Abstract 12742: Positive Cardiac Positron Emission Tomography Correlates with the Appearance of Advanced Heart Block in Patients with Cardiac Sarcoidosis

Abstract

Background: Although the long-term prognosis of patients with sarcoidosis is generally well, that of patients with cardiac sarcoidosis (CS) is poor as it causes fatal arrhythmias including advanced heart block (AHB) and heart failure. In this study, we thus aimed to identify the predictors of occurrence of AHB in patients.

Methods: We examined 61 consecutive patients with CS who were admitted to our Hospital from April 2002 until March 2012. The diagnosis of CS was made based on the guidelines by the Japanese Ministry of Health and Welfare. We analyzed various demographic, clinical, and imaging data and examined their association with AHB as a primary presentation of CS.

Results: The CS patients were characterized by middle-age (57±12 years), more females (70%) and normal heart structure in half of them and septal thinning and a dilated cardiomyopathy-like phenotype in the remaining half. AHB was the most commonly encountered electrical abnormality (39%). Of the parameters studied, no significant association with a primary presentation of AHB was noted for sex or the presence of extra-cardiac sarcoidosis (P=0.36 and 0.98, respectively). In contrast, a significant association with a primary presentation of AHB arrhythmias was noted for older age (P=0.04), compromised LV function at admission, including a worse NYHA class (P=0.03) and a lower LVEF (P=0.04). Importantly, ¹⁸F-fluorodeoxyglucose (18F-FDG) uptake on positron emission tomography (PET) was the most significant parameter associated with AHB presentation (P=0.02, r =0.424) and the absence of ¹⁸F-FDG uptake carried a 100% negative predictive value for AHB.

Conclusions: These results indicate that parameters of compromised LV function and more importantly, ¹⁸F-FDG uptake on PET as a marker of activity, are significant clinical characteristics associated with AHB as a primary presentation of CS.