Sarcoid Heart Disease: Review of Current Knowledge.
Humans
Fluorodeoxyglucose F18
/ therapeutic use
Radiopharmaceuticals
/ therapeutic use
Prednisone
/ therapeutic use
Methotrexate
/ therapeutic use
Contrast Media
/ therapeutic use
Cardiomyopathies
/ diagnosis
Gadolinium
/ therapeutic use
Sarcoidosis
/ diagnosis
Positron-Emission Tomography
/ methods
Heart Failure
Journal
Cardiology in review
ISSN: 1538-4683
Titre abrégé: Cardiol Rev
Pays: United States
ID NLM: 9304686
Informations de publication
Date de publication:
Historique:
pubmed:
17
6
2021
medline:
25
2
2023
entrez:
16
6
2021
Statut:
ppublish
Résumé
Sarcoidosis is a granulomatous disease with the potential of multiple organ system involvement and its etiology remains unknown. Cardiac involvement is associated with worse clinical outcome, and has been reported to be 20-30% in white and as high as 58% in Japanese populations with sarcoidosis. Clinical manifestations of cardiac sarcoidosis highly depend on the extent and location of granulomatous inflammation. The most frequent presentations include heart block, tachyarrhythmia, or heart failure. Endomyocardial biopsy is the most specific diagnostic test, but has poor sensitivity due to often patchy involvement. The diagnosis of cardiac sarcoidosis remains challenging due to nonspecific imaging findings. Both 18 F-fluorodeoxyglucose-positron emission tomography (FDG-PET) and cardiac magnetic resonance imaging can be used to evaluate cardiac sarcoidosis, but evaluate different stages of the disease process. FDG-PET detects metabolically active inflammatory cells while cardiac magnetic resonance imaging with late gadolinium enhancement reveals areas of myocardial necrosis and fibrosis. Aggressive therapy of symptomatic cardiac sarcoidosis is often sought due to the high risk of sudden death and/or progression to heart failure. Prednisone 20-40 mg a day is the recommended initial treatment. In refractory or severe cases, higher doses of prednisone, 1-1.5 mg/kg/d (or its equivalent) and addition of a steroid-sparing agent have been utilized. Methotrexate is added most commonly. Long-term improvement has been reported with the use of a combination of weekly methotrexate and prednisone versus prednisone alone. After initiation of treatment, a cardiac FDG-PET scan may be performed 2-3 months later to assess treatment response.
Identifiants
pubmed: 34132655
doi: 10.1097/CRD.0000000000000400
pii: 00045415-202301000-00006
doi:
Substances chimiques
Fluorodeoxyglucose F18
0Z5B2CJX4D
Radiopharmaceuticals
0
Prednisone
VB0R961HZT
Methotrexate
YL5FZ2Y5U1
Contrast Media
0
Gadolinium
AU0V1LM3JT
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
28-35Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
Disclosure: The authors have no conflicts of interest to report.
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