RESUMEN
Sarcoidosis is a multisystem granulomatous disease of unknown aetiology that involves primarily the lungs and lymph nodes. Cardiac involvement is less common but associated with a poorer prognosis. With contemporary diagnostic modalities such as cardiac magnetic resonance and fluorine-18-fluoro-deoxy-glucose positron emission tomography computed tomography, cardiac involvement in sarcoidosis is increasingly diagnosed with appropriate therapy improving outcomes. Although steroid therapy may be protective or therapeutic in preventing left ventricular scarring and preserving LV function, it may not be as effective in the late stages of disease. (Chiu et al in Am J Cardiol 95:143-146, 2005) We present a case of cardiac sarcoidosis with significantly impaired ejection fraction that was diagnosed late in the course of disease with complete metabolic response to therapy and an improvement of LV function, but with a subsequent complication of ventricular tachycardia storm.
Asunto(s)
Cardiomiopatías/diagnóstico por imagen , Sarcoidosis/diagnóstico por imagen , Taquicardia Ventricular/diagnóstico por imagen , Disfunción Ventricular Izquierda/diagnóstico por imagen , Cardiomiopatías/complicaciones , Femenino , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Tomografía Computarizada por Tomografía de Emisión de Positrones , Sarcoidosis/complicaciones , Taquicardia Ventricular/complicaciones , Disfunción Ventricular Izquierda/complicacionesRESUMEN
INTRODUCTION: Radionuclide imaging for the diagnosis and monitoring of cardiac involvement in sarcoidosis has advanced significantly in recent years. SOURCES OF DATA: This article is based on published clinical guidelines, literature review and our collective clinical experience. AREAS OF AGREEMENT: Gallium-67 scintigraphy is among the diagnostic criteria for cardiac involvement in systemic sarcoidosis, and it is strongly associated with response to treatment. However, fluorine-18, 2-fluoro-deoxyglucose (FDG) positron emission tomography (PET) is now preferred both for diagnosis and for assessing prognosis. AREAS OF CONTROVERSY: Most data are from small observational studies that are potentially biased. GROWING POINTS: Quantitative imaging to assess changes in disease activity in response to treatment may lead to FDG-PET having an important routine role in managing cardiac sarcoidosis. AREAS TIMELY FOR DEVELOPING RESEARCH: Larger prospective studies are required, particularly to assess the effectiveness of radionuclide imaging in improving clinical management and outcome.
Asunto(s)
Cardiomiopatías/diagnóstico por imagen , Sarcoidosis/diagnóstico por imagen , Fluorodesoxiglucosa F18 , Radioisótopos de Galio , Humanos , Imagen de Perfusión Miocárdica/métodos , Imagen de Perfusión Miocárdica/tendencias , Tomografía de Emisión de Positrones/métodos , Tomografía de Emisión de Positrones/tendencias , Pronóstico , Tomografía Computarizada de Emisión de Fotón Único/métodos , Tomografía Computarizada de Emisión de Fotón Único/tendenciasAsunto(s)
Atropina/uso terapéutico , Bradicardia/inducido químicamente , Prueba de Esfuerzo/efectos adversos , Hipotensión/inducido químicamente , Purinas/efectos adversos , Purinas/antagonistas & inhibidores , Pirazoles/efectos adversos , Pirazoles/antagonistas & inhibidores , Agonistas del Receptor de Adenosina A2/efectos adversos , Antídotos/uso terapéutico , Bradicardia/prevención & control , Humanos , Hipotensión/prevención & control , Vasodilatadores/efectos adversos , Vasodilatadores/antagonistas & inhibidoresRESUMEN
PURPOSE: Regadenoson was approved for clinical use in Europe in 2011. Since then, it has become the default form of stress at our institution. We have assessed the side-effect profile and tolerability of regadenoson in patients undergoing clinically indicated myocardial perfusion scintigraphy between July 2011 and July 2012. METHODS: Clinical, stress and imaging data were recorded prospectively. Symptoms during stress were recorded and defined as mild, moderate or severe. An adverse event was defined as any symptom that persisted for more than 30 min or that required investigation or treatment. RESULTS: Of 1,764 consecutive patients, 1,581 (90%) received regadenoson combined with submaximal exercise unless contraindicated. Symptoms were common (63%) but transient and well-tolerated. The severity of symptoms was recorded in most patients as mild (84%). Dyspnoea (36%) and chest discomfort (12%) were the commonest side effects. Adverse events were reported in eight patients (0.5%), thought to be vasovagal in seven of these. All patients recovered fully without sequelae. There were no deaths, myocardial infarction or hospital admissions. Regadenoson stress was performed in 206 patients (12%) with asthma or chronic obstructive pulmonary disease (COPD) without bronchospasm or any other major side effect. CONCLUSION: We studied the symptom profile of regadenoson in the largest European cohort to date. Regadenoson combined with submaximal exercise was well tolerated, notably also in patients with asthma or COPD. The majority of regadenoson-related adverse events were vasovagal episodes without sequelae.
Asunto(s)
Prueba de Esfuerzo , Imagen de Perfusión Miocárdica , Purinas/efectos adversos , Pirazoles/efectos adversos , Radiofármacos/efectos adversos , Anciano , Europa (Continente) , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosAsunto(s)
Anafilaxia/inducido químicamente , Gelatina/efectos adversos , Paro Cardíaco/inducido químicamente , Complicaciones Intraoperatorias/inducido químicamente , Infarto del Miocardio/inducido químicamente , Succinatos/efectos adversos , Anafilaxia/diagnóstico , Electrocardiografía , Paro Cardíaco/diagnóstico , Humanos , Complicaciones Intraoperatorias/diagnóstico , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Quirófanos , Sustitutos del Plasma/efectos adversos , Pruebas Cutáneas , Procedimientos Quirúrgicos Urológicos MasculinosRESUMEN
The concept of hardware fusion between positron emission tomography (PET) and computed tomography (CT) has only been introduced commercially in the last 4 years. The advantages of this combined technique over PET alone have become obvious. There is increasing evidence to suggest that PET/CT adds complementary information in staging, re-staging and follow-up in oncology patients, leading to changes in management plans. The present paper is a review of the strengths, weaknesses, current evidence and future directions of this technique.