P5-2 - 18-Fluorodeoxyglucose Positron Emission Tomography as a Decisive Factor of Cardiac Sarcoidosis

Abstract

A 61 year-old man presented orthopnea in 2004. A echocardiography revealed severe reduction of left ventricle (LV) ejection fraction of 27% and dilation of LV end-dyastoric dimension of 65 mm with posterior wall thinning. There were no specific lung, skin or eye findings suspicious of sarcoidosis. Endomyocardial biopsy also showed no specific findings. Therefore, he was diagnosed and treated as dilated cardiomyopathy. However, the condition of heart failure progressively deteriorated and became refractory. He was hospitalized in March 2017 due to the worsening of heart failure. He was treated with inotropes, because he presented anorexia caused by low cardiac output. During the hospitalization, electrical defibrillation was needed because of the sustained ventricular tachycardia. Under the treatment of inotropes, his pulmonary capillary wedge pressure and cardiac index were 28 mmHg and 1.9 L⋅min−1⋅m−2, respectively. Therefore, we were introduced intra-aortic balloon pumping and planned to register him for heart transplantation. We performed 18-fluorodeoxyglucose (FDG) positron emission tomography for the role out of sarcoidosis, and it showed intense uptake of FDG in diffuse myocardium. Therefore, we finally diagnosed him as cardiac sarcoidosis. We introduced steroid therapy, and heart failure symptoms were improved, after then IABP was successfully weaned.