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Original research
Diagnosis of cardiac sarcoidosis in patients presenting with cardiac arrest or life-threatening arrhythmias
  1. Suzan Hatipoglu1,2,
  2. Syed K M Gardezi1,
  3. Alessia Azzu1,
  4. John Baksi1,3,4,
  5. Francisco Alpendurada1,4,
  6. Cemil Izgi1,4,
  7. Raj Khattar3,
  8. Vasileios Kouranos5,
  9. Athol Umfrey Wells5,
  10. Rakesh Sharma3,
  11. Kshama Wechalekar6,
  12. Dudley J Pennell1,4,
  13. Raad Mohiaddin1,4
  1. 1CMR Unit, Royal Brompton Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
  2. 2Cardiology Department, Kettering General Hospital, Kettering, UK
  3. 3Cardiology Department, Royal Brompton Hospital, Guy's and St Thomas’ NHS Foundation Trust, London, UK
  4. 4Cardiology Department, Imperial College, London, UK
  5. 5Interstitial Lung Disease Unit, Royal Brompton Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
  6. 6Nuclear Medicine Department, Royal Brompton Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
  1. Correspondence to Raad Mohiaddin, Royal Brompton Hospital, London SW3 6NP, UK; r.mohiaddin{at}rbht.nhs.uk

Abstract

Objective Cardiac sarcoidosis (CS) may present with cardiac arrest or life-threatening arrhythmias. There are limited data on this subgroup of patients with CS. Advanced imaging including cardiovascular magnetic resonance (CMR) and cardiac 18-fluorodeoxyglucose (FDG) positron emission tomography (PET) are used for diagnosis. This study aimed to describe advanced imaging patterns suggestive of CS among patients presenting with cardiac arrest or life-threatening arrhythmias.

Methods An imaging database of a CS referral centre (Royal Brompton Hospital, London) was screened for patients presenting with cardiac arrest or life-threatening arrhythmias and having imaging features of suspected CS. Patients diagnosed with definite or probable/possible CS were included.

Results Study population included 60 patients (median age 49 years) with male predominance (76.7%). The left ventricle was usually non-dilated with mildly reduced ejection fraction (53.4±14.8%). CMR studies showed extensive late gadolinium enhancement (LGE) with 5 (4–8) myocardial segments per patient affected; the right ventricular (RV) side of the septum (28/45) and basal anteroseptum (28/45) were most frequently involved. Myocardial inflammation by FDG-PET was detected in 45 out of 58 patients vs 11 out of 33 patients with oedema imaging available on CMR. When PET was treated as reference to detect myocardial inflammation, CMR oedema imaging was 33.3% sensitive and 77% specific.

Conclusions In patients with CS presenting with cardiac arrest or life-threatening arrhythmias, LGE was located in areas where the cardiac conduction system travels (basal anteroseptal wall and RV side of the septum). While CMR was the imaging technique that raised possibility of cardiac scarring, oedema imaging had low sensitivity to detect myocardial inflammation compared with FDG-PET.

  • cardiac imaging techniques
  • arrhythmias, cardiac
  • myocarditis

Data availability statement

Data are available upon reasonable request. Data are available on reasonable request from corresponding author.

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Data availability statement

Data are available upon reasonable request. Data are available on reasonable request from corresponding author.

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Footnotes

  • Contributors SH and RM conducted conception and design of the work. SH, SKMG, AA, KW, FA, CI and VK have collected the data. SH, SKMG, AA, AUW and RM performed the data analysis and interpretation. SH drafted the article and critical revision was performed by JB, RS, KW, RK, DJP and RM. RM is responsible for the overall content as guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.