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Intra-cardiac distribution of late gadolinium enhancement in cardiac sarcoidosis and dilated cardiomyopathy

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ABSTRACT

Cardiac involvement of sarcoid lesions is diagnosed by myocardial biopsy which is frequently false-negative, and patients with cardiac sarcoidosis (CS) who have impaired left ventricular (LV) systolic function are sometimes diagnosed with dilated cardiomyopathy (DCM). Late gadolinium enhancement (LE) in magnetic resonance imaging is now a critical finding in diagnosing CS, and the novel Japanese guideline considers myocardial LE to be a major criterion of CS. This article describes the value of LE in patients with CS who have impaired LV systolic function, particularly the diagnostic and clinical significance of LE distribution in comparison with DCM. LE existed at all LV segments and myocardial layers in patients with CS, whereas it was localized predominantly in the midwall of basal to mid septum in those with DCM. Transmural (nodular), circumferential, and subepicardial and subendocardial LE distribution were highly specific in patients with CS, whereas the prevalence of striated midwall LE were high both in patients with CS and with DCM. Since sarcoidosis patients with LE have higher incidences of heart failure symptoms, ventricular tachyarrhythmia and sudden cardiac death, the analyses of extent and distribution of LE are crucial in early diagnosis and therapeutic approach for patients with CS.

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Non-invasive cardiac imaging in a 61-year-old male patient with cardiac involvement of systemic sarcoidosis. LE-CMR (A) shows diffuse LE in the subepicardium (RV side) and subendocardium (LV side) of basal to apical ventricular septum and patchy LE in the midwall of posterior LV (white arrows); Corresponding FDG-PET (B) demonstrates focal uptake in basal and apical ventricular septum and posterior LV wall (black arrows); 99mTc-sestamibi SPECT (C) exhibits a defect only in ventricular septum (black arrows). CMR: Cardiac magnetic resonance; FDG-PET: 18F-fluorodeoxyglucose-positron emission computed tomography; LE: Late gadolinium enhancement; LV/RV: Left and right ventricles; SPECT: Single photon emission computed tomography.
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Figure 1: Non-invasive cardiac imaging in a 61-year-old male patient with cardiac involvement of systemic sarcoidosis. LE-CMR (A) shows diffuse LE in the subepicardium (RV side) and subendocardium (LV side) of basal to apical ventricular septum and patchy LE in the midwall of posterior LV (white arrows); Corresponding FDG-PET (B) demonstrates focal uptake in basal and apical ventricular septum and posterior LV wall (black arrows); 99mTc-sestamibi SPECT (C) exhibits a defect only in ventricular septum (black arrows). CMR: Cardiac magnetic resonance; FDG-PET: 18F-fluorodeoxyglucose-positron emission computed tomography; LE: Late gadolinium enhancement; LV/RV: Left and right ventricles; SPECT: Single photon emission computed tomography.

Mentions: Patients with CS included more female patients and were younger, but there were no differences in symptoms, ECG findings and medications excluding corticosteroids (Table 2). Patients with CS had less decreased LVEF and smaller LV end-systolic volume index, while LV end-diastolic volume index and LV mass index did not differ from those in DCM. The LV segment number with LE was also greater in patients with CS. Figure 1 shows LE-MRI images (left) and corresponding FDG-PET (middle) and 99mTc-sestamibi single photon emission computed tomography (SPECT: right) in a 61-year-old patient with sCS. LE-MRI exhibits diffuse LE in the subepicardium (RV side) and subendocardium (LV side) of basal to apical ventricular septum and patchy LE in the midwall of posterior LV (white arrows). FDG-PET demonstrates focal uptake in basal and apical ventricular septum and posterior LV wall (black arrows). 99mTc-sestamibi SPECT shows a defect only in ventricular septum (black arrows).


Intra-cardiac distribution of late gadolinium enhancement in cardiac sarcoidosis and dilated cardiomyopathy
Non-invasive cardiac imaging in a 61-year-old male patient with cardiac involvement of systemic sarcoidosis. LE-CMR (A) shows diffuse LE in the subepicardium (RV side) and subendocardium (LV side) of basal to apical ventricular septum and patchy LE in the midwall of posterior LV (white arrows); Corresponding FDG-PET (B) demonstrates focal uptake in basal and apical ventricular septum and posterior LV wall (black arrows); 99mTc-sestamibi SPECT (C) exhibits a defect only in ventricular septum (black arrows). CMR: Cardiac magnetic resonance; FDG-PET: 18F-fluorodeoxyglucose-positron emission computed tomography; LE: Late gadolinium enhancement; LV/RV: Left and right ventricles; SPECT: Single photon emission computed tomography.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5037324&req=5

Figure 1: Non-invasive cardiac imaging in a 61-year-old male patient with cardiac involvement of systemic sarcoidosis. LE-CMR (A) shows diffuse LE in the subepicardium (RV side) and subendocardium (LV side) of basal to apical ventricular septum and patchy LE in the midwall of posterior LV (white arrows); Corresponding FDG-PET (B) demonstrates focal uptake in basal and apical ventricular septum and posterior LV wall (black arrows); 99mTc-sestamibi SPECT (C) exhibits a defect only in ventricular septum (black arrows). CMR: Cardiac magnetic resonance; FDG-PET: 18F-fluorodeoxyglucose-positron emission computed tomography; LE: Late gadolinium enhancement; LV/RV: Left and right ventricles; SPECT: Single photon emission computed tomography.
Mentions: Patients with CS included more female patients and were younger, but there were no differences in symptoms, ECG findings and medications excluding corticosteroids (Table 2). Patients with CS had less decreased LVEF and smaller LV end-systolic volume index, while LV end-diastolic volume index and LV mass index did not differ from those in DCM. The LV segment number with LE was also greater in patients with CS. Figure 1 shows LE-MRI images (left) and corresponding FDG-PET (middle) and 99mTc-sestamibi single photon emission computed tomography (SPECT: right) in a 61-year-old patient with sCS. LE-MRI exhibits diffuse LE in the subepicardium (RV side) and subendocardium (LV side) of basal to apical ventricular septum and patchy LE in the midwall of posterior LV (white arrows). FDG-PET demonstrates focal uptake in basal and apical ventricular septum and posterior LV wall (black arrows). 99mTc-sestamibi SPECT shows a defect only in ventricular septum (black arrows).

View Article: PubMed Central - PubMed

ABSTRACT

Cardiac involvement of sarcoid lesions is diagnosed by myocardial biopsy which is frequently false-negative, and patients with cardiac sarcoidosis (CS) who have impaired left ventricular (LV) systolic function are sometimes diagnosed with dilated cardiomyopathy (DCM). Late gadolinium enhancement (LE) in magnetic resonance imaging is now a critical finding in diagnosing CS, and the novel Japanese guideline considers myocardial LE to be a major criterion of CS. This article describes the value of LE in patients with CS who have impaired LV systolic function, particularly the diagnostic and clinical significance of LE distribution in comparison with DCM. LE existed at all LV segments and myocardial layers in patients with CS, whereas it was localized predominantly in the midwall of basal to mid septum in those with DCM. Transmural (nodular), circumferential, and subepicardial and subendocardial LE distribution were highly specific in patients with CS, whereas the prevalence of striated midwall LE were high both in patients with CS and with DCM. Since sarcoidosis patients with LE have higher incidences of heart failure symptoms, ventricular tachyarrhythmia and sudden cardiac death, the analyses of extent and distribution of LE are crucial in early diagnosis and therapeutic approach for patients with CS.

No MeSH data available.


Related in: MedlinePlus