Elevated 18F-fluorodeoxyglucose uptake in the interventricular septum is associated with atrioventricular block in patients with suspected cardiac involvement sarcoidosis

  • Osamu Manabe
  • Hiroshi Ohira
  • Keiichiro Yoshinaga
  • Takahiro Sato
  • Alisa Klaipetch
  • Noriko Oyama-Manabe
  • Yoichi M. Ito
  • Ichizo Tsujino
  • Masaharu Nishimura
  • Nagara Tamaki
Original Article
First Online:
Received:
Accepted:

Abstract

Purpose

Cardiac involvement in sarcoidosis is one of the leading causes of death associated with abnormalities of the conduction system. 18F-FDG PET is useful for detecting inflammatory lesions in cardiac sarcoidosis. However, the relationship between ECG abnormalities and focal 18F-FDG uptake has not been studied. The aim of this study was to evaluate the relationship between electrocardiogram (ECG) abnormalities and the location of elevated myocardial 18F-FDG uptake in patients with sarcoidosis.

Methods

Included in the study were 50 patients (56.3 ± 14.9 years old) with histologically proven sarcoidosis with suspected cardiac involvement based on ECG or echocardiography. All patients had fasted for at least 6 h and were given unfractionated heparin (50 IU/kg) intravenously to reduce the physiological 18F-FDG uptake in the myocardium. The left ventricle (LV) wall was divided into 17 segments by visual analysis. Obvious accumulation in each segment was defined as positive.

Results

Of the 50 patients, 33 showed some ECG abnormalities, including atrioventricular (AV) block in 13. Patients with abnormal ECG findings had a higher number of regions with 18F-FDG uptake than patients without ECG abnormality (3.48 ± 2.73 vs. 1.41 ± 2.09 regions, p = 0.0051). Among ECG abnormalities, the predictor for interventricular septum wall 18F-FDG involvement was AV block (p = 0.0025).

Conclusion

Patients with ECG abnormalities showed a higher number of abnormal 18F-FDG myocardial uptake regions than patients without ECG abnormalities. In particular, focal 18F-FDG uptake in the interventricular septum in cardiac sarcoidosis was associated with AV block. Therefore, determination of regional 18F-FDG distribution might contribute to patient management in cardiac sarcoidosis.

Keywords

Conduction system Electrocardiography Inflammation Myocardium Tomography Sarcoidosis 
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Notes

Acknowledgments

The authors thank Keiichi Magota, PhD, Hidehiko Omote, RT, Ken-ichi Nishijima, PhD, Daiske Abo, MSc, Kumi Ajiki, and Eriko Suzuki for their support during this study.

This study was supported in part by grants from the Ministry of Education, Science and Culture Japan (Category B, no. 23390294; Category Young Investigator, no. 23790826), the Hokkaido Heart Association for Research (H-23) (Sapporo, Japan), the Adult Vascular Disease Research Foundation (#H22-23) (Kyoto, Japan), and the North-Tech Research Foundation (#H23-S2-17, Sapporo, Japan). Dr.Yoshinaga is supported by an Imura Clinical Research Award (Adult Vascular Disease Research Foundation).

Conflicts of interest

None.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Osamu Manabe
    • 1
  • Hiroshi Ohira
    • 2
  • Keiichiro Yoshinaga
    • 3
  • Takahiro Sato
    • 2
  • Alisa Klaipetch
    • 1
  • Noriko Oyama-Manabe
    • 4
  • Yoichi M. Ito
    • 5
  • Ichizo Tsujino
    • 2
  • Masaharu Nishimura
    • 2
  • Nagara Tamaki
    • 1
  1. 1.Department of Nuclear MedicineHokkaido University Graduate School of MedicineSapporoJapan
  2. 2.First Department of MedicineHokkaido University Graduate School of MedicineSapporoJapan
  3. 3.Department of Molecular ImagingHokkaido University Graduate School of MedicineSapporoJapan
  4. 4.Diagnostic and Interventional RadiologyHokkaido University HospitalSapporoJapan
  5. 5.Department of BiostatisticsHokkaido University Graduate School of MedicineSapporoJapan

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