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The prognostic value of positron emission tomography in the evaluation of suspected cardiac sarcoidosis

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Journal of Nuclear Cardiology Aims and scope

Abstract

Objectives

To assess the prognostic value of positron emission tomography (PET) imaging in patients undergoing evaluation for known or suspected cardiac sarcoidosis (CS) while not on active immunotherapy.

Background

Previous studies have attempted to identify the value of PET imaging to aid in risk stratification of patients with CS, however, most cohorts have included patients currently on immunosuppression, which may confound scan results by suppressing positive findings.

Methods

We retrospectively analyzed 197 patients not on immunosuppression who underwent 18F-fluorodeoxyglucose (FDG) PET scans for evaluation of known or suspected CS. The primary endpoint of the study was time to ventricular arrhythmia (VT/VF), or death. Candidate predictors were identified by univariable Cox proportional hazards regression. Independent predictors were identified by performing multivariable Cox regression with stepwise forward selection.

Results

Median follow-up time was 531 [IQR 309, 748] days. 41 patients met the primary endpoint. After stepwise forward selection, left ventricular ejection fraction (LVEF) (HR 0.98, 95% CI 0.96-0.99, P = 0.02), history of VT/VF (HR 4.19, 95% CI 2.15-8.17, P < 0.001), and summed rest score (SRS) (HR 1.06, 95% CI 1.02-1.12, P = 0.01) were predictive of the primary endpoint. Quantitative and qualitative measures of FDG uptake on PET were not predictive of clinical events.

Conclusions

Among untreated patients who underwent PET scans to evaluate known or suspected CS, LVEF, history of VT/VF, and SRS were associated with adverse clinical outcomes.

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Disclosures

Vaiibhav N. Patel, Justin A. Pieper, David Kopin, Thomas Cascino, Keith Aaronson and Todd Koelling have no conflicts of interest to disclose. Alexis Poitrasson-Rivière is employed by INVIA. INVIA Medical Imaging Solutions did not provide direct support to this study. Venkatesh L. Murthy owns stock in General Electric, has a research grant from Siemens Medical Imaging, and receives non-monetary research support from INVIA.

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Author notes

  1. Vaiibhav N. Patel and Justin A. Pieper have contributed equally to this work and are co-first authors.

  2. Venkatesh L. Murthy and Todd Koelling have contributed equally to this work and are co-senior authors.

Authors and Affiliations

  1. Division of Cardiovascular Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA

    Vaiibhav N. Patel, David Kopin, Thomas Cascino, Keith Aaronson, Venkatesh L. Murthy & Todd Koelling

  2. Department of Medicine, University of Michigan, Ann Arbor, MI, USA

    Justin A. Pieper

  3. INVIA Medical Imaging Solutions, Ann Arbor, MI, USA

    Alexis Poitrasson-Rivière

  4. Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, MI, USA

    Venkatesh L. Murthy

  5. Division of Cardiovascular Medicine, Ross Heart Hospital, The Ohio State University, 452 W 10th Avenue, Columbus, OH, 43210, USA

    Justin A. Pieper

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Correspondence to Justin A. Pieper.

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Funding

V. L. Murthy is supported by 1R01HL136685 from the National, Heart, Lung, Blood Institute and 1RO1AG059729 from the National Institute on Aging.

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Patel, V.N., Pieper, J.A., Poitrasson-Rivière, A. et al. The prognostic value of positron emission tomography in the evaluation of suspected cardiac sarcoidosis. J. Nucl. Cardiol. 29, 2460–2470 (2022). https://doi.org/10.1007/s12350-021-02780-x

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  • DOI: https://doi.org/10.1007/s12350-021-02780-x

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