Prevalence of atrial FDG uptake and association with atrial arrhythmias in patients with cardiac sarcoidosis
Introduction
Sarcoidosis is a multisystemic granulomatous disease of unknown etiology characterized by the formation of noncaseating granulomas involving multiple organs [1]. Cardiac involvement is relatively rare but important as it is responsible for morbidity and mortality in patients with sarcoidosis [[2], [3], [4], [5]]. The main clinical manifestations of cardiac involvement are conduction abnormalities, heart failure, and ventricular arrhythmias [6]. Atrial arrhythmias (AA) had been reported to be less common than ventricular arrhythmias, with an incidence of 17% [4]. However, there is increasing evidence in recent years that a proportion of patients with cardiac sarcoidosis (CS) do in fact have AA [[7], [8], [9]].
Cardiac magnetic resonance imaging (CMR) and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) are useful modalities to diagnose CS. Although delayed enhancement on CMR has high sensitivity for diagnosing CS [10], its specificity is relatively low because it can be detected in the other diseases such as ischemic heart disease and dilated cardiomyopathy. Meanwhile, PET has been reported to be useful for detecting CS with a sensitivity and specificity of 89% and 78%, respectively [11]. FDG uptake in the ventricle on positron emission tomography/computed tomography (PET/CT) is well studied, and focal FDG uptake is associated with poor prognosis [[11], [12], [13], [14]]. However, FDG uptake in the atrium has not been elucidated in detail. The present study seeks to evaluate FDG uptake in the atrium and its relationship with AA in patients with CS.
Section snippets
Study population
We retrospectively investigated consecutive 62 CS patients who underwent PET/CT from April 2006 to March 2018. The diagnosis of CS was made based on the Heart Rhythm Society (HRS) consensus criteria [15]. Thirty two patients had a cardiac device for arrhythmias (pacemaker, n = 21; implantable cardioverter defibrillator, n = 4; cardiac resynchronization therapy defibrillator, n = 7).
We conducted a medical record review to determine the prevalence of known AA, and its association with clinical
Results
Of the studied population, 25 patients (40.3%) had AA, of which 4 patients had atrial tachycardia (AT) and 23 patients had atrial fibrillation (AF). Two patients had both AT and AF. Nineteen out of 23 AFs (84%) were paroxysmal, while 4 AFs were persistent. Characteristics of the patients are summarized in Table 1. The majority of patients did not taking prednisolone because a series of examinations were conducted at the time of diagnosis. PET/CT demonstrated positive atrial uptake in 32
Discussion
The present study demonstrated high prevalence of AA in cardiac sarcoidosis, and its association to atrial FDG uptake, age, and left atrial diameter. Most of the patients with AA had AF (n = 23, 92.0%), including 2 patients who had both AT and AF. Meanwhile, the remaining 2 patients had only AT. All of the 4 AT patients had atrial FDG uptake, suggesting that atrial FDG uptake might be more associated with AT.
Viles-Gonzalez et al. investigated 100 patients with cardiac sarcoidosis and found that
Conclusions
Atrial FDG uptake was common in patients with CS and strongly associated with AA. FDG-PET may be useful for early detection of patients who are prone to developing AA. Close follow up should be considered in CS patients with atrial FDG uptake.
Funding sources
None.
CRediT authorship contribution statement
Kenji Yodogawa: Data curation, Writing - original draft. Yoshimitsu Fukushima: Conceptualization, Methodology, Software, Visualization, Investigation. Takahiro Ando: Software, Visualization, Investigation. Yu-ki Iwasaki: Writing - review & editing. Kazuyoshi Akiyama: Software, Visualization, Investigation. Shin-ichiro Kumita: Validation, Supervision. Arata Azuma: Writing - review & editing, Supervision. Yoshihiko Seino: Writing - review & editing, Supervision. Wataru Shimizu: Validation,
Declaration of competing interest
All authors have no relationships to disclose.
References (38)
- et al.
Supraventricular arrhythmias in patients with cardiac sarcoidosis prevalence, predictors, and clinical implications
Chest.
(2013) - et al.
Evaluation of the accuracy of gadolinium-enhanced cardiovascular magnetic resonance in the diagnosis of cardiac sarcoidosis
J. Am. Coll. Cardiol.
(2005) - et al.
Cardiac positron emission tomography enhances prognostic assessments of patients with suspected cardiac sarcoidosis
J. Am. Coll. Cardiol.
(2014) - et al.
Significant suppression of myocardial 18F-fluorodeoxyglucose uptake using 24-h carbohydrate restriction and a low-carbohydrate, high-fat diet
J. Cardiol.
(2013) - et al.
How common is isolated cardiac sarcoidosis? Extra-cardiac and cardiac findings on clinical examination and whole-body 18F–fluorodeoxyglucose positron emission tomography
Int. J. Cardiol.
(2018) - et al.
Cardiac sarcoidosis detected by late gadolinium enhancement and prevalence of atrial arrhythmias
Am. J. Cardiol.
(2014) - et al.
Relation of proinflammatory activity of epicardial adipose tissue to the occurrence of atrial fibrillation
Am. J. Cardiol.
(2014) - et al.
Positron emission tomography/computed tomography detection of increased 18F-fluorodeoxyglucose uptake in the cardiac atria of patients with atrial fibrillation
Int. J. Cardiol.
(2019) - et al.
Prevalence of atrial fibrillation in elderly subjects (the Cardiovascular Health Study)
Am. J. Cardiol.
(1994) - et al.
Are transthoracic echocardiographic parameters associated with atrial fibrillation recurrence or stroke? Results from the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) study
J. Am. Coll. Cardiol.
(2005)