Right ventricular involvement of cardiac sarcoidosis: A comprehensive evaluation using cardiovascular magnetic resonance imaging and positron emission tomography
Right ventricular involvement of cardiac sarcoidosis: A comprehensive evaluation using cardiovascular magnetic resonance imaging and positron emission tomography
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心脏结节病右心室受累：心血管磁共振成像和正电子发射断层扫描的综合评估
DOI：
10.1007/s12350-021-02655-1
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发表时间：
2022
影响因子：
2.4
通讯作者：
Oyama-Manabe Noriko
中科院分区：
文献类型：
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作者：
Aikawa Tadao;Ibe Tatsuro;Manabe Osamu;Oyama-Manabe Noriko
1例73岁女性，有皮肤结节病病史（图1A，皮肤科Maya Takazawa医生赠送），出现心悸，转诊至心脏病专家。心电图显示正常窦性心律和完全右束支分支传导阻滞（图1 B）;超声心动图显示左心室（LV）心尖部动脉瘤;冠状动脉计算机断层扫描（CT）血管造影排除了阻塞性冠状动脉疾病。心血管磁共振（CMR）电影成像显示左心室功能障碍，右心室（RV）功能正常（补充电影）;但是，使用专用软件进行CMR功能跟踪分析（Vitrea; Canon Medical Systems，Otawara，Japan;图1C，D）显示了区域RV不同步和前RV游离壁中的周向应变降低（图1D，箭头; LV和RV壁的节段和局部应变值以相同的颜色表示）。晚期钆增强（LGE）成像显示心外膜下和中壁增强主要分布在室间隔和LV和RV的前壁（图1 E，箭头）。随后的18 F-氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）/CT显示位于相同区域的异常FDG摄取（图1 F，G，箭头）。她被诊断为心脏结节病，并开始每天30 mg泼尼松龙。据报告，LGE-CMR 1或FDGPET 2检测到的RV受累与心脏结节病患者的不良心脏事件相关。LGE-CMR作为诊断心脏结节病的金标准，不能在肾功能受损的患者中进行。使用特征跟踪的区域应变分析可以回顾性地应用于现有的电影CMR图像，而无需给予造影剂。该病例强调了基于电影CMR的应变分析可能有助于确定心脏结节病患者的RV受累。
A 73-year-old woman with a history of cutaneous sarcoidosis (Figure 1 A, a gift from Dr. Maya Takazawa, Department of Dermatology) presented with palpitations and was referred to a cardiologist. Electrocardiography showed normal sinus rhythm and complete right bundle branch block (Figure 1 B); echocardiography showed a left ventricular (LV) apical aneurysm; and coronary computed tomography (CT) angiography ruled out obstructive coronary artery disease. Cardiovascular magnetic resonance (CMR) cine imaging showed LV dysfunction with normal global right ventricular (RV) function (Supplemental Movies); however, CMR feature tracking analysis using dedicated software (Vitrea; Canon Medical Systems, Otawara, Japan; Figure 1 C, D) revealed regional RV dyssynchrony and reduced circumferential strain in the anterior RV free wall (Figure 1 D, arrows; segments of the LV and RV walls and regional strain values are presented with the same color). Late gadolinium enhancement (LGE) imaging showed subepicardial and mid-wall enhancement predominantly distributed in the interventricular septum and the anterior wall of the LV and RV (Figure 1 E, arrow). Subsequent 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT revealed abnormal FDG uptake located in the same areas (Figure 1 F, G, arrow). She was diagnosed with cardiac sarcoidosis and started prednisolone 30 mg daily. RV involvement detected by LGE-CMR 1 or FDGPET 2 was reported to be associated with adverse cardiac events in patients with cardiac sarcoidosis. LGE-CMR as a gold standard for the diagnosis of cardiac sarcoidosis cannot be performed in patients with impaired renal function. Regional strain analysis using feature tracking can be applied retrospectively to existing cine CMR images without contrast material administration. This case highlights that cine CMR-based strain analysis may help to identify RV involvement in patients with cardiac sarcoidosis.
影响因子：
24
作者：
Blankstein, Ron;Osborne, Michael;Naya, Masanao;Waller, Alfonso;Kim, Chun K.;Murthy, Venkatesh L.;Kazemian, Pedram;Kwong, Raymond Y.;Tokuda, Michifumi;Skali, Hicham;Padera, Robert;Hainer, Jon;Stevenson, William G.;Dorbala, Sharmila;Di Carli, Marcelo F.
通讯作者：
Di Carli, Marcelo F.