Clinical Research
Cardiac Imaging
Cardiac Positron Emission Tomography Enhances Prognostic Assessments of Patients With Suspected Cardiac Sarcoidosis

https://doi.org/10.1016/j.jacc.2013.09.022Get rights and content
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Objectives

This study sought to relate imaging findings on positron emission tomography (PET) to adverse cardiac events in patients referred for evaluation of known or suspected cardiac sarcoidosis.

Background

Although cardiac PET is commonly used to evaluate patients with suspected cardiac sarcoidosis, the relationship between PET findings and clinical outcomes has not been reported.

Methods

We studied 118 consecutive patients with no history of coronary artery disease, who were referred for PET, using [18F]fluorodeoxyglucose (FDG) to assess for inflammation and rubidium-82 to evaluate for perfusion defects (PD), following a high-fat/low-carbohydrate diet to suppress normal myocardial glucose uptake. Blind readings of PET data categorized cardiac findings as normal, positive PD or FDG, positive PD and FDG. Images were also used to identify whether findings of extra-cardiac sarcoidosis were present. Adverse events (AE)—death or sustained ventricular tachycardia (VT)—were ascertained by electronic medical records, defibrillator interrogation, patient questionnaires, and telephone interviews.

Results

Among the 118 patients (age 52 ± 11 years; 57% males; mean ejection fraction: 47 ± 16%), 47 (40%) had normal and 71 (60%) had abnormal cardiac PET findings. Over a median follow-up of 1.5 years, there were 31 (26%) adverse events (27 VT and 8 deaths). Cardiac PET findings were predictive of AE, and the presence of both a PD and abnormal FDG (29% of patients) was associated with hazard ratio of 3.9 (p < 0.01) and remained significant after adjusting for left ventricular ejection fraction (LVEF) and clinical criteria. Extra-cardiac FDG uptake (26% of patients) was not associated with AE.

Conclusions

The presence of focal PD and FDG uptake on cardiac PET identifies patients at higher risk of death or VT. These findings offer prognostic value beyond Japanese Ministry of Health and Welfare clinical criteria, the presence of extra-cardiac sarcoidosis and LVEF.

Key Words

FDG
PET
prognosis
sarcoidosis
VT

Abbreviations and Acronyms

CMR
cardiac magnetic resonance imaging
CT
computed tomography
EMBx
endomyocardial biopsy
FDG
fluorodeoxyglucose
ICD
implantable cardiac defibrillator
JMHW
Japanese Ministry of Health and Welfare
LVEF
left ventricular ejection fraction
PET
positron emission tomography
RV
right ventricular
VT
ventricular tachycardia

Cited by (0)

This study was funded in part by grants from the U.S. National Institutes of Health (T32 HL094301-01A1 and 5K23HL092299). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.