Cardiac Positron Emission Tomography Enhances Prognostic Assessments of Patients With Suspected Cardiac Sarcoidosis
Key result
Concurrent PET perfusion defects and abnormal FDG uptake linked to ~290% higher death or VT risk.
- HR 3.9
- P<0.01
- n=118
Why the study?
Cardiac PET is commonly used to evaluate suspected cardiac sarcoidosis, but the relationship between PET findings and clinical outcomes had not been reported.
Does abnormal cardiac PET (focal perfusion defect and FDG uptake) predict death or sustained ventricular tachycardia in patients with suspected cardiac sarcoidosis?
Population
118 consecutive patients with known or suspected CS and no history of CAD
Comparison
PET findings categorized as normal vs positive PD or FDG vs positive PD and FDG
Design
Observational cohort study with blinded image interpretation
Follow-up
Median 1.5 years
Authors
Discussion
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Implication
Supports risk stratification in suspected cardiac sarcoidosis; leaves open whether PET findings should guide therapy.
Key Points
- This research aims to assess how imaging findings from PET scans relate to adverse cardiac events in patients with suspected cardiac sarcoidosis.
- Study of 118 patients referred for cardiac PET using 18F-FDG and 82Rubidium following a high fat/low carbohydrate diet.
- Categorization of PET findings into normal, positive perfusion defects, positive FDG uptake, or both.
- Assessment of adverse events through electronic records and patient interviews over a median follow-up of 1.5 years.
- Among 118 patients, 60% had abnormal PET findings, correlating with a 26% rate of adverse events, including 27 instances of VT and 8 deaths.
- Presence of both perfusion defects and abnormal FDG uptake significantly increased the hazard ratio for adverse events to 3.9 (p<0.01).
- Extra-cardiac FDG uptake was not linked to higher adverse events.
Study Design
Type
Cohort (n=118)
Blinding
Blinded image analysis
Structured PICO
Does abnormal cardiac PET (focal perfusion defect and FDG uptake) predict death or sustained ventricular tachycardia in patients with suspected cardiac sarcoidosis?
P
Population
118 consecutive patients with known or suspected cardiac sarcoidosis and no history of CAD, mean age 52±11, 57% male, mean LVEF 47%±16%.
I
Intervention
Cardiac positron emission tomography (PET) using 18F-fluorodeoxyglucose (FDG) and 82Rubidium following a high fat / low carbohydrate diet (assessing for positive perfusion defects and FDG uptake)
C
Comparator
Normal cardiac PET findings
O
Outcome
Composite of adverse events (death or sustained ventricular tachycardia) over a median follow-up of 1.5 yearscomposite
Main Result
Effect estimate: HR 3.9
p-value: p=<0.01
Cardiac PET showing both perfusion defects and abnormal FDG uptake strongly predicts death or sustained ventricular tachycardia in patients with suspected cardiac sarcoidosis, independent of LVEF.
Cite This Study
Blankstein et al. (2013) conducted a cohort in Known or suspected cardiac sarcoidosis (n=118). Cardiac PET (18F-FDG and 82Rubidium) vs. Normal cardiac PET findings was evaluated on Adverse events (death or sustained ventricular tachycardia) (HR 3.9, p=<0.01). The presence of both a perfusion defect and abnormal FDG uptake on cardiac PET was associated with a higher risk of death or sustained ventricular tachycardia (HR 3.9; p<0.01).