Unraveling Inflammation and Oxidative Stress in Cardiac Sarcoidosis
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Sarcoidosis is an inflammatory disorder of unknown pathogenesis hallmarked by noncaseating granulomas with multiorgan system involvement. In the United States, estimated prevalence of sarcoidosis ranges from 141.4 per 100 000 in blacks, 49.8 per 100 000 in whites, to 21.7 in Hispanics, and 18.9 in Asians.1 In a series of patients with biopsy-proven extracardiac sarcoidosis and unknown cardiac involvement, 26% seem to have cardiac sarcoidosis (CS) when assessed with cardiac magnetic resonance imaging (CMR),2 a rate that is consistent with a published US autopsy study.3 CS may be associated with significant morbidity and mortality, especially in patients with severe left ventricular dysfunction.4 However, a more recent study suggests that increased awareness, detection, and treatment of CS may be associated with better outcomes.5
See Article by Ishiguchi et al
Both fluorine-18 fluorodeoxyglucose positron emission tomography (18FDG PET) and CMR have become pivotal in the diagnosis, monitoring, and prognostication of CS.6–8 In the largest outcomes study of patients with CS evaluated with PET, Blankstein et al6 assessed 118 consecutive patients with CS and demonstrated that presence of focal PET myocardial perfusion defects and/or 18FDG abnormality predicts patients at high risk for death or ventricular arrhythmias, with the worst outcomes noted in the group with both perfusion defects and 18FDG abnormality. Likewise, the presence of myocardial gadolinium–delayed enhancement on CMR predicts all-cause mortality and ventricular arrhythmias in patients with known or suspected CS.8 However, both techniques have their disadvantages. 18FDG PET is limited by complicated dietary preparations, variable suppression of physiological myocardial 18FDG uptake, and uncertain effects of steroids on both physiological and pathological myocardial 18FDG uptake.7 CMR is relatively contraindicated in patients with cardiac devices which are present in a substantial proportion of patients with CS and …