Effect of Immunosuppressive Therapy and Biopsy Status in Monitoring Therapy Response in Suspected Cardiac Sarcoidosis
Patients with suspected cardiac sarcoidosis frequently undergo fluorodeoxyglucose (FDG)–positron emission tomography (PET)/computed tomography (CT) imaging to assess disease activity at baseline and after treatment initiation. This study investigated the effect of immunosuppressive therapy and biops...
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| Veröffentlicht in: | JACC. Cardiovascular imaging 2022-11, Vol.15 (11), p.1944-1955 |
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| creator | Rojulpote, Chaitanya Bhattaru, Abhijit Jean, Christopher Adams, Sarah L. Patel, Vandan Vidula, Mahesh K. Selvaraj, Senthil Dubroff, Jacob Peyster, Eliot Clancy, Caitlin B. Patterson, Karen Marchlinski, Francis E. Rossman, Milton Goldberg, Lee Bravo, Paco E. |
| description | Patients with suspected cardiac sarcoidosis frequently undergo fluorodeoxyglucose (FDG)–positron emission tomography (PET)/computed tomography (CT) imaging to assess disease activity at baseline and after treatment initiation.
This study investigated the effect of immunosuppressive therapy and biopsy status to achieve complete treatment response (CTR), partial treatment response (PTR), or no response (NR) on myocardial FDG-PET/CT.
This study analyzed 83 patients with suspected cardiac sarcoidosis (aged 53 ± 1.8 years, 71% were male, 69% were White, 61% had a history of biopsy-confirmed sarcoidosis) who were treatment naive, had evidence of myocardial FDG at baseline, and underwent repeat PET imaging after treatment initiation. CTR was graded visually, and PTR/NR were measured both visually and quantitatively using the total glycolytic activity. Patients were also evaluated for the occurrence of death, sustained ventricular arrhythmias, and heart failure admissions.
Overall, 59 patients (71%) achieved CTR/PTR (30%/41%) at follow-up scan (P = 0.04). Total glycolytic activity and visual estimate of PTR/NR had excellent agreement (κ = 0.86 [95% CI: 0.72-0.99]; P < 0.0001). In patients receiving prednisone only, the highest rates of CTR/PTR were observed in patients initiated on moderate or high dose (P < 0.01). In a regression model, moderate prednisone start dose (P = 0.03) was more strongly associated with achieving CTR/PTR than was high prednisone start dose. However, the latter patients were tapered faster between start dose and follow-up scan (P |
| doi_str_mv | 10.1016/j.jcmg.2022.05.015 |
| format | Article |
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This study investigated the effect of immunosuppressive therapy and biopsy status to achieve complete treatment response (CTR), partial treatment response (PTR), or no response (NR) on myocardial FDG-PET/CT.
This study analyzed 83 patients with suspected cardiac sarcoidosis (aged 53 ± 1.8 years, 71% were male, 69% were White, 61% had a history of biopsy-confirmed sarcoidosis) who were treatment naive, had evidence of myocardial FDG at baseline, and underwent repeat PET imaging after treatment initiation. CTR was graded visually, and PTR/NR were measured both visually and quantitatively using the total glycolytic activity. Patients were also evaluated for the occurrence of death, sustained ventricular arrhythmias, and heart failure admissions.
Overall, 59 patients (71%) achieved CTR/PTR (30%/41%) at follow-up scan (P = 0.04). Total glycolytic activity and visual estimate of PTR/NR had excellent agreement (κ = 0.86 [95% CI: 0.72-0.99]; P < 0.0001). In patients receiving prednisone only, the highest rates of CTR/PTR were observed in patients initiated on moderate or high dose (P < 0.01). In a regression model, moderate prednisone start dose (P = 0.03) was more strongly associated with achieving CTR/PTR than was high prednisone start dose. However, the latter patients were tapered faster between start dose and follow-up scan (P < 0.01). After a median follow-up of 4.7 (IQR: 3.1-7.8) years, patients who were biopsy-proven (vs non-biopsy-proven; P = 0.029) and with preserved left ventricular function (P = 002) were less likely to experience major adverse cardiac events. Outcomes based on treatment response status (CTR vs PTR vs NR; P = 0.23) were not significantly different.
Among patients with suspected sarcoidosis and evidence of myocardial inflammation, treatment response by serial FDG-PET was variable, but a favorable response was more common when using moderate-to-high intensity prednisone dose. Biopsy-proven individuals and those with preserved systolic function were less likely to experience adverse outcomes during follow-up.
[Display omitted]</description><identifier>ISSN: 1936-878X</identifier><identifier>EISSN: 1876-7591</identifier><identifier>DOI: 10.1016/j.jcmg.2022.05.015</identifier><identifier>PMID: 36357136</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Cardiomyopathies - diagnostic imaging ; Cardiomyopathies - drug therapy ; Cardiomyopathies - pathology ; Female ; Fluorodeoxyglucose F18 ; Humans ; Immunosuppression Therapy ; Male ; Myocarditis ; positron emission tomography ; Positron Emission Tomography Computed Tomography ; Positron-Emission Tomography - methods ; Predictive Value of Tests ; Prednisone ; Radiopharmaceuticals ; sarcoidosis ; Sarcoidosis - diagnostic imaging ; Sarcoidosis - drug therapy ; Sarcoidosis - pathology ; treatment response</subject><ispartof>JACC. Cardiovascular imaging, 2022-11, Vol.15 (11), p.1944-1955</ispartof><rights>2022 American College of Cardiology Foundation</rights><rights>Copyright © 2022 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c400t-190626df36c5c86ba03a729d9559547b7cbae76711929a8c5ed569442803190e3</citedby><cites>FETCH-LOGICAL-c400t-190626df36c5c86ba03a729d9559547b7cbae76711929a8c5ed569442803190e3</cites><orcidid>0000-0002-7457-9014 ; 0000-0002-3350-3136 ; 0000-0002-7906-9638 ; 0000-0002-7701-8757</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jcmg.2022.05.015$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36357136$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rojulpote, Chaitanya</creatorcontrib><creatorcontrib>Bhattaru, Abhijit</creatorcontrib><creatorcontrib>Jean, Christopher</creatorcontrib><creatorcontrib>Adams, Sarah L.</creatorcontrib><creatorcontrib>Patel, Vandan</creatorcontrib><creatorcontrib>Vidula, Mahesh K.</creatorcontrib><creatorcontrib>Selvaraj, Senthil</creatorcontrib><creatorcontrib>Dubroff, Jacob</creatorcontrib><creatorcontrib>Peyster, Eliot</creatorcontrib><creatorcontrib>Clancy, Caitlin B.</creatorcontrib><creatorcontrib>Patterson, Karen</creatorcontrib><creatorcontrib>Marchlinski, Francis E.</creatorcontrib><creatorcontrib>Rossman, Milton</creatorcontrib><creatorcontrib>Goldberg, Lee</creatorcontrib><creatorcontrib>Bravo, Paco E.</creatorcontrib><title>Effect of Immunosuppressive Therapy and Biopsy Status in Monitoring Therapy Response in Suspected Cardiac Sarcoidosis</title><title>JACC. Cardiovascular imaging</title><addtitle>JACC Cardiovasc Imaging</addtitle><description>Patients with suspected cardiac sarcoidosis frequently undergo fluorodeoxyglucose (FDG)–positron emission tomography (PET)/computed tomography (CT) imaging to assess disease activity at baseline and after treatment initiation.
This study investigated the effect of immunosuppressive therapy and biopsy status to achieve complete treatment response (CTR), partial treatment response (PTR), or no response (NR) on myocardial FDG-PET/CT.
This study analyzed 83 patients with suspected cardiac sarcoidosis (aged 53 ± 1.8 years, 71% were male, 69% were White, 61% had a history of biopsy-confirmed sarcoidosis) who were treatment naive, had evidence of myocardial FDG at baseline, and underwent repeat PET imaging after treatment initiation. CTR was graded visually, and PTR/NR were measured both visually and quantitatively using the total glycolytic activity. Patients were also evaluated for the occurrence of death, sustained ventricular arrhythmias, and heart failure admissions.
Overall, 59 patients (71%) achieved CTR/PTR (30%/41%) at follow-up scan (P = 0.04). Total glycolytic activity and visual estimate of PTR/NR had excellent agreement (κ = 0.86 [95% CI: 0.72-0.99]; P < 0.0001). In patients receiving prednisone only, the highest rates of CTR/PTR were observed in patients initiated on moderate or high dose (P < 0.01). In a regression model, moderate prednisone start dose (P = 0.03) was more strongly associated with achieving CTR/PTR than was high prednisone start dose. However, the latter patients were tapered faster between start dose and follow-up scan (P < 0.01). After a median follow-up of 4.7 (IQR: 3.1-7.8) years, patients who were biopsy-proven (vs non-biopsy-proven; P = 0.029) and with preserved left ventricular function (P = 002) were less likely to experience major adverse cardiac events. Outcomes based on treatment response status (CTR vs PTR vs NR; P = 0.23) were not significantly different.
Among patients with suspected sarcoidosis and evidence of myocardial inflammation, treatment response by serial FDG-PET was variable, but a favorable response was more common when using moderate-to-high intensity prednisone dose. Biopsy-proven individuals and those with preserved systolic function were less likely to experience adverse outcomes during follow-up.
[Display omitted]</description><subject>Cardiomyopathies - diagnostic imaging</subject><subject>Cardiomyopathies - drug therapy</subject><subject>Cardiomyopathies - pathology</subject><subject>Female</subject><subject>Fluorodeoxyglucose F18</subject><subject>Humans</subject><subject>Immunosuppression Therapy</subject><subject>Male</subject><subject>Myocarditis</subject><subject>positron emission tomography</subject><subject>Positron Emission Tomography Computed Tomography</subject><subject>Positron-Emission Tomography - methods</subject><subject>Predictive Value of Tests</subject><subject>Prednisone</subject><subject>Radiopharmaceuticals</subject><subject>sarcoidosis</subject><subject>Sarcoidosis - diagnostic imaging</subject><subject>Sarcoidosis - drug therapy</subject><subject>Sarcoidosis - pathology</subject><subject>treatment response</subject><issn>1936-878X</issn><issn>1876-7591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kM9u1DAQhyMEoqXwAhyQj1wS_Ce2Y4kLrApUKkJii8TN8tqT4tUmDp6kaN-mz9Inw6tte-xpRprv95Pmq6q3jDaMMvVh22z9cN1wynlDZUOZfFadsk6rWkvDnpfdCFV3uvt9Ur1C3FKqqGr1y-pEKCE1E-q0-nfe9-BnknpyMQzLmHCZpgyI8QbI1R_IbtoTNwbyOaYJ92Q9u3lBEkfyPY1xTjmO1w_c3e1PwCmNCIf7esGpNEMgK5dDdP7udu2yTzEkjPi6etG7HcKb-3lW_fpyfrX6Vl_--Hqx-nRZ-5bSuWaGKq5CL5SXvlMbR4XT3AQjpZGt3mi_caCVZsxw4zovIUhl2pZ3VJQsiLPq_bF3yunvAjjbIaKH3c6NkBa0XAvZadoaWVB-RH1OiBl6O-U4uLy3jNqDcLu1B-H2INxSaYvwEnp3379sBgiPkQfDBfh4BKB8eRMhW_QRRg8h5qLHhhSf6v8PjeOUew</recordid><startdate>202211</startdate><enddate>202211</enddate><creator>Rojulpote, Chaitanya</creator><creator>Bhattaru, Abhijit</creator><creator>Jean, Christopher</creator><creator>Adams, Sarah L.</creator><creator>Patel, Vandan</creator><creator>Vidula, Mahesh K.</creator><creator>Selvaraj, Senthil</creator><creator>Dubroff, Jacob</creator><creator>Peyster, Eliot</creator><creator>Clancy, Caitlin B.</creator><creator>Patterson, Karen</creator><creator>Marchlinski, Francis E.</creator><creator>Rossman, Milton</creator><creator>Goldberg, Lee</creator><creator>Bravo, Paco E.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7457-9014</orcidid><orcidid>https://orcid.org/0000-0002-3350-3136</orcidid><orcidid>https://orcid.org/0000-0002-7906-9638</orcidid><orcidid>https://orcid.org/0000-0002-7701-8757</orcidid></search><sort><creationdate>202211</creationdate><title>Effect of Immunosuppressive Therapy and Biopsy Status in Monitoring Therapy Response in Suspected Cardiac Sarcoidosis</title><author>Rojulpote, Chaitanya ; 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Cardiovascular imaging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rojulpote, Chaitanya</au><au>Bhattaru, Abhijit</au><au>Jean, Christopher</au><au>Adams, Sarah L.</au><au>Patel, Vandan</au><au>Vidula, Mahesh K.</au><au>Selvaraj, Senthil</au><au>Dubroff, Jacob</au><au>Peyster, Eliot</au><au>Clancy, Caitlin B.</au><au>Patterson, Karen</au><au>Marchlinski, Francis E.</au><au>Rossman, Milton</au><au>Goldberg, Lee</au><au>Bravo, Paco E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of Immunosuppressive Therapy and Biopsy Status in Monitoring Therapy Response in Suspected Cardiac Sarcoidosis</atitle><jtitle>JACC. Cardiovascular imaging</jtitle><addtitle>JACC Cardiovasc Imaging</addtitle><date>2022-11</date><risdate>2022</risdate><volume>15</volume><issue>11</issue><spage>1944</spage><epage>1955</epage><pages>1944-1955</pages><issn>1936-878X</issn><eissn>1876-7591</eissn><abstract>Patients with suspected cardiac sarcoidosis frequently undergo fluorodeoxyglucose (FDG)–positron emission tomography (PET)/computed tomography (CT) imaging to assess disease activity at baseline and after treatment initiation.
This study investigated the effect of immunosuppressive therapy and biopsy status to achieve complete treatment response (CTR), partial treatment response (PTR), or no response (NR) on myocardial FDG-PET/CT.
This study analyzed 83 patients with suspected cardiac sarcoidosis (aged 53 ± 1.8 years, 71% were male, 69% were White, 61% had a history of biopsy-confirmed sarcoidosis) who were treatment naive, had evidence of myocardial FDG at baseline, and underwent repeat PET imaging after treatment initiation. CTR was graded visually, and PTR/NR were measured both visually and quantitatively using the total glycolytic activity. Patients were also evaluated for the occurrence of death, sustained ventricular arrhythmias, and heart failure admissions.
Overall, 59 patients (71%) achieved CTR/PTR (30%/41%) at follow-up scan (P = 0.04). Total glycolytic activity and visual estimate of PTR/NR had excellent agreement (κ = 0.86 [95% CI: 0.72-0.99]; P < 0.0001). In patients receiving prednisone only, the highest rates of CTR/PTR were observed in patients initiated on moderate or high dose (P < 0.01). In a regression model, moderate prednisone start dose (P = 0.03) was more strongly associated with achieving CTR/PTR than was high prednisone start dose. However, the latter patients were tapered faster between start dose and follow-up scan (P < 0.01). After a median follow-up of 4.7 (IQR: 3.1-7.8) years, patients who were biopsy-proven (vs non-biopsy-proven; P = 0.029) and with preserved left ventricular function (P = 002) were less likely to experience major adverse cardiac events. Outcomes based on treatment response status (CTR vs PTR vs NR; P = 0.23) were not significantly different.
Among patients with suspected sarcoidosis and evidence of myocardial inflammation, treatment response by serial FDG-PET was variable, but a favorable response was more common when using moderate-to-high intensity prednisone dose. Biopsy-proven individuals and those with preserved systolic function were less likely to experience adverse outcomes during follow-up.
[Display omitted]</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>36357136</pmid><doi>10.1016/j.jcmg.2022.05.015</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-7457-9014</orcidid><orcidid>https://orcid.org/0000-0002-3350-3136</orcidid><orcidid>https://orcid.org/0000-0002-7906-9638</orcidid><orcidid>https://orcid.org/0000-0002-7701-8757</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | JACC. Cardiovascular imaging, 2022-11, Vol.15 (11), p.1944-1955 |
| issn | 1936-878X 1876-7591 |
| language | eng |
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| subjects | Cardiomyopathies - diagnostic imaging Cardiomyopathies - drug therapy Cardiomyopathies - pathology Female Fluorodeoxyglucose F18 Humans Immunosuppression Therapy Male Myocarditis positron emission tomography Positron Emission Tomography Computed Tomography Positron-Emission Tomography - methods Predictive Value of Tests Prednisone Radiopharmaceuticals sarcoidosis Sarcoidosis - diagnostic imaging Sarcoidosis - drug therapy Sarcoidosis - pathology treatment response |
| title | Effect of Immunosuppressive Therapy and Biopsy Status in Monitoring Therapy Response in Suspected Cardiac Sarcoidosis |
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