Effect of Immunosuppressive Therapy and Biopsy Status in Monitoring Therapy Response in Suspected Cardiac Sarcoidosis

• Published in: JACC. Cardiovascular imaging 2022-11, Vol.15 (11), p.1944-1955
• Main Authors: 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.
• Format: Article
• Language: English
• 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
• ISSN: 1936-878X; 1876-7591
• DOI: 10.1016/j.jcmg.2022.05.015

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