RECOGNITION OF DISEASE ACTIVITY AND TREATMENT MONITORING IN CARDIAC SARCOIDOSIS: INTEGRAL ROLE OF CARDIAC POSITRON EMISSION TOMOGRAPHY (PET)

Document Type

Conference Proceeding

Publication Date

4-1-2024

Publication Title

J Am Coll Cardiol

Abstract

Background 18F-Flourodeoxyglucose (FDG) PET imaging is crucial for diagnosing and monitoring disease activity in cardiac sarcoidosis (CS). However, little is known regarding the utility of follow-up PET scans in managing immunosuppression. Case 49 year old male with history of heart failure with reduced EF, complete heart block s/p CRT-D, atrial fibrillation, underwent a cardiac 82Rubidium 18F FDG PET scan for suspected CS. In the top figure, multifocal FDG uptake was observed, indicating active inflammation in the septum, right ventricle (RV), and right atrium despite normal perfusion. Treatment began with methotrexate and prednisone. After 3 months, follow-up PET scan revealed no inflammation (middle figure), resulting in reduction of prednisone dose with symptomatic improvement. 6 months later, another PET scan revealed recurrent inflammatory pattern of uptake in the septum, anterior wall, and RV prompting initiation of infliximab alongside methotrexate and a gradual prednisone taper until discontinuation. Decision-making Our case highlights the importance of serial 18F-FDG PET imaging in monitoring CS, emphasizing the challenges of immunosuppressive therapy, the recurrence of inflammation, and the value of follow-up cardiac PET scans. Increased RV FDG uptake is linked to higher long term event rates. Conclusion In the absence of specific guidelines, FDG PET may serve as a valuable tool for monitoring inflammation progression and assessing the response to immunosuppressive therapy. [Formula presented]

Volume

83

Issue

13

First Page

3504

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