Presentation Reduced Sympathetic Nervous Function is Useful Marker to Detect Cardiac Sarcoidosis among Patients with Extracardiac Sarcoidosis and Suspected Cardiac Involvement using C-11 Hydroxyephedrine PET/CT

Yoshinaga, Keiichiro  ,  Osamu Manabe  ,  Tomiyama, Yuuki  ,  Ohira, Hiroshi  ,  Tsujino, Ichizo  ,  Sato, Takahiro  ,  Ken-ichi, Nishijima  ,  Nishimura, Masaharu  ,  Tamaki, Nagara

2015-06-08
Description
Background: The cardiac involvement is a major cause of mortality in patients with sarcoidosis. Diagnostic criteria of cardiac sarcoidosis (CS) have been proposed. However, the diagnosis of CS is still challenge. The clinical manifestation of CS is mainly associated with arrhythmia and heart failure. Cardiac sympathetic nervous system (SNS) dysfunction may have an important pathophysiological role for heart failure and arrhythmia in CS. Thus, underling SNS dysfunction may have a role for detecting CS. However, this possibility has not been studied. The purpose of this study was to evaluate whether SNS dysfunction was able to detect cardiac involvement using C-11 hydroxyephedrine (HED) PET/CT in patients with suspected CS.Methods: Nineteen patients with biopsy proven extracardiac sarcoidosis were undergone fasting F-18 FDG and C-11 HED PET/CT. Left ventricular (LV) wall was divided into 17 segments. Regional focal FDG uptake was defined as positive. Whole LV HED uptake was quantitatively assessed using retention index (RI). CS was diagnosed by the Japanese Ministry of Health, Labor, and Welfare guidelines.Results: CS patients (n=13, age 60±15 y) and non CS (n=6, age 67±10 y) sarcoidosis patients had similar LVEF (61.2±15.7 vs. 68.8±8.7%, P=0.26). CS showed higher frequency of focal FDG uptake compared to non CS (53% vs. 0%, P=0.024). CS showed reduced global LV HED RI compared to non CS (0.08±0.04 vs 0.16±0.03 %/min, P=0.001). Using cut off value of HED RI as 0.064/min based on receiver operating analysis, the sensitivity for detecting CS was 76% and specificity was 100%. The area under curve was 0.92.Conclusions: CS showed global LV SNS dysfunction even though their LVEF was similar to non CS. Reduced SNS function was sensitive and highly specific for detecting CS. In contrast, 47% of CS did not have FDG positive. Thus, global SNS reduction may be a useful diagnostic marker of CS.
62nd Society of Nuclear Medicine and Molecular Imaging

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