Skip to main content
SpringerLink
Log in

Prognosis and recurrence in cardiac sarcoidosis: Serial assessment of BMIPP SPECT and FDG-PET

  • ORIGINAL ARTICLE
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

Background

We analyzed 18F-Fludeoxyglucose positron emission tomography (FDG-PET) and 123I-betamethyl-p-iodophenyl-pentadecanoic acid (BMIPP) single-photon emission computed tomography (SPECT) performed for cardiac sarcoidosis (CS) patients taking prednisolone, identified recurrence by FDG-PET, and investigated BMIPP as a recurrence and prognostic factor in CS.

Methods and Results

CS patients who underwent BMIPP and FDG-PET within 2 months were enrolled. The recurrence-free group included patients with standardized uptake value (SUVmax) < 4 in the myocardium consecutively for ≥ 2 years. The total BMIPP SPECT defect score (BDS) was used to estimate myocardial damage. The predictability of the initial BDS and SUVmax for major adverse cardiac events (MACE) was analyzed using Kaplan–Meier analysis. Overall, 73 patients and 250 BMIPP and FDG-PET sets were analyzed retrospectively (mean follow-up, 3.5 years). The BDS was significantly greater for the recurrence group (N = 21) vs recurrence-free group (20 ± 13 vs 14 ± 12, P = 0.041). Patients with BDS ≥16 had a significantly higher MACE rate than patients with BDS < 16 (log-rank test, P = 0.016). However, MACE occurrence was comparable between patients with SUVmax ≥ 4 and < 4.

Conclusions

BDS is a predictive marker of recurrence and MACE. SUV is not related to MACE. Recurrence, defined by prednisolone treatment-induced SUV variability, was observed in approximately 30% of CS patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7
Figure 8

Similar content being viewed by others

Abbreviations

AUC:

Area under the curve

BDS:

BMIPP defect score

BMIPP:

123I-betamethyl-p-iodophenyl-pentadecanoic acid

CMR:

Cardiac magnetic resonance

CS:

Cardiac sarcoidosis

FDG-PET:

18F-Fludeoxyglucose positron emission tomography

MACE:

Major adverse cardiac events

ROC:

Receiver operating characteristic

SPECT:

Single-photon emission computed tomography

SUV:

Standardized uptake value

References

  1. Kouranos V, Tzelepis GE, Rapti A, Mavrogeni S, Aggeli K, Douskou M et al (2017) Complementary role of CMR to conventional screening in the diagnosis and prognosis of cardiac sarcoidosis. JACC Cardiovasc Imaging 10:1437-47

    Article  Google Scholar 

  2. Yazaki Y, Isobe M, Hiroe M, Morimoto S, Hiramitsu S, Nakano T et al (2001) Prognostic determinants of long-term survival in Japanese patients with cardiac sarcoidosis treated with prednisone. Am J Cardiol 88:1006-10

    Article  CAS  Google Scholar 

  3. Vita T, Okada DR, Veillet-Chowdhury M, Bravo PE, Mullins E, Hulten E et al (2018) Complementary value of cardiac magnetic resonance imaging and positron emission tomography/computed tomography in the assessment of cardiac sarcoidosis. Circ Cardiovasc Imaging 11:e007030

    Article  Google Scholar 

  4. Patel MR, Cawley PJ, Heitner JF, Klem I, Parker MA, Jaroudi WA et al (2009) Detection of myocardial damage in patients with sarcoidosis. Circulation 120:1969-77

    Article  Google Scholar 

  5. Mehta D, Lubitz SA, Frankel Z, Wisnivesky JP, Einstein AJ, Goldman M et al (2008) Cardiac involvement in patients with sarcoidosis: Diagnostic and prognostic value of outpatient testing. Chest 133:1426-35

    Article  Google Scholar 

  6. Greulich S, Deluigi CC, Gloekler S, Wahl A, Zürn C, Kramer U et al (2013) CMR imaging predicts death and other adverse events in suspected cardiac sarcoidosis. JACC Cardiovasc Imaging 6:501-11

    Article  Google Scholar 

  7. Nagai T, Kohsaka S, Okuda S, Anzai T, Asano K, Fukuda K (2014) Incidence and prognostic significance of myocardial late gadolinium enhancement in patients with sarcoidosis without cardiac manifestation. Chest 146:1064-72

    Article  Google Scholar 

  8. Blankstein R, Osborne M, Naya M, Waller A, Kim CK, Murthy VL et al (2014) Cardiac positron emission tomography enhances prognostic assessments of patients with suspected cardiac sarcoidosis. J Am Coll Cardiol 63:329-36

    Article  Google Scholar 

  9. Maruoka Y, Nagao M, Baba S, Takuro I, Kitamura Y, Kawanami S et al (2015) Evaluation of response to steroid therapy for cardiac sarcoidosis using volumetric analysis of 18F-FDG PET/CT. J Bioanal Biomed 09:229-34

    Article  Google Scholar 

  10. Nanasato M, Hirayama H, Ando A, Isobe S, Nonokawa M, Kinoshita Y et al (2004) Incremental predictive value of myocardial scintigraphy with 123I-BMIPP in patients with acute myocardial infarction treated with primary percutaneous coronary intervention. Eur J Nucl Med Mol Imaging 31:1512-21

    Article  Google Scholar 

  11. Chikamori T, Fujita H, Nanasato M, Toba M, Nishimura T (2005) Prognostic value of I-123 15-(p-iodophenyl)-3-(R, S) methylpentadecanoic acid myocardial imaging in patients with known or suspected coronary artery disease. J Nucl Cardiol 12:172-78

    Article  Google Scholar 

  12. Momose M, Fukushima K, Kondo C, Serizawa N, Suzuki A, Abe K et al (2015) Diagnosis and detection of myocardial injury in active cardiac sarcoidosis—Significance of myocardial fatty acid metabolism and myocardial perfusion mismatch. Circ J 79:2669-76

    Article  CAS  Google Scholar 

  13. JCS Joint Working Group (2011) Guidelines for diagnosis and treatment of myocarditis (JCS 2009): Digest version. Circ J 75:734-43

    Article  Google Scholar 

  14. Terasaki F, Azuma A, Anzai T, Ishizaka N, Ishida Y, Isobe M et al (2019) JCS 2016 guideline on diagnosis and treatment of cardiac sarcoidosis – digest version. Circ J 83:2329-88

    Article  Google Scholar 

  15. Ishida Y, Yoshinaga K, Miyagawa M, Moroi M, Kondoh C, Kiso K et al (2014) Recommendations for (18)F-fluorodeoxyglucose positron emission tomography imaging for cardiac sarcoidosis: Japanese Society of Nuclear Cardiology recommendations. Ann Nucl Med 28:393-03

    Article  Google Scholar 

  16. Ballul T, Borie R, Crestani B, Daugas E, Descamps V, Dieude P et al (2019) Treatment of cardiac sarcoidosis: A comparative study of steroids and steroids plus immunosuppressive drugs. Int J Cardiol 276:208-11

    Article  Google Scholar 

  17. Yokoyama R, Miyagawa M, Okayama H, Inoue T, Miki H, Ogimoto A et al (2015) Quantitative analysis of myocardial 18F-fluorodeoxyglucose uptake by PET/CT for detection of cardiac sarcoidosis. Int J Cardiol 195:180-87

    Article  Google Scholar 

  18. Hashimoto H, Nakanishi R, Mizumura S, Hashimoto Y, Okamura Y, Kiuchi S et al (2018) Prognostic value of (123)I-BMIPP SPECT in patients with nonischemic heart failure with preserved ejection fraction. J Nucl Med 59:259-65

    Article  CAS  Google Scholar 

  19. Yamamichi Y, Kusuoka H, Morishita K, Shirakami Y, Kurami M, Okano K et al (1995) Metabolism of iodine-123-BMIPP in perfused rat hearts. J Nucl Med 36:1043-50

    CAS  PubMed  Google Scholar 

  20. Tanaka T, Okamoto F, Sohmiya K, Kawamura K (1997) Lack of myocardial iodine-123 15-(p-iodiphenyl)-3-R, S-methylpentadecanoic acid (BMIPP) uptake and CD36 abnormality—CD36 deficiency and hypertrophic cardiomyopathy. Jpn Circ J 61:724-25

    Article  CAS  Google Scholar 

  21. Fujibayashi Y, Yonekura Y, Takemura Y, Wada K, Matsumoto K, Tamaki N et al (1990) Myocardial accumulation of iodinated beta-methyl-branched fatty acid analogue, iodine-125-15-(p-iodophenyl)-3-(R, S)methylpentadecanoic acid (BMIPP), in relation to ATP concentration. J Nucl Med 31:1818-22

    CAS  PubMed  Google Scholar 

  22. Fujibayashi Y, Nohara R, Hosokawa R, Okuda K, Yonekura Y, Tamaki N et al (1996) Metabolism and kinetics of iodine-123-BMIPP in canine myocardium. J Nucl Med 37:757-61

    CAS  PubMed  Google Scholar 

  23. Hosokawa R, Nohara R, Fujibayashi Y, Okuda K, Ogino M, Hata T et al (1997) Myocardial kinetics of iodine-123-BMIPP in canine myocardium after regional ischemia and reperfusion: Implications for clinical SPECT. J Nucl Med 38:1857-63

    CAS  PubMed  Google Scholar 

  24. Rosenthal DG, Parwani P, Murray TO, Petek BJ, Benn BS, De Marco T et al (2019) Long-term corticosteroid-sparing immunosuppression for cardiac sarcoidosis. J Am Heart Assoc 8:e010952

    Article  Google Scholar 

  25. Shohei K, Mitsuru M, Kenji F, Naoki S, Atsushi S, Chisato K et al (2017) Regional myocardial damage and active inflammation in patients with cardiac sarcoidosis detected by non-invasive multi-modal imaging. Ann Nucl Med 31:135-43

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan

    Atsushi Yamamoto MD, Eri Watanabe MD, Yasutaka Imamura MD, Atsushi Suzuki MD, Kiyoe Ando MD, Risako Nakao MD, Akiko Sakai MD & Nobuhisa Hagiwara MD

  2. Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women’s Medical University, 8-1, Kawadacho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Atsushi Yamamoto MD, Michinobu Nagao MD, Mitsuru Momose MD & Shuji Sakai MD

  3. Department of Diagnostic Imaging and Nuclear Medicine, Saitama Medical University International Medical Center, Saitama, Japan

    Kenji Fukushima MD

Authors
  1. Atsushi Yamamoto MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michinobu Nagao MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eri Watanabe MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yasutaka Imamura MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Atsushi Suzuki MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kenji Fukushima MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kiyoe Ando MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Risako Nakao MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Akiko Sakai MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Mitsuru Momose MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Shuji Sakai MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Nobuhisa Hagiwara MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michinobu Nagao MD.

Ethics declarations

Disclosures

Atsushi Yamamoto, Michinobu Nagao, Eri Watanabe, Yasutaka Imamura, Atsushi Suzuki, Kenji Fukushima, Kiyoe Ando, Risako Nakao, Akiko Sakai, Mitsuru Momose, Shuji Sakai, Nobuhisa Hagiwara have no conflicts of interest to declare.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yamamoto, A., Nagao, M., Watanabe, E. et al. Prognosis and recurrence in cardiac sarcoidosis: Serial assessment of BMIPP SPECT and FDG-PET. J. Nucl. Cardiol. 28, 919–929 (2021). https://doi.org/10.1007/s12350-021-02567-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12350-021-02567-0

Keywords

Search

Navigation