Optimal Timing of Serial 18F-Fluoro-2-Deoxyglucose Positron Emission Tomography after Prednisolone Treatment Introduction for Cardiac Sarcoidosis.

Abstract

Immunosuppressive therapy with prednisolone (PSL) is the first-line treatment for cardiac sarcoidosis (CS), and 18F-fluoro-2-deoxyglucose positron emission tomography (FDG-PET) is used to evaluate its efficacy to guide treatment. However, the appropriate timing of FDG-PET in CS remains unknown. This single-center, retrospective, observational study included 15 consecutive CS patients who underwent 3 serial FDG-PET scans (at baseline, in the early phase [1-2 months after PSL introduction], and in the late phase [≥ 5 months after PSL introduction with a maintenance dose of PSL]). We adhered to the PSL tapering protocol by the Japanese Circulation Society even when early FDG-PET showed positive results (SUVmax ≥ 4.0). No patient died during the 908 (644-1600) days of observation. Negative results in the late phase were observed in 3 of 6 early-positive patients, and 3 of 9 early-negative patients showed positive results in the late phase. Changes in echocardiographic parameters from baseline to the late phase were significantly better in late-negative patients than in late-positive patients (left ventricular end-diastolic diameter: -0.7 (-9.3-[-0.5]) mm versus +3.5 (0.8-7.5) mm, P = 0.039; left ventricular end-systolic diameter: -4.2 (-6.9-[-0.1]) mm versus +5.1 (0.5-7.0) mm, P = 0.015; left ventricular ejection fraction: +4.7% (-1.0-9.0%) versus -1.5% (-11.3-1.5%), P = 0.045) ), although early FDG-PET did not predict those consequent changes. An interval of ≥ 5 months after introducing the PSL with a maintenance dose of PSL is long enough for FDG-PET to reflect consequent left ventricular functions, while an interval of 1-2 months can be too short.

• Authors: Mitsuo Ishizuka, Takeshi Kashimura, Mitsuhiro Watanabe, Mayumi Kase, Ryohei Sakai, Takeshi Okubo, Shinya Fujiki, Tsugumi Takayama, Shiro Ishihara, Kazuyuki Ozaki, Takayuki Inomata
• Journal: International heart journal (Int Heart J) Vol. 64 Issue 2 Pg. 196-202 (Mar 31 2023) ISSN: 1349-3299 [Electronic] Japan
• PMID: 36927938 (Publication Type: Observational Study, Journal Article)

Chemical References

• Prednisolone
• Fluorodeoxyglucose F18
• Radiopharmaceuticals

Topics

• Humans
• Prednisolone (therapeutic use)
• Fluorodeoxyglucose F18
• Cardiomyopathies (diagnostic imaging, drug therapy)
• Radiopharmaceuticals
• Positron-Emission Tomography (methods)
• Sarcoidosis (diagnostic imaging, drug therapy)
• Myocarditis
• Retrospective Studies