Cardiac positron emission tomography enhances prognostic assessments of patients with suspected cardiac sarcoidosis

Ron Blankstein, Michael Osborne, Masanao Naya, Alfonso Waller, Chun K. Kim, Venkatesh L. Murthy, Pedram Kazemian, Raymond Y. Kwong, Michifumi Tokuda, Hicham Skali, Robert Padera, Jon Hainer, William G. Stevenson, Sharmila Dorbala, Marcelo F. Di Carli

Research output: Contribution to journalArticle

274 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)329-336
Number of pages8
JournalJournal of the American College of Cardiology
Volume63
Issue number4
DOIs
StatePublished - Feb 4 2014
Externally publishedYes

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Sarcoidosis
Positron-Emission Tomography
Perfusion
Ventricular Tachycardia
Stroke Volume
Carbohydrate-Restricted Diet
Rubidium
Defibrillators
Electronic Health Records
Fluorodeoxyglucose F18
Reading
Coronary Artery Disease
Fats
Interviews
Inflammation
Glucose
Health

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Blankstein, Ron ; Osborne, Michael ; Naya, Masanao ; Waller, Alfonso ; Kim, Chun K. ; Murthy, Venkatesh L. ; Kazemian, Pedram ; Kwong, Raymond Y. ; Tokuda, Michifumi ; Skali, Hicham ; Padera, Robert ; Hainer, Jon ; Stevenson, William G. ; Dorbala, Sharmila ; Di Carli, Marcelo F. / Cardiac positron emission tomography enhances prognostic assessments of patients with suspected cardiac sarcoidosis. In: Journal of the American College of Cardiology. 2014 ; Vol. 63, No. 4. pp. 329-336.
@article{7e243ed14c8a4f15856d066b812b38c6,
title = "Cardiac positron emission tomography enhances prognostic assessments of patients with suspected cardiac sarcoidosis",
abstract = "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.",
author = "Ron Blankstein and Michael Osborne and Masanao Naya and Alfonso Waller and Kim, {Chun K.} and Murthy, {Venkatesh L.} and Pedram Kazemian and Kwong, {Raymond Y.} and Michifumi Tokuda and Hicham Skali and Robert Padera and Jon Hainer and Stevenson, {William G.} and Sharmila Dorbala and {Di Carli}, {Marcelo F.}",
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Blankstein, R, Osborne, M, Naya, M, Waller, A, Kim, CK, Murthy, VL, Kazemian, P, Kwong, RY, Tokuda, M, Skali, H, Padera, R, Hainer, J, Stevenson, WG, Dorbala, S & Di Carli, MF 2014, 'Cardiac positron emission tomography enhances prognostic assessments of patients with suspected cardiac sarcoidosis', Journal of the American College of Cardiology, vol. 63, no. 4, pp. 329-336. https://doi.org/10.1016/j.jacc.2013.09.022

Cardiac positron emission tomography enhances prognostic assessments of patients with suspected cardiac sarcoidosis. / Blankstein, Ron; Osborne, Michael; Naya, Masanao; Waller, Alfonso; Kim, Chun K.; Murthy, Venkatesh L.; Kazemian, Pedram; Kwong, Raymond Y.; Tokuda, Michifumi; Skali, Hicham; Padera, Robert; Hainer, Jon; Stevenson, William G.; Dorbala, Sharmila; Di Carli, Marcelo F.

In: Journal of the American College of Cardiology, Vol. 63, No. 4, 04.02.2014, p. 329-336.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Cardiac positron emission tomography enhances prognostic assessments of patients with suspected cardiac sarcoidosis

AU - Blankstein, Ron

AU - Osborne, Michael

AU - Naya, Masanao

AU - Waller, Alfonso

AU - Kim, Chun K.

AU - Murthy, Venkatesh L.

AU - Kazemian, Pedram

AU - Kwong, Raymond Y.

AU - Tokuda, Michifumi

AU - Skali, Hicham

AU - Padera, Robert

AU - Hainer, Jon

AU - Stevenson, William G.

AU - Dorbala, Sharmila

AU - Di Carli, Marcelo F.

PY - 2014/2/4

Y1 - 2014/2/4

N2 - 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.

AB - 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.

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U2 - https://doi.org/10.1016/j.jacc.2013.09.022

DO - https://doi.org/10.1016/j.jacc.2013.09.022

M3 - Article

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JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

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