Current Status and Future Perspectives in the Diagnosis and Management of Cardiac Sarcoidosis

A new guideline for cardiac sarcoidosis (CS) is published. This guideline highlights new imaging modalities such as cardiac magnetic resonance imaging (CMR) and 18F-fluorodeoxy glucose (¹⁸F-FDG) PET, and isolated cardiac sarcoidosis (iCS). Late gadolinium enhancement (LGE) of CMR and abnormal ¹⁸F-FDG uptake in the myocardium are adopted as major criteria. Clinical diagnosis of iCS is defined for the first time, although the definition of iCS is controversial. However, ¹⁸F-FDG PET still has a problem regarding myocardial accumulation without inflammation in spite of long fasting time and dietary modification. T2 weighed images of CMR are rarely available in limited cases. Since histologic confirmation of sarcoidosis is essential for the diagnosis in the Western countries, but not in Japan, it is urgently required to improve reliability in those imaging modalities. The aim of medical treatment for CS is to control the inflammatory process by immunosuppressant to prevent further deterioration and sudden cardiac death. However, optimal treatment protocol and reliable markers for evaluating inflammatory activity still remains to be established. Although implantable cardioverter defibrillator is needed in selected patients to prevent sudden death, the indication remains controversial. Cardiac resynchronization therapy and mitral surgical treatment have been introduced in CS patients with refractory heart failure. Future perspectives in the diagnosis and management of CS are discussed in this presentation.