Unmasking Cardiac Sarcoidosis: Integrating Multimodal Imaging with Histochemical and Ultrastructural Analysis

Area of Science:

• Cardiology
• Immunology
• Pathology

Background:

• Cardiac sarcoidosis (CS) is a severe, often missed, manifestation of sarcoidosis.
• It involves granulomatous inflammation of the heart muscle, leading to diverse cardiac issues.

Purpose of the Study:

• To review current knowledge on CS pathogenesis, diagnosis, and management.
• To highlight diagnostic challenges and advancements.

Main Methods:

• Synthesis of current literature on CS.
• Emphasis on multimodal diagnostic strategies including cardiac magnetic resonance (CMR), FDG-PET, and histopathology.
• Review of immunosuppressive and cardiac care management.

Main Results:

• CS presents with varied symptoms, from conduction problems to heart failure and arrhythmias.
• Endomyocardial biopsy sensitivity is limited by patchy granuloma distribution.
• Advanced imaging (CMR-LGE, FDG-PET) aids detection and inflammation assessment.

Conclusions:

• A multimodal diagnostic approach is vital for accurate CS diagnosis.
• Management requires integrated immunosuppression and guideline-directed cardiac care.
• Biomarkers and AI imaging analysis offer future diagnostic and therapeutic advancements.