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Prevalence of newly diagnosed sarcoidosis in patients with ventricular arrhythmias: a cardiac magnetic resonance and 18F-FDG cardiac PET study

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Abstract

Cardiac sarcoidosis (CS) is known to be associated with ventricular tachycardia (VT); however, most investigations to date have focused on patients with known extra-cardiac sarcoidosis. The presence of CS is typically evaluated using 18F-fluorodeoxyglucose (18F-FDG) uptake on cardiac positron emission tomography (PET) or late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR). In this study, we sought to determine the prevalence of primary CS and the relationship between myocardial 18F-FDG uptake and LGE in patients with VT without known sarcoidosis. We retrospectively identified 67 patients without known sarcoidosis or active ischemic heart disease (i.e. significant ischemic disease that had not been previously revascularized) referred for both CMR and PET for evaluation of VT. Standard cine- and LGE- CMR and cardiac PET protocols were used. Myocardial LGE was defined as signal intensity > 5 SDs above the mean signal intensity of normal myocardium. Cardiac PET images were considered positive if there was focal myocardial 18F-FDG uptake having greater activity than the left ventricular blood pool. 45 patients (67%) had LGE, while only 4 (6%) had myocardial FDG uptake. Nine percent of patients with LGE had FDG-uptake while none without LGE did, and 10% of the cohort had indeterminate FDG uptake presumably from poor dietary preparation. Of those with both FDG uptake and LGE, 3/4 ultimately received a clinical diagnosis of CS. 4.5% of patients without previously known sarcoidosis or active ischemic heart disease presenting with VT have newly diagnosed CS. Detection of CS can be increased using a CMR first approach followed by cardiac PET for patients with non-ischemic LGE.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

CMR:

Cardiac magnetic resonance

CS:

Cardiac sarcoidosis

EF:

Ejection fraction

ICD:

Implantable cardioverter-defibrillator

LGE:

Late gadolinium enhancement

LV:

Left ventricle, left ventricular

NSVT:

Non-sustained ventricular tachycardia

PET:

Positron emission tomography

PVC:

Premature ventricular contraction

SUV:

Standardized uptake value

VT:

Ventricular tachycardia

18F-FDG:

18F-fluorodeoxyglucose

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. United Heart and Vascular, St. Paul, MN, USA

    Kalie Y. Kebed

  2. Department of Internal Medicine, University of Chicago, Chicago, USA

    Spencer V. Carter

  3. Department of Medicine, Division of Cardiology, University of California San Francisco, San Francisco, USA

    Erin Flatley & Joshua D. Moss

  4. Department of Medicine, Section of Cardiology, University of Chicago Medicine, 5758 S. Maryland Avenue, MC 9067, Chicago, IL, 60637, USA

    R. Parker Ward, Amita Singh, Roberto M. Lang, Roderick Tung & Amit R. Patel

  5. Department of Radiology, University of Chicago, Chicago, USA

    Daniel E. Appelbaum

Authors
  1. Kalie Y. Kebed
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  2. Spencer V. Carter
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  3. Erin Flatley
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  4. R. Parker Ward
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  5. Joshua D. Moss
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  6. Daniel E. Appelbaum
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  7. Amita Singh
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  8. Roberto M. Lang
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  9. Roderick Tung
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  10. Amit R. Patel
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Contributions

AP (principal investigator), KK, and AS, designed the study, read MRI’s, and developed the manuscript. SC collected and reviewed clinical data and contributed to the manuscript. RW, DA, and RL read PET studies. EF, JM, and RT helped develop the study concept and performed ablations on several patients. All authors reviewed the manuscript prior to submission.

Corresponding author

Correspondence to Amit R. Patel.

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The authors declare that they have no competing interests.

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The University of Chicago IRB approved with a waiver of consent.

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Kebed, K.Y., Carter, S.V., Flatley, E. et al. Prevalence of newly diagnosed sarcoidosis in patients with ventricular arrhythmias: a cardiac magnetic resonance and 18F-FDG cardiac PET study. Int J Cardiovasc Imaging 37, 1361–1369 (2021). https://doi.org/10.1007/s10554-020-02090-2

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  • DOI: https://doi.org/10.1007/s10554-020-02090-2

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