cardiac sarcoidosis - asecho.org · • sarcoidosis is a heterogeneous, non-caseating,...
TRANSCRIPT
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Cardiac Sarcoidosis
Vera H. Rigolin, MDVice-President, American Society of Echocardiography
Professor of MedicineNorthwestern University
Bluhm Cardiovascular InstituteMedical Director, Echocardiography Laboratory
Northwestern Memorial Hospital
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Disclosures: None
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Sarcoidosis
• Sarcoidosis is a heterogeneous, non-caseating, granulomatous disorder of unknown etiology that can involve any organ within the body.
• Myocardial involvement may be more frequent in patients with cardiac symptoms, but asymptomatic cardiac involvement appears to be common
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Clinical Manifestations
• Conduction abnormalities (atrioventricularblock or bundle-branch block)
• Tachyarrhythmias• Sudden cardiac death• Coronary infiltration (leading to spasm or
vasculitis)• Cardiomyopathy• Congestive heart failure
• Granulomatous involvement of myocardium• Granulomatous involvement of valves, pap
muscles
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Prevalence of cardiac findings in cardiac sarcoidosis
• AV block: 26-62%• BBB: 12-61%• SVT: 0-15%• Vtach: 2-42%• HF: 10-30%• SD: 12-65%
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Echo Findings• Left ventricular dilatation• Septal thinning • Segmental or global hypokinesia of
the left ventricle• Ventricular aneurysms• Valvular regurgitation• Right ventricular dilatation and
hypokinesis.
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Echo Findings
• Septum and LV free wall most commonly affected
• Increase in wall thickness simulating LVH or HCM
• Wall motion abnormalities in noncoronary distribution
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Speckle Tracking Echocardiography Identifies Patients with Cardiac Sarcoidosis
Sadiya S. Khan, MD; Jason Chodakowski, BS; Jyothy Puthumana, MD; Alex Chicos, MD
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Cardiac MRI
• T1 weighted images detect wall motion, hypertrophy, wall thinning
• T2 weighted images/early gad detect edema (inflammation)
• Late gad detects fibrosis/scar
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18F-Fluorodeoxyglucose (FDG) PET
• Detects active sarcoidosis with high sensitivity
• May be positive in other inflammatory cardiac conditions
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Radionuclide Imaging: Thallium-201
• Focal perfusion deficits may be seen at rest • With exercise, “reverse redistribution” is seen• Fixed defects may represent scar• Gallium-67 can detect active inflammation
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Accuracy of Diagnostic Tests
Kim JS et al. Am Heart J 2009;157:9-21.
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Guidelines for Diagnosis of Cardiac Sarcoidosis
Japanese Ministry of Health and Welfare 1993
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2006 Revised Guidelines by the Japanese Society of Sarcoidosisand Other Granulomatous Disorders
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Suggested Clinical Algorithm
Kim JS et al. Am Heart J 2009;157:9-21.
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Case 1• 48 yr old female who complains of palpitations
for 1 month• She presented to the ER when palpitations
occurred with lightheadedness• Initial rhythm was Afib. She converted to SR. VT
then noted• CT ordered to look for PE: Lymphadenopathy
noted
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• Endobronchial biopsy: Sarcoidosis• Endomyocardial biopsy: Negative• Cardiac cath: No CAD
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ECG
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Echo
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E/e’= 20
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Treatment• Steroids• Antiarrhythmic therapy• ICD• VT ablation (VT noted to come from multiple
foci, including epicardium and paps)
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Case 2
• 75 yr old male with a history of pulmonary sarcoidosis
• He complained of SOB and palpitations
• ECG showed Afib• Cardiac cath: No obstructive CAD• Endomyocardial biopsy: Negative
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ECG
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Echo
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E/e’= 33
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• Patient sent to the OR for AVR• Myocardial biopsy performed in the OR:
Positive for sarcoidosis
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Case 3
• 48 yr old female who developed progressive SOB, LE edema and increasing abdominal girth.
• Admitted to the hospital with decompensated HF
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ECG
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• Cardiac cath: No obstructive CAD• Cardiac MRI: Myocardial
infiltration suspicious for sarcoidosis
• Endomyocardial biospy: +Sarcoidosis
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Echo
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• Patient had progressive heart failure despite maximal meds
• She ultimately underwent heart transplantation
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Case 4
• 56 yr old ER physician with no past medical history who presented with dyspnea and palpitations
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Hospital Course
• Endobronchial biopsy pending• ICD/pacer implanted
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Thank You