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. 2025 Nov 15:439:133643.
doi: 10.1016/j.ijcard.2025.133643. Epub 2025 Jul 18.

Diagnoses and outcomes of patients referred for FDG PET/CT for suspected cardiac sarcoidosis

Stephen J Hankinson  1 , Sylvain L Carre  1 , Shelby S Laychak  1 , Jon M Hainer  1 , Akshay S Desai  2 , Garrick C Stewart  2 , Neal K Lakdawala  2 , Michael M Givertz  2 , Usha B Tedrow  2 , William H Sauer  2 , Ron Blankstein  3 , Marcelo F Di Carli  3 , Sanjay Divakaran  4
Affiliations

Diagnoses and outcomes of patients referred for FDG PET/CT for suspected cardiac sarcoidosis

Stephen J Hankinson et al. Int J Cardiol. .

Abstract

Background: Fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) imaging is commonly used to facilitate diagnosis in suspected cardiac sarcoidosis (CS). However, there is a gap in evidence regarding the diagnoses and outcomes of patients who undergo FDG PET/CT.

Objectives: Evaluate the diagnoses and outcomes of patients referred for FDG PET/CT imaging for suspected CS.

Methods: We studied all consecutive patients referred to our center for FDG PET/CT for suspected CS from June 2006 to November 2023. Patients were characterized by their final clinical diagnosis and followed to a composite outcome of left ventricular assist device placement, heart transplant, or death.

Results: A total of 1646 patients (mean age 58.4 ± 12.4 years; 66 % male) met inclusion criteria: 285 (17.3 %) with Heart Rhythm Society (HRS) criteria positive CS, 83 (5.0 %) with probable CS, 237 (14.4 %) with sarcoidosis but without HRS criteria for CS, and 1041 (63.2 %) with other diagnoses. 227 patients (13.8 %) underwent genetic testing, of whom 32 (14.1 %) were found to have a pathogenic/likely pathogenic variant. Over a median follow up of 4.4 years, 327 patients (19.9 %) met the primary outcome. There was no significant difference in outcomes by diagnosis (log-rank p = 0.4936).

Conclusions: Most patients referred for FDG PET/CT for suspected CS were not found to have CS in follow up. However, they are at similar risk for the need for advanced therapies and many are found to have genetic CMP. These data highlight the importance of advanced heart disease consultation and referral for genetic testing in this population.

Keywords: Cardiac sarcoidosis; Fluorodeoxyglucose positron emission tomography/computed tomography; Genetic cardiomyopathy; Genetic testing; Infiltrative cardiomyopathy.

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Conflict of interest statement

Declaration of competing interest Dr. Desai has received grants and personal fees from AstraZeneca; personal fees from Abbott, Biofourmis, Boston Scientific, Boehringer Ingelheim, Corvidia, DalCor Pharma, Relypsa, Regeneron, and Merck; grants and personal fees from Alnylam and Novartis; and personal fees from Amgen, outside of the submitted work. Dr. Stewart has served as a consultant (clinical events committee) for Procyrion, Inc. Dr. Lakdawala received unrestricted funding on LMNA heart disease from the O'Hare Family Foundation, Pfizer, and BMS and has received modest consulting incomes from Pfizer, BMS, Nuevocore, Alexion, Bayer, Cytokinetics, Sarepta, and Tenaya. Dr. Givertz reports a relationship with Merck & Co Inc. that includes: consulting or advisory; and with Abbott Vascular Inc., Endtronix, and Natera Inc. that includes: institutional research support. Dr. Tedrow has received consulting, research, speaking, and advisory board honoraria from Boston Scientific, Biosense Webster, and Abbott Medical. Dr. Sauer is a paid consultant for Biosense Webster, Boston Scientific, AtriCure, Abbott, and Sanofi. Dr. Blankstein reports a relationship with Amgen Inc. that includes funding grants and reports a relationship with Novartis Inc. that includes funding grants. Dr. Di Carli reports a relationship with Gilead Sciences that includes funding grants, a relationship with Sun Pharmaceuticals that includes funding grants, a relationship with Amgen that includes funding grants, a relationship with Sanofi that includes consulting or advisory, a relationship with MedTrace Pharma that includes consulting or advisory, and a relationship with Valo Health that includes consulting or advisory. All other authors report no relationships relevant to the contents of this paper to disclose.

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