Presentation Cardiac Sympathetic Nervous Dysfunction Appears before Developing Tissue Fibrosis in Cardiac Sarcoidosis Using C-11 Hydroxyephedine PET/CT and Cardiac Magnetic Resonance

Yoshinaga , Keiichiro  ,  Tsuzino, Ichizou  ,  Manabe, Osamu  ,  Tomiyama, Yuuki  ,  Sato, Takahiro  ,  Noriko, Oyama-Manabe  ,  Ohira, Hiroshi  ,  Ken-ichi, Nishijima  ,  Masaharu Nishimura  ,  Tamaki, Nagara

Background: Cardiac sarcoidosis (CS) increases a risk of life-threatening arrhythmia. The association between the cardiac sympathetic nervous (SNS) dysfunction and active inflammation or tissue fibrosis has not been studied yet. The aim of the study was to evaluate the SNS dysfunction and its association with active inflammation and fibrosis in CS. Methods: We included 11 CS patients with preserved LVEF(>50%) (CS group) underwent HED PET (for assessment of SNS dysfunction), FDG PET (for inflammation), and CMR (for fibrosis) within one week. Ten controls underwent HED PET were also included. The standard 17-segment model was used for segmental analysis. Reduced HED uptake, focal FDG uptake, and late gadolinium enhancement (LGE) on CMR were defined as positive. Whole LV HED uptake was also quantitatively assessed by retention index (RI). Results:CS group had lower global LV HED RI than control(0.09±0.04 vs. 0.15±0.03 %/min, P<0.001). In CS group, FDG positive patients (n=7) had lower global HED RI than negative FDG patients (n=4)(0.065±0.027 vs. 0.13±0.040 %/min, P=0.010). However, the number of segments with LGE was not associated with the results of FDG-PET (FDG positive or negative)(3.14±2.79 vs. 1.25±0.96, P=0.46). There was no agreement between HED defects and LGE(kappa=0.12).Coclusion:Patients with active CS showed global LV SNS dysfunction regardless the presence of fibrosis, which may imply that SNS dysfunction develops in the earlier pathological stage of CS.

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