所属 医学部 医学科（東京女子医科大学病院） 職種 客員教授
|発表タイトル||Detection of undiagnosed cardiac sarcoidosis by FDG-PET and SPECT among patients with Atrioventricular Block routinely followed in a pacemaker outpatient clinic|
|会議名||ESC CONGRESS 2017|
|主催者||European Society of Cardiology|
|発表者・共同発表者||◎SERIZAWA Naoki, FUKUSHIMA Kenji, MOMOSE Mitsuru, SHIGA Tsuyoshi, HAGIWARA Nobuhisa|
|概要||Background: Atrioventricular block (AVB) is a common initial manifestation of cardiac sarcoidosis (CS) and classified as a major finding of CS. However, diagnosing CS is sometimes difficult in practice, especially in case of cardiac disease as the initial manifestation of sarcoidosis. Previous paper reported that 19% of patients with AVB were undiagnosed CS. 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) plays an important role in the detection of CS because of high sensitivity.
Hypothesis: FDG-PET is useful new diagnose CS after pacemaker implantation in patients with AVB.
Methods: We prospectively examined patients with pacemaker implantation for AVB without known cardiac disease using by echocardiography from 2013 to 2015 in a pacemaker outpatient clinic. Patients with left ventricular ejection fraction (LVEF)<50% underwent FDG-PET (after>24hrs with low carbohydrate diet and 18hrs fasting and heparin administration) and TL-BMIPP dual single photon emission computed tomography (SPECT) for diagnosing CS. SUVmax in the entire myocardium was obtained from FDG-PET as a marker of disease activity. Newly diagnosed CS patients underwent serial FDG-PET and SPECT after corticosteroid therapy.
Results: Seventeen of 139 enrolled patients (13%) had LVEF<50%. Three out of 13 patients (23%) were newly diagnosed as CS. Patients with CS had significantly higher SUVmax, BMIPP defect score and TL-BMIPP mismatch score than those without (5.5±1.5 vs. 1.8±0.6, p<0.001 and 14±3 vs. 4±2, p=0.010 and 8±4 vs. 1±1, p=0.001, respectively). In the 3 newly diagnosed CS patients, SUVmax, BMIPP defect score and Tl-BMIPP mismatch score were decreased after corticosteroid treatment (5.5±1.5 to 1.9±0.4, 14±5 to 9±4 and 8±4 to 6±4, respectively).
Conclusions: CS was not uncommon among patients with AVB and reduced LVEF routinely followed in a pacemaker clinic. FDG-PET and SPECT were useful for detecting undiagnosed CS and therapeutic monitoring of those patients.