are rare diseases, their overlapping presence in this case may have led to an increased cardiovascular risk compared with either alone. Thus, not only genetic but comprehensive clinical examinations are important for making a correct diagnosis.
  
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• [Inflammatory cardiomyopathies: Diagnosis, correlations with imaging, interest of myocardial biopsy and place of molecular biology].
  Ann Pathol

  2020 Dec;():. doi: S0242-6498(20)30265-0.
  
  Bourgade Raphaël, Piriou Nicolas, Bressollette-Bodin Céline, Loussouarn Delphine, Toquet Claire,
  
  Abstract
  
  Inflammatory cardiomyopathies, also known as "myocarditis" are inflammatory pathologies affecting the myocardium and characterized by vast etiological and clinical heterogeneity. They can be asymptomatic, particularly in viral forms, or be responsible for sudden death, particularly in subjects under 35 years olds. Due to insufficient sensitivity and specificity of imaging and biology, the gold standard is histopathological and is performed on an endomyocardial biopsy or on explanted heart samples in a transplant context. Their classification has considerably evolved and is now based on the identification of a predominant cell pattern such as lymphocytic, neutrophilic or eosinophilic polynuclear, giant cell or granulomatous myocarditis. These different patterns will guide the etiological diagnosis, prognosis and the therapies to be implemented. Due to the importance of viral etiologies, this morphological analysis must be complemented by a virological analysis based on PCR with viral load quantification. In addition, some authors have been able to demonstrate the occurrence of myocarditis in patients with arrhythmogenic cardiomyopathy of genetic origin. The aim of this chapter is to review the current state of knowledge on inflammatory cardiomyopathies and their management.
  
  Copyright © 2020 Elsevier Masson SAS. All rights reserved.
  
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• Pulmonary hypertension in patients with sarcoidosis: A single-center experience.
  Anatol J Cardiol

  2021 01;25(1):36-41. doi: 10.14744/AnatolJCardiol.2020.88054.
  
  Kaptan Özen Deniz, Mutlu Bülent, Kocakaya Derya, Turan Burak, Sert ?ekerci Sena, Ceyhan Berrin,
  
  Abstract
  
  OBJECTIVE:
  Sarcoidosis is a systemic granulomatous disease rarely complicated by pulmonary hypertension (PH). The prevalence of PH in sarcoidosis is unclear and has differences between ethnic groups. This study aimed to investigate the prevalence and predictors of PH in a Turkish cohort.
  
  METHODS:
  The study included 55 patients with biopsy-proven sarcoidosis in a single center. All patients underwent detailed transthoracic echocardiography (TTE) to assess the probability of PH as recommended. Right heart catheterization (RHC) was performed for patients with intermediate-high risk of PH. Patients with mean pulmonary artery pressure >20 mm Hg by RHC were defined as PH. Demographic and clinical characteristics, laboratory data, spirometry, 6-min walk test, and TTE were compared between low and intermediate-high risk PH groups.
  
  RESULTS:
  The probability of PH was low with 47 patients. Eight patients had intermediate-high probability of PH, and two of them refused to undergo RHC. Of six intermediate-high probability patients, three had PH, and all of them had post-precapillary PH. The prevalence of PH in sarcoidosis was 5.5% (3/55). Six-minute walk distance (6 MWD) and diastolic parameters (E/A ratio, E' wave, and left atrial volume) were significantly lower, and New York Heart association class and N-terminal probrain natriuretic peptide (NT-proBNP) level were higher in intermediate-high risk PH patients compared with low-risk PH patients.
  
  CONCLUSION:
  The frequency of PH in sarcoidosis was 5.5% in a Turkish cohort. NT-proBNP, 6 MWD, diastolic function parameters, and myocardial strain parameters can be useful predictors of PH in patients with sarcoidosis, besides known echocardiographic parameters.
  
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• Pathological Insight into 5-HT Receptor Activation in Fibrosing Interstitial Lung Diseases.
  Int J Mol Sci

  2020 Dec;22(1):. doi: E225.
  
  Löfdahl Anna, Tornling Göran, Wigén Jenny, Larsson-Callerfelt Anna-Karin, Wenglén Christina, Westergren-Thorsson Gunilla,
  
  Abstract
  
  Interstitial lung disease (ILD) encompasses a heterogeneous group of more than 200 conditions, of which primarily idiopathic pulmonary fibrosis (IPF), idiopathic nonspecific interstitial pneumonia, hypersensitivity pneumonitis, ILD associated with autoimmune diseases and sarcoidosis may present a progressive fibrosing (PF) phenotype. Despite different aetiology and histopathological patterns, the PF-ILDs have similarities regarding disease mechanisms with self-sustaining fibrosis, which suggests that the diseases may share common pathogenetic pathways. Previous studies show an enhanced activation of serotonergic signaling in pulmonary fibrosis, and the serotonin (5-HT) receptors have been implicated to have important roles in observed profibrotic actions. Our research findings in support by others, demonstrate antifibrotic effects with 5-HT receptor antagonists, alleviating several key events common for the fibrotic diseases such as myofibroblast differentiation and connective tissue deposition. In this review, we will address the potential role of 5-HT and in particular the 5-HT receptors in three PF-ILDs: ILD associated with systemic sclerosis (SSc-ILD), ILD associated with rheumatoid arthritis (RA-ILD) and IPF. Highlighting the converging pathways in these diseases discloses the 5-HT receptor as a potential disease target for PF-ILDs, which today have an urgent unmet need for therapeutic strategies.
  
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• Cardiac sarcoidosis and prediction of sudden death: An ongoing clinical dilemma?
  Int J Cardiol

  2020 Dec;():. doi: S0167-5273(20)34283-2.
  
  Schindler Thomas H, Derenoncourt Paul, Leucker Thorsten M,
  
  
  
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• Long-Term Benefits of Tailored Exercise in Severe Sarcoidosis: A Case Report.
  Int J Environ Res Public Health

  2020 Dec;17(24):. doi: E9512.
  
  Herrera-Olivares Alba M, García-Manso Juan M, Rodríguez-Gómez Irene, Ara Ignacio, Lucia Alejandro, Santalla Alfredo,
  
  Abstract
  
  BACKGROUND:
  We studied the effects of a supervised, structured exercise program in a severe sarcoidosis patient.
  
  METHODS:
  After being clinically stable for two years, a 52-year-old woman (stage IV, American Thoracic Society) who originally had irreversible lung fibrosis, pulmonary arterial hypertension (PAH), mild mitral insufficiency, and atrial dilatation, and was candidate for lung transplant, performed a combined high-intensity interval, high load resistance, and inspiratory muscle training for 4.5 years, and was tested (cardiopulmonary exercise testing and dual X-ray absorptiometry) every six months.
  
  RESULTS:
  Cardiorespiratory fitness (CRF) and maximal pulmonary ventilation increased by 44% and 60%, respectively. Ventilatory efficiency also improved (decrease in the ventilatory equivalent for oxygen by 32% and 14% at the ventilatory threshold and respiratory compensation point, respectively). She improved New York Heart Association (NYHA) class (from III to II), and cardiac alterations as well as PAH reversed so that she was not in need of lung transplantation anymore. Likewise, she suffered no more episodes of hemoptysis. Bone health was overall maintained despite the post-menopausal status and the corticoid treatment.
  
  CONCLUSIONS:
  A long-term combined exercise intervention safely contributed-at least partly-to improve CRF and NYHA class in a patient with severe sarcoidosis, suggesting a potential coadjuvant effect to attenuate clinical manifestations.
  
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• Giant cell myocarditis causing sudden death in a patient with sarcoidosis.
  Autops Case Rep

  2020 Nov;10(4):e2020238. doi: 10.4322/acr.2020.238.
  
  Ziegler John P, Batalis Nicholas I, Fulcher James W, Ward Michael E,
  
  Abstract
  
  Giant cell myocarditis (GCM) is a rare and rapidly fatal cardiovascular condition most often seen in young adults. It is characterized microscopically by myocardial necrosis with multinucleated giant cells in the absence of well-defined granulomas. This disorder has typically been attributed to manifest as heart failure, but in some individuals, GCM may present as sudden cardiac death. Herein, we present a fatal case of GCM in a 36-year-old male with a history of autoimmune disorders. The decedent presented to the emergency room due to vomiting and was treated for nausea due to suspected dehydration. He was discharged that night and found dead on his bathroom floor the following day. Postmortem examination revealed psoriasis and granulomatous lesions in the lungs consistent with sarcoidosis, further supporting circumstantial evidence existing between GCM and autoimmune disorders. Additionally, this case provides an opportunity to distinguish GCM from the distinct clinical entity of cardiac sarcoidosis (CS), especially in the setting of systemic sarcoidosis. We hope to raise awareness of this rare disease process and its potential to cause sudden cardiac death so that it may be considered in a differential diagnosis as immunosuppression and early cardiac transplantation largely determine the prognosis.
  
  Copyright: © 2020 The Authors.
  
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• Radiologic imaging shows variable accuracy in diagnosing orbital inflammatory disease and assessing its activity.
  Sci Rep

  2020 12;10(1):21875. doi: 10.1038/s41598-020-78830-0.
  
  Lee Min Joung, Hamilton Bronwyn E, Pettersson David, Ogle Kimberly, Murdock Jennifer, Dailey Roger A, Ng John D, Steele Eric A, Verma Rohan, Planck Stephen R, Martin Tammy M, Choi Dongseok, Rosenbaum James T,
  
  Abstract
  
  Radiologic orbital imaging provides important information in the diagnosis and management of orbital inflammation. However, the diagnostic value of orbital imaging is not well elucidated. This study aimed to investigate the diagnostic accuracy of orbital imaging to diagnose orbital inflammatory diseases and its ability to detect active inflammation. We collected 75 scans of 52 patients (49 computed tomography (CT) scans; 26 magnetic resonance (MR) imaging scans). Clinical diagnoses included thyroid eye disease (TED) (41 scans, 31 patients), non-specific orbital inflammation (NSOI) (22 scans, 14 patients), sarcoidosis (4 scans, 3 patients), IgG4-related ophthalmic disease (IgG4-ROD) (5 scans, 3 patients), and granulomatosis with polyangiitis (GPA) (3 scans, 1 patient). Two experienced neuroradiologists interpreted the scans, offered a most likely diagnosis, and assessed the activity of inflammation, blinded to clinical findings. The accuracy rate of radiological diagnosis compared to each clinical diagnosis was evaluated. Sensitivity and specificity in detecting active inflammation were analyzed for TED and NSOI. The accuracy rate of radiologic diagnosis was 80.0% for IgG4-ROD, 77.3% for NSOI, and 73.2% for TED. Orbital imaging could not diagnose sarcoidosis. Orbital CT had a sensitivity of 50.0% and a specificity of 75.0% to predict active TED using clinical assessment as the gold standard. The sensitivity/specificity of orbital MR was 83.3/16.7% for the detection of active NSOI. In conclusion, orbital imaging is accurate for the diagnosis of IgG4, NSOI, and TED. Further studies with a large number of cases are needed to confirm this finding, especially with regard to uncommon diseases. Orbital CT showed moderate sensitivity and good specificity for identifying active TED.
  
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• Evolution of Diagnostic and Treatment Patterns of Cardiac Sarcoidosis.
  Mo Med

  ;117(6):543-547.
  
  Grodzinsky Anna, Fendler Timothy J, Howell Gregory, Gupta Sanjaya, Lawhorn Stephanie, Bhardwaj Bhaskar, Sharma Akshit, Taduru Siva Sagar, Sperry Brett, Saeed Ibrahim M,
  
  Abstract
  
  Cardiac sarcoidosis (CS) may impart substantial morbidity and mortality, and novel imaging modalities are now available to aid in early diagnosis of this clinically silent disease. A better understanding of the clinical experience with CS is important. Twenty-eight patients were diagnosed with the aid of multimodality imaging techniques and were treated by a multidisciplinary team. Demographics, symptomatology, imaging, and therapeutic interventions were compiled from our referral center. In patients with CS, nuclear and MR techniques were often the first studies performed. Echocardiographic findings differed widely. Immunosuppressive therapy and cardiac devices were frequently used. Importantly, isolated CS was not an infrequent finding.
  
  Copyright 2020 by the Missouri State Medical Association.
  
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• Exploring Occupational, Recreational, and Environmental Associations in Patients With Clinically Manifest Cardiac Sarcoidosis.
  CJC Open

  2020 Nov;2(6):585-591. doi: 10.1016/j.cjco.2020.07.010.
  
  Spence Stewart D, Medor Maria C, Nery Pablo B, Shepherd-Perkins Eva, Juneau Daniel, Promislow Steve, Nikolla Alyssa, deKemp Robert A, Beanlands Rob S, Birnie David H,
  
  Abstract
  
  Background:
  Sarcoidosis is a condition of unknown etiology. A number of occupational, recreational, and environmental exposures have been associated with the development of extra-cardiac sarcoidosis. Patients with clinically manifest cardiac sarcoidosis (CS) have a distinct clinical phenotype. We sought to explore the exposures associated with clinically manifest CS.
  
  Methods:
  Two groups of patients were recruited in a prospective registry: cases (patients with clinically manifest CS) and controls (patients without sarcoidosis and who had similar cardiac presentations to cases). A validated survey, previously used in other sarcoidosis phenotypes, was sent to all patients.
  
  Results:
  A total of 113 patients met the inclusion criteria and were sent the survey, of whom 79 of 113 (69.9%) completed the survey. We found 3 environmental associations. First, we found a negative association of CS with smoking, with 8 of 43 (18.6%) CS patients being current or ex-smokers compared to 17 of 36 (47.2%) of the controls. Second, we found a positive association with mold exposure, with 21 of 43 (48.8%) CS patients having a prior history of mold exposure compared to 9 of 36 (25.0%) of the controls. After multivariable analysis, there remained significant associations between CS and smoking (odds ratio 0.14 [95% confidence interval 0.04-0.51],  = 0.002) and mold exposure (odds ratio 5.69 [95% confidence interval 1.68-19.25],  = 0.005). Finally, patients with CS and self-reported acne had a significantly longer duration of active acne (7.82 ± 3.97 years) than did control patients 2.67 ± 1.03 years ( = 0.006).
  
  Conclusions:
  We found a negative association between smoking history and the diagnosis of CS. We also found a significant 5-fold increase in mold exposure and a positive association with duration of acne in patients with CS compared to controls.
  
  © 2020 Canadian Cardiovascular Society. Published by Elsevier Inc.
  
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• The Spectrum of Non-ischemic Cardiac Magnetic Resonance Imaging Findings: A Retrospective Analysis.
  Cureus

  2020 Nov;12(11):e11354. doi: 10.7759/cureus.11354.
  
  Almas Talal, Saleem Hassan, Ehtesham Maryam, Hussain Salman, Khedro Tarek, Alsufyani Reema, Alahmed Fatimah, Almubarak Dana, Zaidi Syed Muhammad Jawad, Hameed Aamir,
  
  Abstract
  
  Introduction Since cardiac pathologies remain ubiquitous, their prompt diagnosis through the means of innovative technologies, such as cardiac magnetic resonance imaging, remains pivotal. The spectrum of these pathologies varies widely, ranging from ischemic etiologies to rare cardiac malignancies. This study evaluates the prevalence of nonischemic cardiac pathologies, such as infiltrative heart diseases, that often warrant meticulous diagnostic evaluation through the means of cardiac magnetic resonance imaging. Methods We performed a retrospective study in order to analyse the cardiac magnetic resonance imaging records of 250 patients over a period of six months with previously remarkable cardiac histories. Patients with a prior history of ischemic cardiac disease, as determined from past medical and surgical records, were excluded from the study. The prevalence of various nonischemic findings was ascertained. The demographic characteristics and comorbidities of the patients were also tabulated.  Results In the present study, 250 patients were included, of which 115 were females and 135 were males, with the mean age hovering at 48.21 ± 11.49 years. The top two most prevalent cardiac magnetic resonance imaging findings were concentric moderate-to-severe left ventricular hypertrophy and patchy subendocardial late gadolinium enhancement of the left ventricle; these were observed in 62.2% and 23.7% of the patients, respectively. Cardiac magnetic resonance imaging also divulged findings typical of rarer pathologies, including cardiac sarcoidosis and primary cardiac lymphoma. Conclusion Pathologies of the heart often mandate extensive diagnostic workup through the means of radiological modalities such as cardiac magnetic resonance imaging. In patients with indications of nonischemic cardiac pathologies, cardiac magnetic resonance imaging can be employed as part of the initial radiological armamentarium. Furthermore, cardiac magnetic resonance remains the imaging modality of choice for detecting infrequent cardiac pathologies, such as cardiac sarcoidosis.
  
  Copyright © 2020, Almas et al.
  
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• FLT-PET for the assessment of systemic sarcoidosis including cardiac and CNS involvement: a prospective study with comparison to FDG-PET.
  EJNMMI Res

  2020 Dec;10(1):154. doi: 10.1186/s13550-020-00742-x.
  
  Martineau Patrick, Pelletier-Galarneau Matthieu, Juneau Daniel, Leung Eugene, Nery Pablo, deKemp Rob, Beanlands Rob, Birnie David,
  
  Abstract
  
  BACKGROUND:
  2-deoxy-2-[18F]fluoro-D-glucose's (FDG) biodistribution limits the evaluation of cardiac sarcoidosis (CS) and neurosarcoidosis (NS). While protocols for cardiac suppression exist, they can be inconvenient for patients and lead to incomplete cardiac suppression in many cases. Furthermore, FDG PET is limited in the detection of neurosarcoidosis due to an inability to suppress high level of physiological uptake within the brain. 3'-deoxy-3'-[F]fluorothymidine (FLT) has been shown to accumulate in sarcoidosis lesions and this tracer lacks significant physiological myocardial and brain uptake, suggesting that this tracer may be useful for the assessment of sarcoidosis, including CS and NS, without the need for patient preparation. This prospective pilot study examined the performance of FLT vs FDG PET for systemic sarcoidosis, including cardiac and neural involvement.
  
  MATERIALS AND METHODS:
  Fourteen subjects with sarcoidosis were prospectively recruited and imaged with FDG- and FLT-PET. Two blinded, experienced readers independently reviewed the FLT-PET and FDG-PET images. Lesion distribution was compared between FLT and FDG. Agreement between FLT- and FDG-PET was determined using Cohen's kappa and the intra-class correlation coefficient. Inter-observer variability of FLT and FDG-PET was assessed.
  
  RESULTS:
  Twelve subjects had CS as per Heart Rhythm Society criteria and 1 had NS. FLT-PET was positive in 12 (86%), and FDG-PET in 11 (79%), with cardiac uptake present in 6 (50%) and 7 (58%) of subjects with CS, respectively. The subject with NS demonstrated uptake on both FLT and FDG-PET, with more lesions on FLT. There were no significant differences in the anatomical distribution of lesions between FLT and FDG. SUVs were significantly (p?
  CONCLUSIONS:
  FLT-PET may be useful for the assessment of systemic sarcoidosis, as well as cardiac and neural involvement.
  
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• Latent tuberculosis infection associates with cardiac involvement in patients with sarcoidosis.
  Sarcoidosis Vasc Diffuse Lung Dis

  2020 ;37(3):e2020005. doi: 10.36141/svdld.v37i3.9926.
  
  Beijer Els, Bakker Annelies, Kraaijvanger Raisa, Meek Bob, Post Marco, Grutters Jan, Veltkamp Marcel,
  
  Abstract
  
  Background:
  Sarcoidosis is a systemic disease characterized by formation of non-caseating granulomas. About 5% of patients have symptoms of cardiac sarcoidosis. Identification of cardiac involvement is important since it is a major cause of death. Mycobacterial antigens have been linked to sarcoidosis pathogenesis. Previous findings suggest that a latent tuberculosis infection (LTBI) might associate with development of cardiac involvement in patients with sarcoidosis. The aim of the present study was to further evaluate these findings in another cohort of cardiac sarcoidosis patients.
  
  Methods:
  Interferon release assays (IGRAs) or tuberculin skin tests (TST) were analysed in a cohort of cardiac sarcoidosis patients (n=103) and compared to non-cardiac sarcoidosis patients (n=153).
  
  Results:
  In the cohort of patients with cardiac sarcoidosis, 7 could be diagnosed with a LTBI (6.8%) compared to only one of the non-cardiac patients (0.7%), p = 0.008.
  
  Conclusions:
  To conclude, we were able to show an association between a LTBI and cardiac involvement in patients with sarcoidosis. Future research is however required to unravel the mechanism involved in this association. .
  
  Copyright: © 2020 SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES.
  
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• Association of the calcitriol to calcifediol ratio with cardiac involvement in newly diagnosed sarcoidosis.
  Sarcoidosis Vasc Diffuse Lung Dis

  2020 ;37(3):e2020008. doi: 10.36141/svdld.v37i3.9939.
  
  Gialafos Elias, Kolilekas Lykourgos, Manali Effrosyni, Katsanos Spyros, Steiropoulos Paschalis, Tsougos Elias, Stratakos Grigorios, Gaga Mina, Koulouris Nikos, Papiris Spyros, Ilias Ioannis,
  
  
  
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• Patterns of healthcare resource utilization in patients with sarcoidosis: a cross-sectional study.
  Sarcoidosis Vasc Diffuse Lung Dis

  2020 ;37(3):e2020002. doi: 10.36141/svdld.v37i3.9261.
  
  Kampstra Nynke A, van der Nat Paul B, van Beek Frouke T, Grutters Jan C, Biesma Douwe H, van der Wees Philip J,
  
  Abstract
  
  Background:
  Limited data are available on healthcare resource use and costs in patients with sarcoidosis.
  
  Objectives:
  The primary aim of this study was to describe cost-drivers of the top 1% and top ?1-5% high-cost patients with sarcoidosis. The secondary aim was to compare costs of patients with and without fatigue complaints and to compare comorbidities.
  
  Methods:
  We conducted a retrospective observational cross-sectional study in 200 patients diagnosed with sarcoidosis. Hospital administrative databases were used to extract healthcare utilization on the individual patient level. Healthcare costs were categorized into nine groups.
  
  Results:
  Average total health care costs for the top 1% (n=22), top ?1%-5% (n=88) and bottom 95% beneficiaries (n=90) were ? 108.296, ?53.237 and ?4.817, respectively. Mean treatment time in days for the top 1%, top ?1-5% and the random sample of the bottom 95% was 1688 days (±225), 1412 days (±367) and 775 days (±659), respectively. Mean annual costs for the top 1%, top ?1-5% and the random sample of the bottom 95% are ?51.082, ?27.840 and ?8.692, respectively. We identified three cost-drivers in the top 5% high-cost patients: 1) expensive medication, 2) intensive care and 3) costs made at the respiratory unit. Patients with and without fatigue showed to have comparable mean costs. High-cost patients were more likely to have multiple organs involved due to sarcoidosis.
  
  Conclusions:
  We identified expensive medication as the main cost-driver in the top 5% high-cost patients with sarcoidosis. The study findings can help to tailor interventions for improving the quality of care and reducing overall costs. .
  
  Copyright: © 2020 SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES.
  
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