Cardiac Sarcoidosis in a Patient With Hypertrophic Cardiomyopathy Demonstrated by Magnetic Resonance Imaging and Single Photon Emission Computed Tomography Dual-Isotope Scintigraphy
2004; Lippincott Williams & Wilkins; Volume: 110; Issue: 24 Linguagem: Inglês
10.1161/01.cir.0000149749.95902.a4
ISSN1524-4539
AutoresJan‐Peter Smedema, Marinus J.P.G. van Kroonenburgh, Gabriël Snoep, Walter H. Backes, Anton P.M. Gorgels,
Tópico(s)Cardiomyopathy and Myosin Studies
ResumoHomeCirculationVol. 110, No. 24Cardiac Sarcoidosis in a Patient With Hypertrophic Cardiomyopathy Demonstrated by Magnetic Resonance Imaging and Single Photon Emission Computed Tomography Dual-Isotope Scintigraphy Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBCardiac Sarcoidosis in a Patient With Hypertrophic Cardiomyopathy Demonstrated by Magnetic Resonance Imaging and Single Photon Emission Computed Tomography Dual-Isotope Scintigraphy Jan-Peter Smedema, Marinus J.P.G. van Kroonenburgh, Gabriel Snoep, Walter Backes and Anton P. Gorgels Jan-Peter SmedemaJan-Peter Smedema From the Departments of Cardiology (J.-P.S., A.P.G.), Nuclear Medicine (M.v.K.), and Radiology (G.S., W.B.), the Maastricht Cardiovascular Sarcoidosis Study Group (MACAS), University Hospital Maastricht, Maastricht, the Netherlands. , Marinus J.P.G. van KroonenburghMarinus J.P.G. van Kroonenburgh From the Departments of Cardiology (J.-P.S., A.P.G.), Nuclear Medicine (M.v.K.), and Radiology (G.S., W.B.), the Maastricht Cardiovascular Sarcoidosis Study Group (MACAS), University Hospital Maastricht, Maastricht, the Netherlands. , Gabriel SnoepGabriel Snoep From the Departments of Cardiology (J.-P.S., A.P.G.), Nuclear Medicine (M.v.K.), and Radiology (G.S., W.B.), the Maastricht Cardiovascular Sarcoidosis Study Group (MACAS), University Hospital Maastricht, Maastricht, the Netherlands. , Walter BackesWalter Backes From the Departments of Cardiology (J.-P.S., A.P.G.), Nuclear Medicine (M.v.K.), and Radiology (G.S., W.B.), the Maastricht Cardiovascular Sarcoidosis Study Group (MACAS), University Hospital Maastricht, Maastricht, the Netherlands. and Anton P. GorgelsAnton P. Gorgels From the Departments of Cardiology (J.-P.S., A.P.G.), Nuclear Medicine (M.v.K.), and Radiology (G.S., W.B.), the Maastricht Cardiovascular Sarcoidosis Study Group (MACAS), University Hospital Maastricht, Maastricht, the Netherlands. Originally published14 Dec 2004https://doi.org/10.1161/01.CIR.0000149749.95902.A4Circulation. 2004;110:e529–e531A 41-year-old man, who had been diagnosed with stage 2 pulmonary sarcoidosis 3 years earlier, was referred to the cardiac clinic complaining of palpitations, dyspnea, and atypical chest pain. Except for central obesity (body mass index of 37 kg/m2) and hypertension, no abnormalities were found on physical examination. The 12-lead ECG demonstrated apical and inferolateral ST-segment elevation, whereas multiple polymorphic premature ventricular beats were found during exercise testing and 24-hour ambulatory ECG.Coronary angiography showed no abnormalities. Because of the man's obesity, the image quality of the transthoracic echocardiography was suboptimal. Cardiac MRI revealed severe asymmetric hypertrophy of the left ventricle, a finding that points to hypertrophic cardiomyopathy. T2-weighted cardiac MRI revealed increased signal in the apical region (Figure 1), and contrast-enhanced cardiac MRI (0.1 mmol/kg gadolinium-diethylenetriamine pentaacetic acid [Gd-DTPA]) showed late enhancement of the same region (Figures 2 through 5). Download figureDownload PowerPointFigure 1. T2-weighted cardiac MRI short-axis view of the apex reveals increased signal in this region.Download figureDownload PowerPointFigure 2. Contrast-enhanced cardiac MRI demonstrates late enhancement of the same region in the 4-chamber view.Download figureDownload PowerPointFigure 3. Contrast-enhanced cardiac MRI demonstrates late enhancement of apical region in the short-axis view.Download figureDownload PowerPointFigure 4. Contrast-enhanced cardiac MRI after inversion recovery prepulse demonstrates late enhancement of the apical region in the 4-chamber view.Download figureDownload PowerPointFigure 5. Contrast-enhanced cardiac MRI after inversion recovery prepulse demonstrates late enhancement of the apical region in the short-axis view.A dual-isotope 99mTc-Hexamibi (Cardiolite, DuPont) and 111In-pentetreotide (OctreoScan, Tyco Healthcare, Mallinckrodt Medical BV; dose 190 MBq) SPECT was performed during exercise (dose 280 MBq) and rest (dose 870 MBq), revealing a reversible apical perfusion defect and apical uptake of 111Inpentetreotide (Figure 6). The presence of somatostatin receptors in the apical region suggests active apical cardiac sarcoidosis. Download figureDownload PowerPointFigure 6. Fusion of the resting 99mTc-Hexamibi and 111In-pentetreotide SPECT images demonstrates matching of the apical 99mTc-Hexamibi perfusion defect and 111In-pentetreotide uptake.The SPECT and cardiac MRI images were fused (Figures 7 and 8) by rigid-body transformations based on anatomic landmarks (apex and basal interventricular septum) and the geometric dimensions identified in the different types of images. The spatial image transformations were computed in the MatLab (MathWorks) programming environment. 111In-pentetreotide binds to somatostatin receptors on macrophages and has been reported to be useful in the management of sarcoidosis. It is possible to differentiate between active inflammation and fibrosis with different cardiac MRI techniques (eg, T2-weighted versus contrast-enhanced T1-weighted cardiac MRI). Download figureDownload PowerPointFigure 7. Fusion of the contrast-enhanced cardiac MRI and 99mTc-Hexamibi SPECT images demonstrates matching of the perfusion defect and Gd-DTPA enhancement of the apical region.Download figureDownload PowerPointFigure 8. Fusion of the contrast-enhanced cardiac MRI and 111In-pentetreotide SPECT images demonstrates matched uptake of 111In-pentetreotide and Gd-DTPA in the apical region.This case demonstrates the usefulness of matching different imaging techniques to visualize inflammation and the different stages of this process in the myocardium.The authors thank Geert J. Ensing, PhD, Tyco Healthcare, Mallinckrodt Medical BV, Petten, the Netherlands, for providing us with 111In-pentetreotide.FootnotesCorrespondence to Dr J.-P. Smedema, University Hospital Maastricht, Dr P Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Qasim R, Alkatout K, Qaddoura F and Nagib A (2022) Rare Presentation of Cardiac Sarcoidosis With Recurrent Large Pericardial Effusion and Stress-induced Cardiomyopathy, Journal of Asian Pacific Society of Cardiology, 10.15420/japsc.2022.10 Bravo P, Bajaj N, Padera R, Morgan V, Hainer J, Bibbo C, Harrington M, Park M, Hyun H, Robertson M, Lakdawala N, Groarke J, Stewart G, Dorbala S, Blankstein R and Di Carli M (2019) Feasibility of somatostatin receptor-targeted imaging for detection of myocardial inflammation: A pilot study, Journal of Nuclear Cardiology, 10.1007/s12350-019-01782-0, 28:3, (1089-1099), Online publication date: 1-Jun-2021. Mathias I, Oliveira Lima Filho J, Culver D, Rodriguez E, Tan C, Ribeiro Neto M, Jellis C, Gray B, Melato G, Halliday B, Simovic S and Kott K (2021) Case report of isolated cardiac sarcoidosis presenting as hypertrophic obstructive cardiomyopathy—a clinical picture printed on lenticular paper, European Heart Journal - Case Reports, 10.1093/ehjcr/ytab208, 5:6, Online publication date: 29-May-2021. Bravo P, Singh A, Di Carli M and Blankstein R (2018) Advanced cardiovascular imaging for the evaluation of cardiac sarcoidosis, Journal of Nuclear Cardiology, 10.1007/s12350-018-01488-9, 26:1, (188-199), Online publication date: 1-Feb-2019. Agarwal A, Sulemanjee N, Cheema O, Downey F and Tajik A (2014) Cardiac Sarcoid: A Chameleon Masquerading as Hypertrophic Cardiomyopathy and Dilated Cardiomyopathy in the Same Patient, Echocardiography, 10.1111/echo.12536, 31:5, (E138-E141), Online publication date: 1-May-2014. O'Hanlon R and Mohiaddin R (2012) Inherited Cardiomyopathies Magnetic Resonance Imaging of Congenital Heart Disease, 10.1007/978-1-4471-4267-6_13, (211-229), . Fukami T, Sato H, Wu J, Lwin T, Yuasa T, Kawano S, Iida K, Akatsuka T, Hontani H, Takeda T, Tamura M and Yokota H (2007) Quantitative evaluation of myocardial function by a volume-normalized map generated from relative blood flow, Physics in Medicine and Biology, 10.1088/0031-9155/52/14/019, 52:14, (4311-4330), Online publication date: 21-Jul-2007. December 14, 2004Vol 110, Issue 24 Advertisement Article InformationMetrics https://doi.org/10.1161/01.CIR.0000149749.95902.A4PMID: 15596554 Originally publishedDecember 14, 2004 PDF download Advertisement SubjectsComputerized Tomography (CT)Nuclear Cardiology and PET
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