Abstract: Background: Cardiac imaging is a cornerstone in the initial diagnosis, management, and follow-up of cardiac sarcoidosis. However, ordering thresholds, access, and follow-up imaging vary across the globe.
Objectives: A Delphi study was conducted to define areas of consensus and areas requiring further study in the use of cardiac imaging in suspected or established cardiac sarcoidosis.
Methods: An international, multidisciplinary panel of experts in cardiac sarcoidosis completed a modified two-round Delphi study. We evaluated clinical decision-making on the use of cardiac imaging, including indication thresholds, interpretation, and interval follow-up imaging. Consensus was defined a priori as ≥70% agreement or disagreement.
Results: A total of 89 experts in cardiac sarcoidosis (89 in round 1, and 75 in round 2) participated, which represented 61 centers in 13 countries. Consensus was reached on 22/46 (48%) items in Round 1, and 21/29 (72%) items in Round 2. There was a low threshold to order advanced cardiac imaging for new rhythm abnormalities, or ventricular dysfunction on echocardiography in patients with established extra-cardiac sarcoidosis. FDG-positron emission tomography (FDG-PET) was an important co-primary modality with cardiac magnetic resonance imaging (CMR) for initial diagnosis. If CMR was the first test, there was consensus to proceed to FDG-PET testing following any abnormal CMR, or even a normal CMR in the setting of moderate or high pre-test probability for CS. There was consensus that late gadolinium enhancement (LGE) quantification was important, but no consensus on threshold of risk or how best to quantify LGE. Similarly, reduction in FDG uptake was an important factor to guide treatment response, but there was no consensus on how to best quantify FDG uptake or what constituted an adequate radiographic response.
Conclusion: Several consensus areas for cardiac imaging in suspected and established cardiac sarcoidosis were identified. This consensus study identified areas of priority for future prospective, controlled multicenter research studies.
Editors
Editor-in-Chief
Y.S. Chandrashekhar, MD, DM, FACC
CME Editor
Kenneth A. Ellenbogen, MD
Author
Talal Alnabelsi, MD
Important Dates
Date of Release: June 2, 2025
Term of Approval/Date of CME/MOC Expiration: June 1, 2026