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Serial cardiac magnetic resonance imaging to assess myocardial inflammation in PET-positive cardiac sarcoidosis under immunomodulatory therapy: a retrospective observational study
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Serial cardiac magnetic resonance imaging to assess myocardial inflammation in PET-positive cardiac sarcoidosis under immunomodulatory therapy: a retrospective observational study
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Serial cardiac magnetic resonance imaging to assess myocardial inflammation in PET-positive cardiac sarcoidosis under immunomodulatory therapy: a retrospective observational study
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Journal Article
Serial cardiac magnetic resonance imaging to assess myocardial inflammation in PET-positive cardiac sarcoidosis under immunomodulatory therapy: a retrospective observational study
2025
Overview
ObjectiveTo evaluate changes in cardiac magnetic resonance (CMR) tissue characteristics in patients with active cardiac sarcoidosis (CS) confirmed by positron emission tomography (PET)-CT undergoing immunomodulatory therapy (IMT), and to explore their potential use for inflammation monitoring.DesignRetrospective observational cohort study.SettingTertiary care referral centre in Germany.ParticipantsFrom a cohort of 47 patients with CS, 24 patients with PET-confirmed active myocardial inflammation and complete baseline and follow-up CMR imaging after ≥6 months of IMT were included.Primary and secondary endpointsPrimary outcome: Changes in CMR-derived tissue characteristics (T1, T2 mapping, late gadolinium enhancement (LGE) mass). Secondary outcomes: Changes in functional (ejection fraction (EF) and global longitudinal strain (GLS)) and morphological parameters (end-diastolic/systolic volume indices (EDVi/ESVi)).ResultsPatients with PET-confirmed active CS show increased global T1 and T2 compared with healthy volunteers. Over the course of IMT, significant reductions in global T2 (median (IQR): 39 (38–41) ms vs 37 (36–39) ms; p=0.002), LGE-region T2 (43 (40–46) ms vs 41 (38–42) ms; p=0.003), and relative LGE mass (23% (17–38) vs 15% (8–32); p=0.006) were observed. No significant differences were found in EF (p=0.78), GLS (p=0.49), EDVi (p=0.56), ESVi (p=0.28) or native T1 values (p=0.23).ConclusionIn patients with PET-confirmed active CS undergoing IMT, serial CMR demonstrated measurable changes in T2 mapping and LGE parameters, suggesting a potential role for CMR tissue characterisation in monitoring myocardial inflammation. However, due to the observational design and absence of a control group, causal treatment effects cannot be confirmed. Further prospective studies are needed to validate the utility of CMR for treatment monitoring in CS.
Publisher
British Medical Journal Publishing Group,BMJ Publishing Group LTD,BMJ Publishing Group
Subject
/ Biopsy
/ Cardiomyopathies - diagnostic imaging
/ Cardiomyopathies - drug therapy
/ Female
/ Germany
/ Heart
/ Humans
/ Inflammation - diagnostic imaging
/ Magnetic Resonance Imaging - methods
/ Male
/ Myocarditis - diagnostic imaging
/ Patients
/ Positron Emission Tomography Computed Tomography
