Optimizing routine screening for cardiac sarcoidosis through use of commonly available studies.

BACKGROUND: Sarcoidosis is a multisystem granulomatous disorder with unclear etiology. Morbidity and mortality vary based on organ involvement, with cardiac sarcoidosis (CS) associated with higher mortality; despite this, CS remains underdiagnosed. The Heart Rhythm Society (HRS) expert consensus statement recommends screening sarcoidosis patients for CS utilizing a symptom screen, EKG, and echocardiogram (TTE), while the American Thoracic Society (ATS) guideline recommends only EKG and symptom screening. These recommendations, however, are based on limited data with recommendations for further studies. RESEARCH QUESTION: The purpose is to evaluate the prevalence of abnormal screening tests in patients with sarcoidosis and the correlation of these tests with the subsequent diagnosis of CS. A specific emphasis was placed on evaluating the sensitivity of the recommendations versus the sensitivity of a modified criteria. STUDY DESIGN: and Methods: This study retrospectively evaluated a database of prospectively enrolled patients from a tertiary military academic center. All patients who underwent imaging with cardiac MRI and/or FDG-PET were identified. These results were correlated with screening studies (symptom screen, EKG, TTE, and ambulatory rhythm monitoring (ARM)) and used to calculate sensitivity, specificity, and positive and negative predictive values for each test. Using a clinical diagnosis of CS as the reference standard, the sensitivity and specificity of the HRS criteria were calculated and compared to a modified screening rubric developed a priori, consisting of minor changes to the criteria and the addition of ARM. RESULTS: This study evaluated 114 patients with sarcoidosis with 132 advanced imaging events, leading to a diagnosis of CS in 36 patients. Utilizing HRS screening recommendations, the sensitivity for CS was 63.9%, while the modified criteria increased sensitivity to 94.4%. INTERPRETATION: This study suggests that the HRS guidelines lack sensitivity to effectively screen for CS and that a modified screening model which includes ARM may be more effective.

The Prognostic Value of Late Gadolinium Enhancement in Nonischemic Heart Disease.

Late gadolinium enhancement (LGE) has become a standard clinical tool to evaluate myocardial fibrosis to define myocardial viability in the context of ischemic myocardial disease. More recently, LGE has also been used to characterize the presence and pattern of fibrosis in nonischemic cardiomyopathies. It yields unique and valuable diagnostic and prognostic insights for myriad nonischemic clinical indications and has become a key part of routine cardiac MR imaging, and a tool to guide treatment. This article reviews the technical aspects of LGE performance and its diagnostic and prognostic implications in nonischemic cardiomyopathy.

The Journal of Cardiovascular Computed Tomography year in review - 2018.

Since the introduction of ≥64 detector row coronary computed tomography angiography (CCTA) as a noninvasive imaging modality, various clinical trials have established its diagnostic performance and prognostic significance when compared to other anatomic and functional tests for coronary artery disease (CAD). CCTA has been increasingly utilized for a wide range of clinical scenarios, driven by both advances in technology as well as data showing improvement in outcomes. Accumulating evidence has continually refined and supported the central role of CCTA within clinical care, and this year has witnessed continued evolution of the application of CCTA within healthcare and translational research. The purpose of the present review is to summarize the year of the Journal of Cardiovascular Computed Tomography (JCCT), highlighting the evidence base supporting the appropriate application of cardiac computed tomography across numerous clinical domains.

Valvular Heart Disease.

This article outlines the diagnosis and management of commonly occurring valvular heart diseases for the primary care provider. Basic understanding of pathologic murmurs is important for appropriate referral. Echocardiography is the gold standard for diagnosis and severity grading. Patients with progressive valvular heart disease should be followed annually by cardiology and imaging should be performed based on the severity of valvular dysfunction. Surgery or intervention is recommended only when symptoms dictate or when changes in left ventricular function occur. Surgery or intervention should be performed after discussion by a heart team, including cardiologists and cardiac surgeons.

Transfusion-transmitted malaria not preventable by current blood donor screening guidelines: a case report.

BACKGROUND: Transfusion-transmitted malaria (TTM) is a well-known, though rare, entity in the United States with only 100 cases previously reported. With no Food and Drug Administration-approved screening tests of donated blood for malaria in the United States, prevention relies solely on deferral of the highest-risk donors. We present a case of TTM not preventable by these guidelines. CASE REPORT: A 76-year-old male presented with fever, hypotension, tachycardia, and a urinalysis consistent with a urinary tract infection. He was admitted to the intensive care unit and initiated on broad-spectrum antibiotics. On Hospital Day 2, he was incidentally found to have intraerythrocytic parasites on a peripheral smear, identified as Plasmodium malariae by polymerase chain reaction and was treated successfully with atovaquone-proguanil. The patient had no recent foreign travel or exposure to malaria but had received 15 units of blood products in the past 6 years. Index samples from the 10 most recent units were obtained, with one testing positive for P. malariae via serology. The donor was a 20-year-old male who immigrated to the United States from Liberia at the age of 5 with no subsequent travel or exposure to malaria. DISCUSSION: A review of current literature demonstrated that 71% of TTM cases occur from imperfect application of the current deferral guidelines. In this case, however, 15 years had elapsed between the donor's immigration and the transmission of the disease, placing him well outside any current deferral period. As such, the case demonstrates the need for continued development of highly sensitive and cost-effective laboratory screening for high-risk donors.