Chetan Shenoy

Prediction of ventricular arrhythmic outcomes in suspected cardiac sarcoidosis: a comparison of cardiovascular magnetic resonance phenotyping vs. societal recommendations for implantable cardioverter-defibrillator placement

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#Cardiosky #WhyCMR #Epeeps #Medsky

Identifying the Cause of Cardiomyopathy Using CMR (Chetan Shenoy, MBBS, MS) YouTube video by Houston Methodist DeBakey CV Education

Must-watch lecture on cardiomyopathy and CMR by @cshenoy.bsky.social

„more often than what is the EF we should ask the why?“

youtube.com/live/9or85hk...

Here's our paper in Circulation on the topic - bsky.app/profile/para...

YouTube video by Houston Methodist DeBakey CV Education Identifying the Cause of Cardiomyopathy Using CMR (Chetan Shenoy, MBBS, MS)

Here's my talk on how to identify the etiology of cardiomyopathy using CMR - www.youtube.com/watch?v=9or8...

In my opinion, both trials are fundamentally useless.

What is ischemic cardiomyopathy?

Both trials defined ischemic cardiomyopathy as LV dysfunction + obstructive CAD.

This does not identify the etiology of cardiomyopathy as ischemic, but identifies the presence of CAD. Two different things!!!

I don't exactly know. But...

1 - There was no real change in ECV in Explorer HCM (PMID 33190524).
2 - An increase in ECV is not necessarily bad. It increases after AVR (PMID 29471937).
3 - The amount of dead myocardium will never decrease. So, a "decrease in LGE" does not mean less badness.

Interesting. The ECV increased 1.1% (25 min) to 2.2% (5 min), which is difficult to explain. But it explains why LGE was less; it was quantified as the amount of myocardium 6SD brighter than "remote". LGE amount will be less if the remote myocardium is brighter after mavacamten than at baseline.

#cardiosky #medsky #WhyCMR

CMR May Improve Assessment of ICD Need in Cardiac Sarcoidosis The imaging was better than societal recommendations at discriminating long-term risk of ventricular arrhythmias.

“CMR phenotyping can be used immediately in clinical practice to identify patients with suspected cardiac sarcoidosis who would benefit from a primary prevention ICD," said Chetan Shenoy, MD. Read more about how this can prevent life-threatening ventricular arrhythmias: www.tctmd.com/news/cmr-may...

Thank you, @toddneale.bsky.social, for your excellent reporting on our EHJ paper!

@tctmd.bsky.social @escardio.bsky.social @paragbawaskar.bsky.social

#EHJCVI 🫀 What's the value of ventricular strain in systemic sclerosis? 📉 Both LVGLS and RVGLS are linked to death or MACE, unlike LVEF and RVEF 🧠 How does strain compare to traditional prognostic markers? 🔍 Read more 👉 doi.org/10.1093/ehjc... #CardioSky @jgrapsa.bsky.social @escardio.bsky.social

Prediction of ventricular arrhythmic outcomes in suspected cardiac sarcoidosis: a comparison of cardiovascular magnetic resonance phenotyping vs. societal recommendations for implantable cardioverter-defibrillator placement

academic.oup.com/eurheartj/ad...

#Cardiosky #WhyCMR #Epeeps #Medsky

Cardiac sarcoidosis is a undervalued disease and difficult to diagnose and treat, considering potential life-threatening arrhythmias. Nice to have some more guidance.

#cardiosky.

VT and VF/cardiac arrest - correct. That would be secondary prevention.

AV block is a Class IIa indication for an ICD in the guidelines for cardiac sarcoidosis. But who has cardiac sarcoidosis is not always clear.

What if patient has extracardiac sarcoidosis and complete AV block but no LGE? 🤔

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@escardio.bsky.social
#Cardiosky #WhyCMR #Epeeps #Medsky

Please DM me if you would like a full-text PDF of the paper!

pmc.ncbi.nlm.nih.gov/articles/PMC...

#HCM #CardioSky #Cardiomyopathy

In patients with suspected cardiac sarcoidosis, cardiac FDG-PET is recommended after a normal CMR if there is a high clinical suspicion. What are the data supporting this recommendation? #CardioSky #MedSky #Sarcoidosis

Query sarcoid, normal #WhyCMR, so then should we do FDG-PET? Not much benefit.

We discuss this in our editorial:
academic.oup.com/ehjcimaging/...

Cardiac FDG-PET imaging in patients with suspected cardiac sarcoidosis and no late gadolinium enhancement on cardiovascular magnetic resonance imaging: the emperor has no clothes! This editorial refers to ‘The Role of FDG PET/CT in Assessing Cardiac Sarcoidosis with No High-Risk Cardiac Features and Normal CMR’, by F. Shuduyeva et al

Read our accompanying editorial for our thoughts on the important paper –

academic.oup.com/ehjcimaging/...

@paragbawaskar.bsky.social #CardioSky #MedSky #Sarcoidosis

The role of FDG-PET/CT in assessing cardiac sarcoidosis with no high-risk cardiac features and normal CMR AbstractAims. Diagnosing cardiac sarcoidosis (CS) is challenging due to the variable presentation and the lack of consensus on optimal screening strategies

Link to the study - academic.oup.com/ehjcimaging/...

#CardioSky #MedSky #Sarcoidosis

A new study in EHJ - Cardiovascular Imaging describes 324 patients with normal CMR and no high-risk features who all also had FDG-PET.

21.3% had FDG uptake.

Their annualized event rate was <1%, indicating that FDG-PET has little diagnostic or prognostic utility.

A wealth of data indicates that patients evaluated for suspected cardiac sarcoidosis have excellent long-term outcomes if their CMR is normal, indirectly indicating that a normal CMR reliably rules out cardiac sarcoidosis.

None. This recommendation is based on clinical observations that sometimes FDG-PET is positive even when a CMR is normal. Is that good enough?

In patients with suspected cardiac sarcoidosis, cardiac FDG-PET is recommended after a normal CMR if there is a high clinical suspicion. What are the data supporting this recommendation? #CardioSky #MedSky #Sarcoidosis

The odds of having both genetic cardiomyopathy (which is not common) and cardiac sarcoidosis (which is very rare) are extremely rare.

Even in such cases, it’s simply a coincidence rather than a mechanistic link (based on what we know thus far).

A patient with cardiac sarcoidosis may meet the ARVC diagnostic criteria, but that does not mean the cardiomyopathy is ARVC.

A patient can have extracardiac sarcoidosis and a genetic cardiomyopathy.

They may meet the cardiac sarcoidosis diagnostic criteria, but that does not mean the cardiomyopathy is cardiac sarcoidosis.

Comparison of Necropsy Findings in Patients With Sarcoidosis Dying Suddenly from Cardiac Sarcoidosis Versus Dying Suddenly from Other Causes The clinical diagnosis of cardiac sarcoidosis can be difficult and is largely dependent on newer imaging modalities. A retrospective search of sudden cardiac deaths was performed from a reference labo...

In patients with extracardiac sarcoidosis, non-caseating granulomas of sarcoidosis can occur in the heart incidentally without causing cardiac sarcoidosis (myocardial damage or its clinical consequences).

www.ajconline.org/article/S000...

Prevalence and Electronic Health Record-Based Phenotype of Loss-of-Function Genetic Variants in Arrhythmogenic Right Ventricular Cardiomyopathy-Associated Genes | Circulation: Genomic and Precision Me... Background: Arrhythmogenic right ventricular cardiomyopathy (ARVC) is associated with variants in desmosome genes. Secondary findings of pathogenic/likely pathogenic variants, primarily loss-of-functi...

Genetic variants without phenotypic manifestations (no penetrance) are common.

In a study of 61K clinical individuals, 1 in 435 had a desmosomal loss-of-function variant, but the estimated penetrance was only 6%.

www.ahajournals.org/doi/10.1161/...