Cardiac sarcoidosis/diagnostics

PET / CT of a patient with verified sarcoidosis of the lungs, liver and spleen. The image shows a significant accumulation of 18-FDG in the liver and spleen.

ECG and ECHO

It is used to monitor the ongoing status of patients in the screening. In the case of echocardiography, left ventricular hypertrophy is often detected, typically with thinning of the basal part of the septum due to fibrosis. Furthermore, we observe a violation of the systolic / diastolic function of the left ventricle. Sometimes there is also pericardial effusion and signs of pulmonary hypertension.

Magnetic resonance imaging and PET

Magnetic resonance imaging of the heart is indicated to diagnose heart disease and also to stratify the risk of sudden death. A typical finding is late gadolinium enhancement (LGE) of the subepicardial and middle myocardial basal parts of the interventricular septum or the lateral wall of the left ventricle.

PET examination using 18-FDG is used in the diagnosis of the disease and also to monitor the effectiveness of therapy. The principle is the uptake of 18-FDG by the inflammatory altered myocardium. It is therefore essential that patients undergo preparation before this examination (eg. exclusion of sugars 6-12 hours before examination).

Other diagnostic methods

Endomyocardial Biopsy has a low yield (25%) for inhomogeneous distribution, so its routine use is not recommended. It is preferred to perform a biopsy of extracardiac areas in which higher yields and a lower risk of complications are achieved. Endomyocardial biopsy is performed in cases where it is not possible to perform a biopsy of extracardiac areas, and especially when isolated cardiac sarcoidosis is suspected.

Literature

• KAUTZNER, Josef. Srdeční selhání : aktuality pro klinickou praxi. - edition. Mladá fronta, 2015. ISBN 9788020435736.

• MANN, Douglas L, et al. Braunwald´s Heart Disease : A Textbook of Cardiovascular Medicine. 10th Edition edition. 2015. ISBN 978-0-323-29429-4.

• KOPŘIVA, Petr – GŘIVA, Martin – TÜDÖS, Zbyněk. Management of cardiac sarcoidosis - A practical guide. Cor et Vasa. 2018, vol. 60, no. 2, p. e155-e164, ISSN 0010-8650. DOI: 10.1016/j.crvasa.2017.05.012.

• BIRNIE, David H. – KANDOLIN, Riina – NERY, Pablo B.. Cardiac manifestations of sarcoidosis: diagnosis and management. European Heart Journal. 2016, vol. -, p. ehw328, ISSN 0195-668X. DOI: 10.1093/eurheartj/ehw328.

• BIRNIE, David H. – NERY, Pablo B. – HA, Andrew C.. Cardiac Sarcoidosis. Journal of the American College of Cardiology. 2016, vol. 68, no. 4, p. 411-421, ISSN 0735-1097. DOI: 10.1016/j.jacc.2016.03.605.

• OKADA, David R. – SMITH, John – DERAKHSHAN, Arsalan. Ventricular Arrhythmias in Cardiac Sarcoidosis. Circulation. 2018, vol. 138, no. 12, p. 1253-1264, ISSN 0009-7322. DOI: 10.1161/circulationaha.118.034687.

• ANTON, Jan. Materiály k přednášce "Sarkoidóza".