Cardiology and Angiology: An International Journal

Reversible Severe Heart Failure in Corticosteroid-Refractory Cardiac Sarcoidosis: The Crucial Role of 18F-FDG PET/CT in MRI-Negative Disease

Salma Nafidi — 2026-06-01

Background: Cardiac involvement significantly impacts the prognosis of sarcoidosis. While conduction abnormalities represent the classic presentation, inaugural acute heart failure with severe left ventricular dysfunction is a less common and diagnostically challenging phenotype that can closely mimic idiopathic dilated cardiomyopathy. Furthermore, diagnosing cardiac sarcoidosis (CS) can be complex when initial advanced imaging yields false-negative results.

Case Presentation: A 43-year-old female with a history of cutaneous sarcoidosis, maintained on chronic oral corticosteroids, presented with rapidly progressive heart failure (New York Heart Association class III). Transthoracic echocardiography revealed severe left ventricular systolic dysfunction with an ejection fraction of 26%. Her clinical course was notably complicated by an episode of paroxysmal atrial fibrillation and a subsequent transient ischemic attack (TIA). Cardiac magnetic resonance (CMR) imaging was non-contributory, showing no evidence of edema or late gadolinium enhancement. However, due to high clinical suspicion, an 18F-FDG PET/CT was performed, revealing intense, multifocal myocardial uptake indicative of active granulomatous inflammation. Recognising the corticosteroid-refractory nature of her flare-up, she was treated with intravenous corticosteroid pulses, followed by the early introduction of methotrexate as a steroid-sparing agent, optimised guideline-directed medical therapy (GDMT) for heart failure, and therapeutic anticoagulation with apixaban. At one year, the patient was completely asymptomatic with a full normalisation of her ejection fraction to 52%.

Conclusion: This case highlights that a normal CMR does not exclude active cardiac sarcoidosis, especially in the early inflammatory stages, reinforcing the critical diagnostic value of 18F-FDG PET/CT. Additionally, it demonstrates that severe, corticosteroid-refractory ventricular dysfunction can achieve complete functional reversibility through the early and synergistic use of methotrexate and GDMT.

Profile of Rhythm Disturbances and Predictive Factors of Sudden Death in Sarcomeric Hypertrophic Cardiomyopathy: A Retrospective Study of 30 Patients

Kamel Ghanem — 2026-05-23

Introduction: Sarcomeric hypertrophic cardiomyopathy (HCM) is the most common inherited heart disease. Its prognosis is primarily determined by the risk of ventricular arrhythmias and sudden cardiac death (SCD). This study aimed to describe the rhythm profile of patients with sarcomeric HCM, to identify clinical and paraclinical predictors of arrhythmias, and to assess the risk of SCD using the European Society of Cardiology (ESC) risk stratification score.

Materials and Methods: This retrospective descriptive study included 30 patients with sarcomeric HCM followed in an electrophysiology department between July 2021 and December 2025. All included patients underwent a complete clinical examination, a surface electrocardiogram (ECG), a 24- to 48-hour Holter ECG recording, a transthoracic echocardiogram, and, for 20 of them, cardiac magnetic resonance (CMR) imaging. The 5-year risk of SCD was calculated using the ESC online risk score.

Results: The mean age of the patients was 46 ± 29 years, with a male-to-female ratio of 2.7. Atrial fibrillation (AF) was the most frequent arrhythmia, affecting 20% of patients (16% of whom presented with a paroxysmal form). Premature ventricular contractions (PVCs) were observed in 90% of patients on Holter monitoring, while only one patient (3.3%) presented with non-sustained ventricular tachycardia (NSVT). Regarding the SCD risk score, 73% of patients were classified as low risk (<4%), 10% as intermediate risk (4–6%), and 17% as high risk (≥6%). Five patients underwent implantable cardioverter-defibrillator (ICD) implantation for primary prevention. Notably, no thromboembolic complications or deaths were recorded during the 4-year follow-up period.

Conclusion: In our series, atrial fibrillation was the most frequent arrhythmia in patients with sarcomeric HCM. The ESC 2014 score proved to be an effective tool for stratifying the risk of SCD. ICD implantation in high-risk patients was well tolerated and may improve prognosis.

Cardiac Structural and Functional Alterations in End-stage Renal Disease : An Echocardiographic Study

Chadbellah Imane — 2026-05-29

Background: Cardiovascular disease accounts for approximately 45% of all-cause mortality in hemodialysis patients — a risk 10 to 20 times higher than in the general population. Despite the critical role of echocardiography in characterizing this cardiac burden, systematic echocardiographic data from local dialysis centers remain scarce.

Objectives: The study aims to provide a comprehensive echocardiographic characterization of end-stage of chronic kidney disease (CKD) patients on maintenance hemodialysis. We assessed left ventricular (LV) geometry, systolic function, diastolic function, and the prevalence and severity of valvular disease.

Methods : Single-center cross-sectional study of 78 consecutive adults with end stage renal disease (ESRD) on maintenance hemodialysis (≥ 3 months) at the Echocardiography Department of University Hospital Mohamed VI, Marrakesh, from May 2024 to May 2025. All examinations followed the 2015 ASE/EACVI chamber quantification guidelines. Diastolic function was formally graded in 49 patients in sinus rhythm without significant mitral disease, using the 2016 ASE/EACVI four-variable algorithm.

Results : Mean age 56.3 ± 12.8 years; 59.0% male. LV hypertrophy was found in 74.4%, predominantly concentric (56.4%). Only 7 patients (9.0%) had completely normal LV geometry. Reduced LV ejection fraction (EF < 50%) was present in 30.8%, with severely reduced EF (< 35%) in 12.8%. Among 49 formally evaluable patients, diastolic dysfunction was identified in 77.6%: Grade I in 32.7%, Grade II in 28.6%, Grade III in 16.3%. valvular abnormalities were found in 61.5%; moderate-to-severe aortic stenosis in 7.7%; moderate-to-severe mitral regurgitation in 15.4%; and non-rheumatic mitral stenosis in 6.4%. Elevated estimated pulmonary artery systolic pressure (> 35 mmHg) was present in 43.6%.

Conclusions : End-stage CKD patients on hemodialysis carry a severe, multidimensional cardiac burden. These findings support the implementation of routine, protocol-driven echocardiographic evaluation at dialysis initiation and at regular intervals thereafter.