PDF(Pubmed)
Abstract：
Diagnosing cardiac sarcoidosis (CS), especially in isolated cases, is challenging, particularly due to the limitations of endomyocardial biopsy, leading to potential undiagnosed cases in pacemaker-implanted patients. This study aims to provide real world findings to support new guideline for CS using 18F-fluoro-deoxyglucose positron-emission tomography computed tomography (FDG-PET/CT) which give a definite diagnosis of isolated CS (iCS) without histological findings. We examined consecutive patients with cardiac pacemakers for atrioventricular block (AV-b) attending our outpatient pacemaker clinic. The patients underwent periodical follow-up echocardiography and were divided into two groups according to echocardiographic findings: those with suspected CS and those without suspected CS. Patients suspected of having nonischemic cardiomyopathy underwent FDG-PET/CT for CS diagnosis. We investigated the utility of the new guideline for CS using FDG-PET/CT. Among the 272 patients enrolled, 97 patients were implanted with cardiac pacemakers for AV-b. Twenty-two patients were suspected of having CS during a median observation period of 5.4 years after pacemaker implantation. Of these, one did not consent, and nine of 21 cases (43%) were diagnosed with definite CS according to the new guidelines. Five of these nine patients were diagnosed with iCS using FDG-PET/CT. The number of patients diagnosed with definite CS using the new guidelines tended to be approximately 2.3 times that of the conventional criteria (p = 0.074). Three of the nine patients underwent steroid treatment. The composite outcome, comprising all-cause death, heart failure hospitalization, and a substantial reduction in left ventricular ejection fraction, were significantly lower in patients receiving steroid treatment compared to those without steroid treatment (p = 0.048). The utilization of FDG-PET/CT in accordance with the new guidelines facilitates the diagnosis of CS, including iCS, resulting in approximately 2.3 times as many diagnoses of CS compared to the conventional criteria. This guideline has the potential to support the early identification of iCS and may contribute to enhancing patient clinical outcomes.
摘要：
诊断心脏结节病（CS），特别是在孤立的情况下，具有挑战性，特别是由于心内膜活检的局限性，导致起搏器植入患者的潜在未确诊病例。这项研究旨在提供真实世界的发现，以支持使用18F-氟-脱氧葡萄糖正电子发射断层扫描计算机断层扫描（FDG-PET/CT）的CS新指南，该指南可明确诊断孤立的CS（iCS），而没有组织学发现。我们在门诊起搏器诊所检查了连续使用心脏起搏器的房室传导阻滞（AV-b）患者。患者接受定期随访超声心动图检查，并根据超声心动图检查结果分为两组：可疑CS和无可疑CS。怀疑患有非缺血性心肌病的患者接受FDG-PET/CT进行CS诊断。我们使用FDG-PET/CT研究了CS新指南的实用性。在入选的272名患者中，97例患者植入了用于AV-b的心脏起搏器。在起搏器植入后5.4年的中位观察期内，有22例患者被怀疑患有CS。其中,一个人不同意，根据新指南，21例中有9例（43％）被诊断为明确的CS。这9例患者中有5例使用FDG-PET/CT诊断为iCS。使用新指南诊断为明确CS的患者人数趋于约为常规标准的2.3倍（p=0.074）。9名患者中有3名接受了类固醇治疗。综合结果，包括全因死亡,心力衰竭住院，左心室射血分数大幅降低，与未接受类固醇治疗的患者相比，接受类固醇治疗的患者显着降低（p=0.048）。根据新指南使用FDG-PET/CT有助于CS的诊断，包括iCS，与传统标准相比，诊断CS的次数约为2.3倍。该指南有可能支持iCS的早期识别，并可能有助于提高患者的临床结果。
