Imamura Yasutaka, Momose Mitsuru, Yamamoto Atsushi, Suzuki Atsushi, Serizawa Naoki, Uto Kenta, Watanabe Eri, Nagao Michinobu, Sakai Shuji, Yamaguchi Junichi
Department of Cardiology, Tokyo Women's Medical University, Japan.
Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, Japan.
Int J Cardiol. 2025 Aug 1;432:133273. doi: 10.1016/j.ijcard.2025.133273. Epub 2025 Apr 11.
Cardiac sarcoidosis (CS) is a granulomatous disease that can lead to heart failure and fatal arrhythmias. While F-fluorodeoxyglucose-positron emission tomography (FDG-PET) is useful in assessing active inflammation, its role in guiding immunosuppressive therapy and predicting long-term prognosis remains unclear.
This retrospective study analyzed 36 CS patients who underwent FDG-PET-guided immunosuppressive therapy between 2012 and 2017. FDG uptake was quantitatively evaluated before treatment, at 6 and 12 months, and annually thereafter. Prognostic outcomes, including major adverse cardiac events (MACE) and mortality, were assessed.
Over a median follow-up of 8.2 years, 11 patients experienced MACE, and 7 died. SUVmax at 6 months (six-M SUVmax) and 1 year (one-y SUVmax) significantly correlated with prognosis. Patients with one-y SUVmax >4.5 had a higher risk of adverse events (p < 0.0001), while patients with six-M SUVmax >3.5 had a higher risk of adverse events (p = 0.035). Lower left ventricular ejection fraction (LVEF <40 %) was also associated with worse outcomes. Those requiring a final prednisolone (PSL) dose ≥10 mg had increased mortality (p < 0.0001).
FDG-PET-derived SUVmax at 1 year is a critical prognostic indicator in CS patients undergoing immunosuppressive therapy. Poor response to PSL, indicated by persistent FDG uptake, correlates with worse outcomes. Regular FDG-PET monitoring and personalized treatment strategies are essential to optimizing long-term management.
心脏结节病（CS）是一种肉芽肿性疾病，可导致心力衰竭和致命性心律失常。虽然氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）有助于评估活动性炎症，但其在指导免疫抑制治疗和预测长期预后方面的作用仍不明确。
这项回顾性研究分析了2012年至2017年间接受FDG-PET引导的免疫抑制治疗的36例CS患者。在治疗前、治疗6个月和12个月时以及此后每年对FDG摄取进行定量评估。评估包括主要不良心脏事件（MACE）和死亡率在内的预后结果。
在中位随访8.2年期间，11例患者发生MACE，7例死亡。6个月时的SUVmax（6-M SUVmax）和1年时的SUVmax（1-y SUVmax）与预后显著相关。1-y SUVmax>4.5的患者发生不良事件的风险较高（p<0.0001），而6-M SUVmax>3.5的患者发生不良事件的风险较高（p=0.035）。较低的左心室射血分数（LVEF<40%）也与较差的预后相关。那些最终需要泼尼松龙（PSL）剂量≥10mg的患者死亡率增加（p<0.0001）。
1年时FDG-PET得出的SUVmax是接受免疫抑制治疗的CS患者的关键预后指标。持续的FDG摄取表明对PSL反应不佳，与较差的预后相关。定期进行FDG-PET监测和个性化治疗策略对于优化长期管理至关重要。
