Skip to main content
Top
Published in: Journal of Nuclear Cardiology 1/2021

Open Access 01-02-2021 | Sarcoidosis | Original Article

FDG-PET in possible cardiac sarcoidosis: Right ventricular uptake and high total cardiac metabolic activity predict cardiovascular events

Authors: Heikki Tuominen, MD, Atte Haarala, MD, PhD, Antti Tikkakoski, MD, Mika Kähönen, MD, PhD, Kjell Nikus, MD, PhD, Kalle Sipilä, MD, PhD

Published in: Journal of Nuclear Cardiology | Issue 1/2021

Login to get access

Abstract

Background

Cardiac involvement accounts for the majority of morbidity and mortality in sarcoidosis. Pathological myocardial fluorodeoxyglucose (FDG)-uptake in positron emission tomography (PET) has been associated with cardiovascular events and quantitative metabolic parameters have been shown to add prognostic value. Our aim was to study whether the pattern of pathological cardiac FDG-uptake and quantitative parameters are able to predict cardiovascular events in patients with suspected cardiac sarcoidosis (CS).

Methods

137 FDG-PET examinations performed in Tampere University Hospital were retrospectively analyzed visually and quantitatively. Location of pathological uptake was noted and pathological metabolic volume, average standardized uptake value (SUV), and total cardiac metabolic activity (tCMA) were calculated. Patients were followed for ventricular tachycardia, decrease in left ventricular ejection fraction, and death.

Results

Eleven patients had one or more cardiovascular events during the follow-up. Five patients out of 12 with uptake in both ventricles had an event during follow-up. Eight patients had high tCMA (> 900 MBq) and three of them had a cardiovascular event. Right ventricular uptake and tCMA were significantly associated with cardiovascular events during follow-up (P-value .001 and .018, respectively).

Conclusions

High tCMA and right ventricular uptake were significant risk markers for cardiac events among patient with suspected CS.
Appendix
Available only for authorised users
Literature
1.
go back to reference Okura Y, Dec GW, Hare JM, et al. A clinical and histopathologic comparison of cardiac sarcoidosis and idiopathic giant cell myocarditis. J Am Coll Cardiol 2003;41:322-9.CrossRef Okura Y, Dec GW, Hare JM, et al. A clinical and histopathologic comparison of cardiac sarcoidosis and idiopathic giant cell myocarditis. J Am Coll Cardiol 2003;41:322-9.CrossRef
2.
go back to reference Schatka I, Bengel FM. Advanced imaging of cardiac sarcoidosis. J Nucl Med 2014;55:99-106.CrossRef Schatka I, Bengel FM. Advanced imaging of cardiac sarcoidosis. J Nucl Med 2014;55:99-106.CrossRef
3.
go back to reference Gideon NM, Mannino DM. Sarcoidosis mortality in the united states 1979-1991: An analysis of multiple-cause mortality data. Am J Med 1996;100:423-7.CrossRef Gideon NM, Mannino DM. Sarcoidosis mortality in the united states 1979-1991: An analysis of multiple-cause mortality data. Am J Med 1996;100:423-7.CrossRef
4.
go back to reference Youssef G, Leung E, Mylonas I, et al. The use of 18F-FDG PET in the diagnosis of cardiac sarcoidosis: A systematic review and metaanalysis including the ontario experience. J Nucl Med 2012;53:241-8.CrossRef Youssef G, Leung E, Mylonas I, et al. The use of 18F-FDG PET in the diagnosis of cardiac sarcoidosis: A systematic review and metaanalysis including the ontario experience. J Nucl Med 2012;53:241-8.CrossRef
5.
go back to reference Roberts WC, McAllister HA,Jr, Ferrans VJ. Sarcoidosis of the heart. A clinicopathologic study of 35 necropsy patients (group 1) and review of 78 previously described necropsy patients (group 11). Am J Med 1977;63(1):86-108. Roberts WC, McAllister HA,Jr, Ferrans VJ. Sarcoidosis of the heart. A clinicopathologic study of 35 necropsy patients (group 1) and review of 78 previously described necropsy patients (group 11). Am J Med 1977;63(1):86-108.
6.
go back to reference Kandolin R, Lehtonen J, Airaksinen J, et al. Cardiac sarcoidosis: Epidemiology, characteristics, and outcome over 25 years in a nationwide study. Circulation 2015;131:624-32.CrossRef Kandolin R, Lehtonen J, Airaksinen J, et al. Cardiac sarcoidosis: Epidemiology, characteristics, and outcome over 25 years in a nationwide study. Circulation 2015;131:624-32.CrossRef
7.
go back to reference Yazaki Y, Isobe M, Hiroe M, et al. Prognostic determinants of long-term survival in japanese patients with cardiac sarcoidosis treated with prednisone. Am J Cardiol 2001;88:1006-10.CrossRef Yazaki Y, Isobe M, Hiroe M, et al. Prognostic determinants of long-term survival in japanese patients with cardiac sarcoidosis treated with prednisone. Am J Cardiol 2001;88:1006-10.CrossRef
8.
go back to reference Chiu CZ, Nakatani S, Zhang G, et al. Prevention of left ventricular remodeling by long-term corticosteroid therapy in patients with cardiac sarcoidosis. Am J Cardiol 2005;95:143-6.CrossRef Chiu CZ, Nakatani S, Zhang G, et al. Prevention of left ventricular remodeling by long-term corticosteroid therapy in patients with cardiac sarcoidosis. Am J Cardiol 2005;95:143-6.CrossRef
9.
go back to reference Nery PB, Leung E, Birnie DH. Arrhythmias in cardiac sarcoidosis: Diagnosis and treatment. Curr Opin Cardiol 2012;27:181-9.CrossRef Nery PB, Leung E, Birnie DH. Arrhythmias in cardiac sarcoidosis: Diagnosis and treatment. Curr Opin Cardiol 2012;27:181-9.CrossRef
10.
go back to reference Uusimaa P, Ylitalo K, Anttonen O, et al. Ventricular tachyarrhythmia as a primary presentation of sarcoidosis. Europace 2008;10:760-6.CrossRef Uusimaa P, Ylitalo K, Anttonen O, et al. Ventricular tachyarrhythmia as a primary presentation of sarcoidosis. Europace 2008;10:760-6.CrossRef
11.
go back to reference Nery PB, Mc Ardle BA, Redpath CJ, et al. Prevalence of cardiac sarcoidosis in patients presenting with monomorphic ventricular tachycardia. Pacing Clin Electrophysiol 2014;37:364-74.CrossRef Nery PB, Mc Ardle BA, Redpath CJ, et al. Prevalence of cardiac sarcoidosis in patients presenting with monomorphic ventricular tachycardia. Pacing Clin Electrophysiol 2014;37:364-74.CrossRef
12.
go back to reference Blankstein R, Osborne M, Naya M, et al. Cardiac positron emission tomography enhances prognostic assessments of patients with suspected cardiac sarcoidosis. J Am Coll Cardiol 2014;63:329-36.CrossRef Blankstein R, Osborne M, Naya M, et al. Cardiac positron emission tomography enhances prognostic assessments of patients with suspected cardiac sarcoidosis. J Am Coll Cardiol 2014;63:329-36.CrossRef
13.
go back to reference Sperry BW, Tamarappoo BK, Oldan JD, et al. Prognostic impact of extent, severity, and heterogeneity of abnormalities on (18)F-FDG PET scans for suspected cardiac sarcoidosis. JACC Cardiovasc Imaging 2018;11:336-45.CrossRef Sperry BW, Tamarappoo BK, Oldan JD, et al. Prognostic impact of extent, severity, and heterogeneity of abnormalities on (18)F-FDG PET scans for suspected cardiac sarcoidosis. JACC Cardiovasc Imaging 2018;11:336-45.CrossRef
14.
go back to reference Ahmadian A, Brogan A, Berman J, et al. Quantitative interpretation of FDG PET/CT with myocardial perfusion imaging increases diagnostic information in the evaluation of cardiac sarcoidosis. J Nucl Cardiol 2014;21:925-39.CrossRef Ahmadian A, Brogan A, Berman J, et al. Quantitative interpretation of FDG PET/CT with myocardial perfusion imaging increases diagnostic information in the evaluation of cardiac sarcoidosis. J Nucl Cardiol 2014;21:925-39.CrossRef
16.
go back to reference Tuominen H, Haarala A, Tikkakoski A, et al. 18F-FDG-PET in finnish patients with clinical suspicion of cardiac sarcoidosis: Female sex and history of atrioventricular block increase the prevalence of positive PET findings. J Nucl Cardiol 2017. https://doi.org/10.1007/s12350-017-0940-x Tuominen H, Haarala A, Tikkakoski A, et al. 18F-FDG-PET in finnish patients with clinical suspicion of cardiac sarcoidosis: Female sex and history of atrioventricular block increase the prevalence of positive PET findings. J Nucl Cardiol 2017. https://​doi.​org/​10.​1007/​s12350-017-0940-x
17.
go back to reference Danwade TA, Devidutta S, Shelke AB, et al. Prognostic value of fluorine-18 fluoro-2-deoxyglucose positron emission computed tomography in patients with unexplained atrioventricular block. Heart Rhythm 2018;15:234-9.CrossRef Danwade TA, Devidutta S, Shelke AB, et al. Prognostic value of fluorine-18 fluoro-2-deoxyglucose positron emission computed tomography in patients with unexplained atrioventricular block. Heart Rhythm 2018;15:234-9.CrossRef
18.
go back to reference Muser D, Santangeli P, Castro SA, et al. Prognostic role of serial quantitative evaluation of (18)F-fluorodeoxyglucose uptake by PET/CT in patients with cardiac sarcoidosis presenting with ventricular tachycardia. Eur J Nucl Med Mol Imaging 2018;45:1394-404.CrossRef Muser D, Santangeli P, Castro SA, et al. Prognostic role of serial quantitative evaluation of (18)F-fluorodeoxyglucose uptake by PET/CT in patients with cardiac sarcoidosis presenting with ventricular tachycardia. Eur J Nucl Med Mol Imaging 2018;45:1394-404.CrossRef
19.
go back to reference Ishiyama M, Soine LA, Vesselle HJ. Semi-quantitative metabolic values on FDG PET/CT including extracardiac sites of disease as a predictor of treatment course in patients with cardiac sarcoidosis. EJNMMI Res 2017;7(1):67-017-0315-y. Ishiyama M, Soine LA, Vesselle HJ. Semi-quantitative metabolic values on FDG PET/CT including extracardiac sites of disease as a predictor of treatment course in patients with cardiac sarcoidosis. EJNMMI Res 2017;7(1):67-017-0315-y.
20.
go back to reference Greulich S, Deluigi CC, Gloekler S, et al. CMR imaging predicts death and other adverse events in suspected cardiac sarcoidosis. JACC Cardiovasc Imaging 2013;6:501-11.CrossRef Greulich S, Deluigi CC, Gloekler S, et al. CMR imaging predicts death and other adverse events in suspected cardiac sarcoidosis. JACC Cardiovasc Imaging 2013;6:501-11.CrossRef
21.
go back to reference Murtagh G, Laffin LJ, Beshai JF, et al. Prognosis of myocardial damage in sarcoidosis patients with preserved left ventricular ejection fraction: Risk stratification using cardiovascular magnetic resonance. Circ Cardiovasc Imaging 2016;9:e003738.CrossRef Murtagh G, Laffin LJ, Beshai JF, et al. Prognosis of myocardial damage in sarcoidosis patients with preserved left ventricular ejection fraction: Risk stratification using cardiovascular magnetic resonance. Circ Cardiovasc Imaging 2016;9:e003738.CrossRef
22.
go back to reference Smedema JP, van Geuns RJ, Ector J, Heidbuchel H, Ainslie G, Crijns HJGM. Right ventricular involvement and the extent of left ventricular enhancement with magnetic resonance predict adverse outcome in pulmonary sarcoidosis. ESC Heart Fail 2018;5:157–71.CrossRef Smedema JP, van Geuns RJ, Ector J, Heidbuchel H, Ainslie G, Crijns HJGM. Right ventricular involvement and the extent of left ventricular enhancement with magnetic resonance predict adverse outcome in pulmonary sarcoidosis. ESC Heart Fail 2018;5:157–71.CrossRef
23.
go back to reference Koplan BA, Soejima K, Baughman K, Epstein LM, Stevenson WG. Refractory ventricular tachycardia secondary to cardiac sarcoid: Electrophysiologic characteristics, mapping, and ablation. Heart Rhythm 2006;3:924-9.CrossRef Koplan BA, Soejima K, Baughman K, Epstein LM, Stevenson WG. Refractory ventricular tachycardia secondary to cardiac sarcoid: Electrophysiologic characteristics, mapping, and ablation. Heart Rhythm 2006;3:924-9.CrossRef
24.
go back to reference Kumar S, Barbhaiya C, Nagashima K, et al. Ventricular tachycardia in cardiac sarcoidosis: Characterization of ventricular substrate and outcomes of catheter ablation. Circ Arrhythm Electrophysiol 2015;8:87-93.CrossRef Kumar S, Barbhaiya C, Nagashima K, et al. Ventricular tachycardia in cardiac sarcoidosis: Characterization of ventricular substrate and outcomes of catheter ablation. Circ Arrhythm Electrophysiol 2015;8:87-93.CrossRef
Metadata
Title
FDG-PET in possible cardiac sarcoidosis: Right ventricular uptake and high total cardiac metabolic activity predict cardiovascular events
Authors
Heikki Tuominen, MD
Atte Haarala, MD, PhD
Antti Tikkakoski, MD
Mika Kähönen, MD, PhD
Kjell Nikus, MD, PhD
Kalle Sipilä, MD, PhD
Publication date
01-02-2021
Publisher
Springer International Publishing
Published in
Journal of Nuclear Cardiology / Issue 1/2021
Print ISSN: 1071-3581
Electronic ISSN: 1532-6551
DOI
https://doi.org/10.1007/s12350-019-01659-2

Other articles of this Issue 1/2021

Journal of Nuclear Cardiology 1/2021 Go to the issue