Advertisement

Journal of Nuclear Cardiology

, Volume 21, Issue 1, pp 166–174 | Cite as

Reduction in 18F-fluorodeoxyglucose uptake on serial cardiac positron emission tomography is associated with improved left ventricular ejection fraction in patients with cardiac sarcoidosis

  • Michael T. Osborne
  • Edward A. Hulten
  • Avinainder Singh
  • Alfonso H. Waller
  • Marcio S. Bittencourt
  • Garrick C. Stewart
  • Jon Hainer
  • Venkatesh L. Murthy
  • Hicham Skali
  • Sharmila Dorbala
  • Marcelo F. Di Carli
  • Ron Blankstein
Original Article

Abstract

Background

Cardiac positron emission tomography (PET) using 18F-fluorodeoxyglucose (FDG) has been used to diagnose and monitor cardiac sarcoidosis (CS). It is not known whether a reduction in myocardial inflammation, as measured by FDG uptake, is associated with improvement in LV ejection fraction (EF).

Methods

For 23 patients with CS followed by a total of 90 serial PET exams (median 4 per patient), two physicians blinded to EF quantified the maximum of standardized uptake value (SUV) and volume of inflamed tissue above two distinct thresholds to assess the intensity and extent of FDG uptake on each study. Using gated 82Rubidium rest myocardial perfusion images, EF was measured blinded to all clinical and FDG data. To account for clustering and differences in scan frequency, a longitudinal mixed effects model was used to evaluate the relationship between FDG uptake and changes in EF on interval scans.

Results

Among 23 patients with serial PET exams (mean age 49, 74% male, mean baseline EF 43% ± 13%), the median time between the first and last scan was 2.0 years. Overall, 91% were treated with corticosteroids, 78% with ACE/ARB, 83% with beta-blockers, and 83% had ICDs. Longitudinal regression demonstrated a significant inverse linear relationship between maximum SUV and EF with an expected increase in EF of 7.9% per SUV reduction of 10 g·mL−1 (P = .008). Likewise, in an analysis based on volume, there was an increase in EF of 2.1% per 100 cm3 decrease in volume of inflamed tissue using a threshold of 2.7 g·mL−1 (P = .028) and an increase in EF of 3.8% per 100 cm3 decrease (P = .022) using a SUV threshold of 4.1 g·mL−1.

Conclusions

In a longitudinal cohort of CS patients, a reduction in the intensity and extent of myocardial inflammation on FDG PET is associated with improvement in EF. These data suggest serial PET scanning may help guide titration of immunosuppressive therapy to improve or prevent heart failure in CS.

Keywords

PET imaging fluorodeoxyglucose (FDG) cardiomyopathy metabolism PET 

Notes

Disclosure

None.

References

  1. 1.
    Iannuzzi MC, Fontana JR. Sarcoidosis: Clinical presentation, immunopathogenesis, and therapeutics. J Am Med Assoc 2011;305:391-9.CrossRefGoogle Scholar
  2. 2.
    Silverman KJ, Hutchins GM, Bulkley BH. Cardiac sarcoid: A clinicopathologic study of 84 unselected patients with systemic sarcoidosis. Circulation 1978;58:1204-11.PubMedCrossRefGoogle Scholar
  3. 3.
    Yazaki Y, Isobe M, Hiroe M, Morimoto S, Hiramitsu S, Nakano T, et al. Prognostic determinants of long-term survival in Japanese patients with cardiac sarcoidosis treated with prednisone. Am J Cardiol 2001;88:1006-10.PubMedCrossRefGoogle Scholar
  4. 4.
    Schliamser JE, Kadish AH, Subacius H, Shalaby A, Schaechter A, Levine J, et al. Significance of follow-up left ventricular ejection fraction measurements in the Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation trial (DEFINITE). Heart Rhythm 2013;10:838-46.PubMedCrossRefGoogle Scholar
  5. 5.
    Chiu CZ, Nakatani S, Zhang G, Tachibana T, Ohmori F, Yamagishi M, et al. Prevention of left ventricular remodeling by long-term corticosteroid therapy in patients with cardiac sarcoidosis. Am J Cardiol 2005;95:143-6.PubMedCrossRefGoogle Scholar
  6. 6.
    Grutters JC, van den Bosch JM. Corticosteroid treatment in sarcoidosis. Eur Respir J 2006;28:627-36.PubMedCrossRefGoogle Scholar
  7. 7.
    Nery PB, Leung E, Birnie DH. Arrhythmias in cardiac sarcoidosis: Diagnosis and treatment. Curr Opin Cardiol 2012;27:181-9.PubMedCrossRefGoogle Scholar
  8. 8.
    Youssef G, Beanlands RS, Birnie DH, Nery PB. Cardiac sarcoidosis: Applications of imaging in diagnosis and directing treatment. Heart 2011;97:2078-87.PubMedCrossRefGoogle Scholar
  9. 9.
    Blankstein R, Osborne M, Naya M, Waller A, Kim CK, Murthy VL, et al. Cardiac positron emission tomography enhances prognostic assessments of patients with suspected cardiac sarcoidosis. J Am Coll Cardiol 2013. doi: 10.1016/j.jacc.2013.09.022.Google Scholar
  10. 10.
    Okumura W, Iwasaki T, Toyama T, Iso T, Arai M, Oriuchi N, et al. Usefulness of fasting 18F-FDG PET in identification of cardiac sarcoidosis. J Nucl Med 2004;45:1989-98.PubMedGoogle Scholar
  11. 11.
    Ohira H, Tsujino I, Yoshinaga K. (1)F-Fluoro-2-deoxyglucose positron emission tomography in cardiac sarcoidosis. Eur J Nucl Med Mol Imaging 2011;38:1773-83.PubMedCrossRefGoogle Scholar
  12. 12.
    Dorbala S, Vangala D, Sampson U, Limaye A, Kwong R, Di Carli MF. Value of vasodilator left ventricular ejection fraction reserve in evaluating the magnitude of myocardium at risk and the extent of angiographic coronary artery disease: A 82Rb PET/CT study. J Nucl Med 2007;48:349-58.PubMedGoogle Scholar
  13. 13.
    Kida K, Yoneyama K, Kobayashi Y, Takano M, Akashi YJ, Miyake F. Late gadolinium enhancement on cardiac magnetic resonance images predicts reverse remodeling in patients with nonischemic cardiomyopathy treated with carvedilol. Int J Cardiol 2013;168:1588-9.PubMedCrossRefGoogle Scholar
  14. 14.
    Lower EE, Baughman RP. Prolonged use of methotrexate for sarcoidosis. Arch Intern Med 1995;155:846-51.PubMedCrossRefGoogle Scholar
  15. 15.
    Schuller JL, Zipse M, Crawford T, Bogun F, Beshai J, Patel AR, et al. Implantable cardioverter defibrillator therapy in patients with cardiac sarcoidosis. J Cardiovasc Electrophysiol 2012;23:925-9.PubMedCrossRefGoogle Scholar
  16. 16.
    Betensky BP, Tschabrunn CM, Zado ES, Goldberg LR, Marchlinski FE, Garcia FC, et al. Long-term follow-up of patients with cardiac sarcoidosis and implantable cardioverter-defibrillators. Heart Rhythm 2012;9:884-91.PubMedCrossRefGoogle Scholar
  17. 17.
    Boellaard R. Need for standardization of 18F-FDG PET/CT for treatment response assessments. J Nucl Med 2011;52:93S-100S.PubMedCrossRefGoogle Scholar
  18. 18.
    Boellaard R. Standards for PET image acquisition and quantitative data analysis. J Nucl Med 2009;50:11S-20S.PubMedCrossRefGoogle Scholar

Copyright information

© American Society of Nuclear Cardiology 2013

Authors and Affiliations

  • Michael T. Osborne
    • 1
  • Edward A. Hulten
    • 2
  • Avinainder Singh
    • 3
  • Alfonso H. Waller
    • 2
  • Marcio S. Bittencourt
    • 2
  • Garrick C. Stewart
    • 4
  • Jon Hainer
    • 2
  • Venkatesh L. Murthy
    • 5
  • Hicham Skali
    • 2
  • Sharmila Dorbala
    • 2
  • Marcelo F. Di Carli
    • 2
  • Ron Blankstein
    • 2
  1. 1.Department of MedicineBrigham and Women’s HospitalBostonUSA
  2. 2.Non-Invasive Cardiovascular Imaging Program, Department of Medicine (Cardiovascular Division) and Department of RadiologyBrigham and Women’s HospitalBostonUSA
  3. 3.Government Medical College and HospitalChandigarhIndia
  4. 4.Cardiovascular Division, Department of MedicineBrigham and Women’s HospitalBostonUSA
  5. 5.Departments of Internal Medicine and RadiologyUniversity of MichiganAnn ArborUSA

Personalised recommendations