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The rate of myocardial perfusion recovery after steroid therapy and its implication for cardiac events in cardiac sarcoidosis and primarily preserved left ventricular ejection fraction

  • Kazuhiro Koyanagawa
  • Masanao NayaEmail author
  • Tadao Aikawa
  • Osamu Manabe
  • Sho Furuya
  • Masato Kuzume
  • Noriko Oyama-Manabe
  • Hiroshi Ohira
  • Ichizo Tsujino
  • Toshihisa Anzai
Original Article

Abstract

Background

Sarcoidosis is a multisystemic disorder of unknown cause characterized by immune granuloma formation in the involved organs. Few studies have reported on the myocardial perfusion changes by immunosuppression therapy in cardiac sarcoidosis (CS). Additionally, the relationship between myocardial perfusion changes and prognosis is unknown. Therefore, this study aimed to clarify myocardial perfusion recovery after steroid therapy and its prognostic value for major adverse cardiac events (MACE) in patients with CS.

Methods and Results

Thirty-eight consecutive patients with CS {median age, 63 [interquartile range (IQR) 51–68] years; 10 men} underwent both 18F-fluorodeoxyglucose positron emission tomography/computed tomography (CT) and electrocardiography-gated single-photon emission CT (SPECT) pre- and post-steroid therapy. Patients with improved or preserved myocardial perfusion after post-therapy were defined as the recovery group and those with worsened myocardial perfusion as the non-recovery group. Twenty-six patients (68%) were categorized as the recovery group. MACE occurred in eight patients. The Kaplan–Meier curves revealed a significantly higher rate of MACE in the non-recovery group (17.4%/y vs 2.9%/y, P = 0.007).

Conclusions

Myocardial perfusion was recovered by steroid therapy in 61% and preserved in 8% of patients. Myocardial perfusion recovery after steroid therapy was significantly associated with a low incidence of MACE.

Abbreviations

CS

Cardiac sarcoidosis

SPECT

Single-photon emission computed tomography

FDG

18F-fluorodeoxyglucose

PET

Positron emission tomography

CT

Computed tomography

SRS

Summed rest score

BW

Bandwidth

MACE

Major adverse cardiac events

Notes

Funding

None.

Disclosure

Dr. Aikawa is affiliated with the endowed department of Medtronic Japan Co., Ltd. and Win International Co., Ltd. All other authors have no conflicts of interest to disclose.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was waived due to the retrospective study design.

Supplementary material

12350_2019_1916_MOESM1_ESM.docx (15 kb)
Supplementary material 1 (DOCX 14 kb)
12350_2019_1916_MOESM2_ESM.pptx (809 kb)
Supplementary material 1 (PPTX 809 kb)

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Copyright information

© American Society of Nuclear Cardiology 2019

Authors and Affiliations

  • Kazuhiro Koyanagawa
    • 1
  • Masanao Naya
    • 1
    Email author
  • Tadao Aikawa
    • 1
  • Osamu Manabe
    • 2
  • Sho Furuya
    • 2
  • Masato Kuzume
    • 1
  • Noriko Oyama-Manabe
    • 2
  • Hiroshi Ohira
    • 3
  • Ichizo Tsujino
    • 3
  • Toshihisa Anzai
    • 1
  1. 1.Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoJapan
  2. 2.Department of Diagnostic and Interventional RadiologyHokkaido University HospitalSapporoJapan
  3. 3.First Department of MedicineHokkaido University HospitalSapporoJapan

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