Key result
CMR and FDG-PET direct immunosuppression, HF therapy, and arrhythmia prevention in cardiac sarcoidosis.
Why the study?
Diagnosis and management of cardiac sarcoidosis remain challenging due to patchy myocardial involvement and limited evidence from randomized trials.
Cardiac sarcoidosis requires a multimodal diagnostic approach using CMR and FDG-PET, with management centered on immunosuppression and ICD therapy for high-risk patients to prevent sudden cardiac death.
Supports multimodal imaging and combined therapies in cardiac sarcoidosis; extends evidence synthesis while leaving optimal regimens open for prospective trials.
Purpose of Review Cardiac sarcoidosis (CS) is an inflammatory granulomatous cardiomyopathy associated with atrioventricular block, ventricular arrhythmias, heart failure (HF), and sudden cardiac death (SCD). Diagnosis and management remain challenging because myocardial involvement is patchy and evidence from randomized trials is limited. This review summarizes current knowledge on CS, focusing on advances in diagnosis, immunosuppression, and prevention of arrhythmic events. Recent Findings Cardiac involvement is clinically recognized in 5–10% of patients with sarcoidosis but is more frequent in imaging and autopsy studies. Cardiac magnetic resonance (CMR) and ^18F-fluorodeoxyglucose positron emission tomography (FDG-PET) provide complementary information on myocardial scar and active inflammation. Multimodality imaging, extracardiac tissue diagnosis, guided endomyocardial biopsy, and consensus criteria improve diagnostic confidence. Corticosteroids remain first-line therapy for active inflammation, while steroid-sparing agents are increasingly used to reduce corticosteroid exposure or treat persistent disease. Inflammasome/interleukin-1 inhibition is an emerging targeted strategy, but its clinical efficacy remains unproven. SCD risk stratification now extends beyond left ventricular ejection fraction to include ventricular arrhythmias, conduction disease, ventricular dysfunction, and myocardial scar burden. Implantable cardioverter-defibrillator therapy remains central in selected high-risk patients. Summary CS requires early recognition of both inflammation and myocardial scar. CMR and FDG-PET are central to diagnosis, prognosis, and therapeutic decisions, while management combines immunosuppression, HF therapy, and arrhythmia prevention. Major uncertainties remain regarding optimal diagnostic criteria, immunosuppression strategies, serial imaging, and primary-prevention ICD selection. Prospective studies and randomized trials are needed to refine treatment and risk stratification.
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Imazio et al. (2026) conducted a review in Cardiac sarcoidosis. Cardiac sarcoidosis requires early recognition of inflammation and myocardial scar using CMR and FDG-PET, with management combining immunosuppression, heart failure therapy, and arrhythmia prevention.
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