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Review
. 2019 Nov 25;21(12):152.
doi: 10.1007/s11886-019-1238-1.

Cardiac Sarcoidosis

Pranav Mankad  1 , Brian Mitchell  1 , David Birnie  2 , Jordana Kron  3
Affiliations
Review

Cardiac Sarcoidosis

Pranav Mankad et al. Curr Cardiol Rep. .

Abstract

Purpose of review: In this state-of-the-art review, we highlight our current understanding of diagnosis, assessment, and management of cardiac sarcoidosis (CS), focusing on recently published data and expert consensus statement guidelines.

Recent findings: Academic interest in cardiac sarcoidosis research has increased over the past decade along with increased clinical awareness among clinicians. In 2014, the Heart Rhythm Society published the first expert consensus statement on diagnosing and managing arrhythmias associated with CS. Cardiac magnetic resonance has emerged as a valuable tool both for diagnosing CS and predicting risk of life-threatening ventricular arrhythmias based on burden of late gadolinium enhancement. Cardiac fluorodeoxyglucose-positron emission tomography now plays a role in diagnosis, risk stratification, and assessing response to immunosuppressive therapy. Collaborative, multidisciplinary research efforts are needed to further our understanding of this rare, complex disease. Two large multicenter prospective registries-the international Cardiac Sarcoidosis Consortium and the Canadian Cardiac Sarcoidosis Research Group-are enrolling patients to help provide insights into the natural history of the disease and current treatment strategies. Future research should focus on randomized controlled trials comparing different treatment strategies and identifying and testing novel therapeutic agents.

Keywords: Cardiac magnetic resonance; Cardiac sarcoidosis; Implantable cardioverter defibrillator; Positron emission tomography; Sudden cardiac death.

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Conflict of interest statement

Conflict of Interest Pranav Mankad, Brian Mitchell, David Birnie, and Jordana Kron declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
The sensitivity and specificity of various tests for the diagnosis of cardiac sarcoidosis in two sarcoidosis cohorts. Mehta: A sarcoidosis cohort of 62 patients from New York City, USA. Kouranos: A sarcoidosis cohort of 321 patients from Athens, Greece. Orange lines: 95% confidence intervals for specificity of various tests with the means identified; Black lines: 95% confidence intervals for sensitivity of various tests with the means identified. Cardiac sx, cardiac symptoms; ECG, electrocardiogram; Holter, 24-h ambulatory electrocardiographic monitoring; TTE, transthoracic echocardiogram; any variable, combination of all previous tests; CMR, cardiac nuclear magnetic imaging. (Reproduced from: Judson MA. Respir Med 2019, 154:155–157, with permission from Elsevier) [42]
Fig. 2
Fig. 2
Cardiac magnetic resonance image of a 61-year-old male with cardiac sarcoidosis showing patchy late gadolinium enhancement (yellow arrows) involving the base of the anteroseptum, and multiple areas of the anteroseptum and inferoseptum and lateral wall shown in the short axis (a) and 4 chamber view (b) consistent with cardiac sarcoidosis
Fig. 3
Fig. 3
FDG-PET of a 63-year-old female on methotrexate for cardiac sarcoidosis before (a) and during (b) therapy with methotrexate for 2 years, exhibiting a significant decrease in FDG uptake in the heart suggesting adequate response to therapy. The scan continues to show FDG uptake in mediastinal lymph nodes
See this image and copyright information in PMC

References

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MeSH terms