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Diagnosis of cardiac sarcoidosis: histological evidence vs. imaging

Shinichi Kurashima1, Takeshi Kitai1, Andrew Xanthopoulos2

  • 1Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.

Expert Review of Cardiovascular Therapy
|September 30, 2023
PubMed

Insights

Diagnosing cardiac sarcoidosis (CS) is challenging due to low biopsy detection rates. Current criteria, including Heart Rhythm Society and Japanese Circulation Society guidelines, offer different approaches, with advanced imaging aiding clinical diagnosis but requiring careful interpretation.

Area of Science:

  • Cardiology
  • Immunology
  • Medical Imaging

Background:

  • Cardiac sarcoidosis (CS) has a poor prognosis, necessitating early and accurate diagnosis.
  • Endomyocardial biopsy has a low detection rate, complicating CS diagnosis.
  • Current diagnostic criteria, including Heart Rhythm Society (HRS) and Japanese Circulation Society (JCS) guidelines, have limitations.

Purpose of the Study:

  • To review the advantages and disadvantages of current CS diagnostic criteria.
  • To discuss the role of advanced imaging in CS diagnosis.
  • To highlight the significance of clinical manifestations and extracardiac findings in CS.

Main Methods:

  • Comparison of HRS and JCS diagnostic guidelines for CS.
  • Evaluation of multimodality imaging techniques (cardiac MRI, PET) in CS diagnosis.
  • Analysis of clinical presentation and histological findings in CS.

Main Results:

  • HRS criteria's reliance on histology can lead to missed diagnoses.
  • JCS guidelines incorporate advanced imaging for clinical CS diagnosis.
  • Clinical CS diagnosis shows promise but requires careful validation.
  • Phenotyping based on clinical and extracardiac findings is crucial.

Conclusions:

  • Accurate CS diagnosis remains challenging, balancing imaging and histology.
  • Advanced imaging improves detection, but histological confirmation is often desired.
  • Comprehensive phenotyping is essential for effective CS management.
Abstract

Keywords:
Cardiac sarcoidosisdiagnosisheart failureimagingprognosis

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