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Advanced imaging of cardiac sarcoidosis
Chadi Ayoub1, Elena Pena, Hiroshi Ohira
1National Cardiac PET Centre, Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, K1Y 4W7, Canada, cayoub@ottawaheart.ca.
Insights
Cardiac sarcoidosis is often underdiagnosed, posing risks for heart failure and sudden death. Early investigation and advanced imaging are crucial for timely diagnosis and management of this condition.
Area of Science:
- Cardiology
- Immunology
- Internal Medicine
Background:
- Cardiac sarcoidosis is a serious manifestation of sarcoidosis.
- It is frequently underdiagnosed due to subtle or absent clinical signs.
- Cardiac involvement significantly increases patient morbidity and mortality risk.
Purpose of the Study:
- To highlight the underdiagnosis of cardiac sarcoidosis.
- To emphasize the importance of considering cardiac sarcoidosis in specific patient groups.
- To discuss the role of advanced imaging in diagnosis and management.
Main Methods:
- Review of clinical presentation and diagnostic challenges.
- Discussion of diagnostic criteria and patient selection for investigation.
- Evaluation of advanced imaging techniques like cardiac MRI and PET scans.
Main Results:
- Cardiac sarcoidosis presents diagnostic challenges due to non-specific symptoms.
- Patients with extracardiac sarcoidosis and unexplained atrioventricular block <60 years are at high risk.
- Advanced imaging aids in diagnosis and treatment monitoring.
Conclusions:
- Cardiac sarcoidosis requires increased clinical suspicion.
- Prompt investigation in at-risk individuals is essential.
- Advanced imaging modalities improve diagnostic accuracy and treatment assessment, potentially reducing adverse outcomes.
Abstract:
Sarcoidosis with cardiac involvement is underdiagnosed and can put patients at risk of morbidity including conduction defects, arrhythmias and heart failure, as well as sudden cardiac death. In addition, cardiac sarcoidosis may have no clinical manifestations or non-specific presentation and diagnosis may be difficult on clinical criteria. Investigation for cardiac sarcoidosis should be considered in those with extra-cardiac sarcoidosis and cardiac findings as well as those under the age of 60 years presenting with atrioventricular block without a clear cause. Advanced imaging modalities including cardiac magnetic resonance and positron emission tomography may help in both the diagnosis and assessment of response to treatment for cardiac sarcoidosis. This ultimately may help to minimize associated adverse outcomes from this enigmatic disease.
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