Multimodality Cardiovascular Imaging in the Evaluation of Cardiac Sarcoidosis

Cardiac sarcoidosis (CS) is a granulomatous disease associated with increased cardiovascular risk, including symptomatic high-grade atrioventricular block, ventricular arrhythmia, heart failure, and sudden cardiac death. Diagnosis can be challenging and requires a high index of suspicion. Although endomyocardial biopsy demonstrating noncaseating granulomas can diagnose CS with high specificity, sampling error leads to low sensitivity. CS is typically diagnosed using a combination of clinical criteria and advanced cardiac imaging, such as cardiac magnetic resonance and positron emission tomography, which can detect myocardial inflammation and fibrosis seen in CS. Recent advances in cardiac magnetic resonance and positron emission tomography have not only substantially improved the diagnosis of CS, but have also improved prognostic assessment, monitoring of treatment response, and guidance of other clinical decision-making, such as immunosuppressive and device therapy. Advanced cardiac imaging has been incorporated into recent international guidelines on inflammatory heart disease, and holds great promise to reshape contemporary clinical care for patients with CS.