Evaluation of the Prognostic Value of PET/MRI in Cardiac Sarcoidosis

Not Applicable

Not yet recruiting

Brief Summary: Cardiac damage is the second leading cause of death in patients with sarcoidosis, after lung damage. Today's challenge is to diagnose the disease as effectively as possible, and to develop tools for better risk stratification, especially for sudden death, in order to better target therapies and implantable devices, such as corticoids and immunosuppressant.

The hypothesis is that combined PET (Positron Emission Tomography)/MRI (Magnetic Resonance Imaging) could be a relevant prognostic marker of progression, and would significantly improve diagnostic performance in patients with suspected cardiac sarcoidosis (CS). This study will also make it possible to distinguish sequellar fibrosis lesions from granulomatous lesions and assess the therapeutic response. Incorporating PET/MRI into the diagnostic strategy for patients with suspected CS could therefore improve their management.

Recruitment & Eligibility

Inclusion Criteria

Age ≥ 18 years
Sarcoidosis defined according to ATS/ERS/WASOG criteria
Suspicion of cardiac involvement in sarcoidosis:
- Clinical manifestations (syncope, lipothymia, persistent palpitations, signs of heart failure) and/or
- Cardiac rhythm or conduction disorder (Mobitz type 2 atrioventricular block (AVB), AVB 3, right or left bundle branch block, Q wave in at least 2 leads, ventricular arrhythmia (ventricular mono/polymorphic complexes> 1000 per 24 h, ventricular tachycardia, ventricular fibrillation), unexplained sustained VT or epsilon wave) and/or
- Compatible cardiac ultrasound abnormality: left ventricular dilatation, septal thickening or wall thinning (especially basal), segmental kinetic disorder and wall aneurysm without coronary anomaly, altered left ventricular ejection fraction, altered diastolic function, altered right ventricular systolic function.
Informed patient consent
Membership of a social security scheme

Exclusion Criteria

Psychiatric illness not controlled by treatment
Claustrophobia
Known pregnancy or breast-feeding patient
Unbalanced diabetes (influence on carbohydrate metabolism for PET)
Previous infarction or known coronary disease
Known allergy to gadolinium and fluoro-desoxyglucose and their excipients
Renal insufficiency (Clairance < 30 mL/min/1.73m2)
Implanted pacemaker not compatible with a 3 Teslas magnetic field
Patients with ocular metallic foreign bodies, pacemakers, neurostimulators, cochlear implants, metallic heart valves, vascular clips formerly implanted on cranial aneurysms and, in general, any non-removably implanted electronic medical equipment
Inability or refusal to follow a low-carbohydrate diet for 24 hours, followed by a 6-hour fast required prior to the examination
Patient unable to hold a 10-second apnea.
Patient deprived of liberty by judicial or administrative decision
Patient under legal protection (guardianship, curatorship)
Participation in other interventional research involving the human person or being in the exclusion period following previous research involving the human person
Patients under AME

Exclusion criteria (post signature of consent) for women of reproductive age :

Arm && Interventions

Group	Intervention	Description
Prospective cohort of patients	PET/MRI	Patients with suspected cardiac sarcoidosis

Primary Outcome Measures

Name	Time	Method
Occurrence of a severe cardiological event	Up to 24 months	Occurrence during follow-up of at least one of the severe cardiological events listed below attributed to sarcoidosis, assessed at 24 months: * Death from cardiac causes. * Placement of an automatic implantable defibrillator or pacemaker. * Conduction disorder (Mobitz type 2 atrioventricular block (AVB), AVB 3, ventricular arrhythmia (ventricular mono/polymorphic complexes \> 1000 per 24 h, ventricular tachycardia (VT), ventricular fibrillation), unexplained sustained VT). * Degradation of cardiac function of more than 10% of LVEF assessed by transthoracic (TTE) or cardiac MRI. * Acute heart failure with no other known cause

Secondary Outcome Measures

Name	Time	Method
Frequency of severe cardiological events according to each modality of PET/MRI results in terms of Delayde MRI enhancement and hypermetabolic fixation on PET.	Up to month 24.	MRI- PET-; MRI- PET+; MRI+ PET-; and MRI+ PET+.
Frequency of severe cardiological events between patients with and without Delayde MRI enhancement	Up to 24 months.	Among patients with hypermetabolic FDG PET uptake
Percentage of patients initially well classified (diagnostic accuracy) in terms of probability of cardiac involvement	Up to month 24.	Percentage of patients initially well classified (diagnostic accuracy) in terms of probability of cardiac involvement (absent, possible, probable or very probable) by each examination (MRI alone, PET alone, or PET/MRI) in relation to the diagnosis established at two years (reference).
Comparison of FDG PET metabolic activity and late gadolinium enhancement of pathological areas before and after treatment.	Up to month 3 and 12.	For patients with initial pathological MRI-PET.