TY  - BOOK
AU  - Ahmed, Sara
AU  - Constantinescu, Florina
AU  - Devraj, Mithun
AU  - Garcia, Carlos
AU  - Mohammed, Selma F
AU  - Pillarisetty, Anjani
AU  - Sheikh, Farooq
TI  - Clinical and Imaging Response to Tumor Necrosis Factor Alpha Inhibitors in Treatment of Cardiac Sarcoidosis: A Multicenter Experience
SN  - 1071-9164
PY  - 2021///
KW  - *Cardiomyopathies
KW  - *Heart Failure
KW  - *Sarcoidosis
KW  - Cardiomyopathies/dg [Diagnostic Imaging]
KW  - Cardiomyopathies/dt [Drug Therapy]
KW  - Female
KW  - Fluorodeoxyglucose F18
KW  - Humans
KW  - Male
KW  - Middle Aged
KW  - Positron-Emission Tomography
KW  - Radiopharmaceuticals
KW  - Retrospective Studies
KW  - Sarcoidosis/dg [Diagnostic Imaging]
KW  - Sarcoidosis/dt [Drug Therapy]
KW  - Stroke Volume
KW  - Tumor Necrosis Factor-alpha
KW  - Ventricular Function, Left
KW  - MedStar Heart & Vascular Institute
KW  - MedStar Washington Hospital Center
KW  - Medicine/Nuclear Medicine
KW  - Medicine/Rheumatology
KW  - Journal Article
N1  - Available online from MWHC library: 1995 - present
N2  - BACKGROUND: Cardiac sarcoidosis (CS) is an increasingly recognized cause of cardiomyopathy, however data on immunosuppressive strategies are limited. Treatment with tumor necrosis factor (TNF) alpha inhibitors is not well described; moreover, there may be heart failure (HF)-related safety concerns; CONCLUSIONS: TNF alpha inhibitor treatment guided by FDG-PET may minimize corticosteroid use and effectively reduce cardiac inflammation without significant adverse effect on cardiac function. However infections were common, some of which were serious, and therefore patients require close monitoring for both infection and cardiac symptoms. Copyright (c) 2020. Published by Elsevier Inc; METHODS: Retrospective multicenter study of TNF alpha inhibitor treated CS patients. Baseline characteristics, treatments, and outcomes were adjudicated; RESULTS: Thirty-eight patients with CS (mean 49.9 years old, 42% women, 53% African American) were treated with TNF alpha inhibitor (30 infliximab, 8 adalimumab). Prednisone dose decreased from time of TNF alpha inhibitor initiation (21.7+/-17.5 mg) to 6-months (10.4+/-6.1 mg, p=0.001) and 12-months post (7.3+/-7.3 mg, p=0.002). On pre-TNF alpha inhibitor treatment 18-flourodoxyglucose position emission tomography (FDG-PET), 84% of patients had cardiac FDG uptake. Post-treatment, there was a significant decrease in number of segments involved (3.5+/-3.8 to 1+/-2.5, p=0.008) and maximum standardized uptake value (3.59+/-3.7 to 0.57+/-1.6, p=0.0005), with 73% of patients demonstrating complete resolution or improvement of cardiac FDG uptake. Left ventricular ejection fraction remained stable (45+/-16.5 to 47+/-15.0%, p=0.10). Four patients required inpatient HF treatment, and 8 had infections; 2 required treatment cessation
UR  - https://dx.doi.org/10.1016/j.cardfail.2020.08.013
ER  -