{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T15:54:27Z","timestamp":1770393267811,"version":"3.49.0"},"posted":{"date-parts":[[2026,2,3]]},"group-title":"Cardiovascular Medicine","reference-count":37,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T00:00:00Z","timestamp":1770076800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.medrxiv.org\/about\/FAQ#license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,2,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>\n                    Myocardial\n                    <jats:sup>18<\/jats:sup>\n                    fluorodeoxyglucose (\n                    <jats:sup>18<\/jats:sup>\n                    FDG)-avidity is frequently seen in patients with genetic cardiomyopathy (CMP), as well as a growing \u201cidiopathic\n                    <jats:sup>18<\/jats:sup>\n                    FDG-avidity\u201d group of genotype-negative patients who do not clearly have cardiac sarcoidosis (CS).\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>\n                    To determine the prognostic implications of\n                    <jats:sup>18<\/jats:sup>\n                    FDG-avidity in patients with and without genetic CMP, and the effects of immunosuppression in the latter.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>\n                    This multicenter, retrospective study included all patients who were referred for both\n                    <jats:sup>18<\/jats:sup>\n                    FDG-PET and CMP genetic testing. Patients with acute myocarditis, biopsy-proven sarcoidosis or extracardiac\n                    <jats:sup>18<\/jats:sup>\n                    FDG-avidity were excluded. We investigated heart failure (HF) composite (left ventricular assist device, heart transplant, HF hospitalization, death) and arrhythmia composite (sustained ventricular arrhythmias (VT\/VF), atrio-ventricular block, death) outcomes using survival analysis including Cox proportional hazards modeling and inverse probability of treatment weighting (IPWT).\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>\n                    Among 372 patients, 142 (38%) were\n                    <jats:sup>18<\/jats:sup>\n                    FDG-avid. Prevalence of genetic CMP among\n                    <jats:sup>18<\/jats:sup>\n                    FDG-avid patients (12%) was similar to that of\n                    <jats:sup>18<\/jats:sup>\n                    FDG-negative patients (19%, p=0.07).\n                    <jats:sup>18<\/jats:sup>\n                    FDG-avidity was associated with increased risk of HF composite (HR 1.69 (1.04-2.75), p=0.034) and arrhythmia composite (HR 1.63 (1.1-2.4), p=0.014) outcomes compared to\n                    <jats:sup>18<\/jats:sup>\n                    FDG-negative patients. However, these associations were present only in genotype-negative patients, and not in genetic CMP. After IPWT, immunosuppression of\n                    <jats:sup>18<\/jats:sup>\n                    FDG-avid patients (n=49) was not associated with a reduction in HF (HR 3.31 (1.25, 8.77), p=0.016) or arrhythmia composite outcomes (HR 1.61 (0.79, 3.25), p=0.19) compared with those who were not immunosuppressed (n=93).\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>\n                    Myocardial-only\n                    <jats:sup>18<\/jats:sup>\n                    FDG-avidity is only associated with adverse HF and arrhythmia outcomes in genotype-negative patients who do not clearly have CS. IST does not seem to modify the disease course, suggesting that not all myocardial\n                    <jats:sup>18<\/jats:sup>\n                    FDG uptake reflects clinically significant inflammation.\n                  <\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.01.30.26345250","type":"posted-content","created":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T23:25:12Z","timestamp":1770161112000},"source":"Crossref","is-referenced-by-count":0,"title":["Impact of\n                  <sup>18<\/sup>\n                  FDG-avidity and immunosuppression on idiopathic and genetic cardiomyopathies"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0098-6706","authenticated-orcid":false,"given":"Shiva","family":"Tabaghi","sequence":"first","affiliation":[{"name":"Division of Cardiology, University of Washington, Seattle, WA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Graham H.","family":"Bevan","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Washington, Seattle, WA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Hankinson","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Diseases and Hypertension, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2639-2949","authenticated-orcid":false,"given":"Esra D","family":"Gumuser","sequence":"additional","affiliation":[{"name":"Cardiovascular Imaging Program, Brigham and Women\u2019s Hospital, Boston, MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mallika","family":"Lal","sequence":"additional","affiliation":[{"name":"Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Madison","family":"Pico","sequence":"additional","affiliation":[{"name":"Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8290-127X","authenticated-orcid":false,"given":"Neal","family":"Chatterjee","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Washington, Seattle, WA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1380-5364","authenticated-orcid":false,"given":"Alexi","family":"Vasbinder","sequence":"additional","affiliation":[{"name":"Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, Seattle, WA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard K.","family":"Cheng","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Washington, Seattle, WA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6976-6512","authenticated-orcid":false,"given":"April","family":"Stempien-Otero","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Washington, Seattle, WA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6458-5421","authenticated-orcid":false,"given":"Neal K","family":"Lakdawala","sequence":"additional","affiliation":[{"name":"Cardiovascular Imaging Program, Brigham and Women\u2019s Hospital, Boston, MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ron","family":"Blankstein","sequence":"additional","affiliation":[{"name":"Cardiovascular Imaging Program, Brigham and Women\u2019s Hospital, Boston, MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3119-025X","authenticated-orcid":false,"given":"Marcelo F","family":"Di Carli","sequence":"additional","affiliation":[{"name":"Cardiovascular Imaging Program, Brigham and Women\u2019s Hospital, Boston, MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1742-8030","authenticated-orcid":false,"given":"Benjamin","family":"Levin","sequence":"additional","affiliation":[{"name":"Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0598-6502","authenticated-orcid":false,"given":"Sanjay","family":"Divakaran","sequence":"additional","affiliation":[{"name":"Cardiovascular Imaging Program, Brigham and Women\u2019s Hospital, Boston, MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4078-9064","authenticated-orcid":false,"given":"Babak","family":"Nazer","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Washington, Seattle, WA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2026020506151070000_2026.01.30.26345250v1.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2016.03.605"},{"key":"2026020506151070000_2026.01.30.26345250v1.2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001240"},{"key":"2026020506151070000_2026.01.30.26345250v1.3","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.58.6.1204"},{"key":"2026020506151070000_2026.01.30.26345250v1.4","doi-asserted-by":"publisher","DOI":"10.1111\/j.1749-6632.1976.tb47058.x"},{"key":"2026020506151070000_2026.01.30.26345250v1.5","unstructured":"Uemura A , Morimoto S , Hiramitsu S , Kato Y , Ito T , Hishida H. Histologic diagnostic rate of cardiac sarcoidosis: evaluation of endomyocardial biopsies"},{"key":"2026020506151070000_2026.01.30.26345250v1.6","doi-asserted-by":"crossref","first-page":"ehae666.2070","DOI":"10.1093\/eurheartj\/ehae666.2070","article-title":"Endomyocardial biopsy in the diagnosis of cardiac sarcoidosis","volume":"45","year":"2024","journal-title":"Eur Heart J"},{"key":"2026020506151070000_2026.01.30.26345250v1.7","first-page":"2329","article-title":"JCS 2016 Guideline on Diagnosis and Treatment of Cardiac Sarcoidosis -Digest Version","volume":"83","year":"2019","journal-title":"Circ J Off J Jpn Circ Soc"},{"key":"2026020506151070000_2026.01.30.26345250v1.8","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.jacc.2022.10.021","article-title":"Genetic Cardiomyopathy Masquerading as Cardiac Sarcoidosis","volume":"81","year":"2023","journal-title":"J Am Coll Cardiol"},{"key":"2026020506151070000_2026.01.30.26345250v1.9","doi-asserted-by":"crossref","first-page":"e0188479","DOI":"10.1371\/journal.pone.0188479","article-title":"Evaluation of myocardial glucose metabolism in hypertrophic cardiomyopathy using 18F-fluorodeoxyglucose positron emission tomography","volume":"12","year":"2017","journal-title":"PLOS ONE"},{"key":"2026020506151070000_2026.01.30.26345250v1.10","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.121.055890"},{"key":"2026020506151070000_2026.01.30.26345250v1.11","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.121.058457"},{"key":"2026020506151070000_2026.01.30.26345250v1.12","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1016\/j.jacbts.2023.02.018","article-title":"Multimodal Detection and Targeting of Biopsy-Proven Myocardial Inflammation in Genetic Cardiomyopathies","volume":"8","year":"2023","journal-title":"JACC Basic Transl Sci"},{"key":"2026020506151070000_2026.01.30.26345250v1.13","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1161\/CIRCGEN.123.004099","article-title":"Cardiac Sarcoidosis Mimickers: Genetic Testing in Undifferentiated Inflammatory Cardiomyopathies","volume":"16","year":"2023","journal-title":"Circ Genomic Precis Med"},{"key":"2026020506151070000_2026.01.30.26345250v1.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.01.043"},{"key":"2026020506151070000_2026.01.30.26345250v1.15","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.122.014065"},{"key":"2026020506151070000_2026.01.30.26345250v1.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2018.10.083"},{"key":"2026020506151070000_2026.01.30.26345250v1.17","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1016\/S0735-1097(22)01261-X","article-title":"CARDIAC SARCOIDOSIS MIMICKERS: GENETIC TESTING IN UNDIFFERENTIATED INFLAMMATORY CARDIOMYOPATHIES","volume":"79","year":"2022","journal-title":"J Am Coll Cardiol"},{"key":"2026020506151070000_2026.01.30.26345250v1.18","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1161\/CIRCGEN.122.003850","article-title":"Prevalence of Pathogenic Variants in Dilated Cardiomyopathy\u2013Associated Genes in Patients Evaluated for Cardiac Sarcoidosis","volume":"16","year":"2023","journal-title":"Circ Genomic Precis Med"},{"key":"2026020506151070000_2026.01.30.26345250v1.19","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.119.044934"},{"key":"2026020506151070000_2026.01.30.26345250v1.20","doi-asserted-by":"crossref","first-page":"e008975","DOI":"10.1161\/CIRCIMAGING.118.008975","article-title":"Diagnostic Accuracy of Advanced Imaging in Cardiac Sarcoidosis","volume":"12","year":"2019","journal-title":"Circ Cardiovasc Imaging"},{"key":"2026020506151070000_2026.01.30.26345250v1.21","doi-asserted-by":"publisher","DOI":"10.1007\/s12350-016-0502-7"},{"key":"2026020506151070000_2026.01.30.26345250v1.22","doi-asserted-by":"crossref","first-page":"1249","DOI":"10.1161\/CIRCULATIONAHA.120.046900","article-title":"Diagnostic Yield of Electroanatomic Voltage Mapping in Guiding Endomyocardial Biopsies","volume":"142","year":"2020","journal-title":"Circulation"},{"key":"2026020506151070000_2026.01.30.26345250v1.23","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.09.072"},{"key":"2026020506151070000_2026.01.30.26345250v1.24","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/j.jacc.2024.10.080","article-title":"2024 ACC Expert Consensus Decision Pathway on Strategies and Criteria for the Diagnosis and Management of Myocarditis","volume":"85","author":"null null","year":"2025","journal-title":"JACC"},{"key":"2026020506151070000_2026.01.30.26345250v1.25","first-page":"19","article-title":"The WASOG Sarcoidosis Organ Assessment Instrument: An update of a previous clinical tool","volume":"31","year":"2014","journal-title":"Sarcoidosis Vasc Diffuse Lung Dis Off J WASOG"},{"key":"2026020506151070000_2026.01.30.26345250v1.26","doi-asserted-by":"crossref","unstructured":"Mannan ZM , Hankinson SJ , Laychak SS , et al. Prevalence of Lateral Wall Myocardial FDG Uptake in Patients with Left Bundle Branch Block or Ventricular Pacing Referred for Sarcoidosis FDG PET\/CT Imaging. J Nucl Cardiol. 2025:102581.","DOI":"10.1016\/j.nuclcard.2025.102581"},{"key":"2026020506151070000_2026.01.30.26345250v1.27","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198604033141405"},{"key":"2026020506151070000_2026.01.30.26345250v1.28","doi-asserted-by":"crossref","unstructured":"Chelko SP , Penna VR , Engel M , et al. NF\u0138B signaling drives myocardial injury via CCR2+ macrophages in a preclinical model of arrhythmogenic cardiomyopathy. J Clin Invest. 2024;134.","DOI":"10.1172\/JCI183441"},{"key":"2026020506151070000_2026.01.30.26345250v1.29","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.119.315483"},{"key":"2026020506151070000_2026.01.30.26345250v1.30","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1016\/j.jacbts.2016.06.009","article-title":"Evidence of Glycolysis Up-Regulation and Pyruvate Mitochondrial Oxidation Mismatch During Mechanical Unloading of the Failing Human Heart","volume":"1","year":"2016","journal-title":"JACC Basic Transl Sci"},{"key":"2026020506151070000_2026.01.30.26345250v1.31","doi-asserted-by":"publisher","DOI":"10.1126\/science.abc8861"},{"key":"2026020506151070000_2026.01.30.26345250v1.32","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1016\/j.jcmg.2024.05.013","article-title":"Risk Stratification in Cardiac Sarcoidosis With Cardiac Positron Emission Tomography","volume":"17","year":"2024","journal-title":"JACC Cardiovasc Imaging"},{"key":"2026020506151070000_2026.01.30.26345250v1.33","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.09.022"},{"key":"2026020506151070000_2026.01.30.26345250v1.34","doi-asserted-by":"crossref","first-page":"2471","DOI":"10.1007\/s12350-021-02809-1","article-title":"FDG PET imaging in suspected cardiac sarcoidosis: diagnosis vs. prognosis","volume":"29","year":"2022","journal-title":"J Nucl Cardiol"},{"key":"2026020506151070000_2026.01.30.26345250v1.35","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2013.02.004"},{"key":"2026020506151070000_2026.01.30.26345250v1.36","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2004.08.083"},{"key":"2026020506151070000_2026.01.30.26345250v1.37","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/j.amjcard.2022.04.051","article-title":"Effect of Corticosteroids on Left Ventricular Function in Patients With Cardiac Sarcoidosis","volume":"177","year":"2022","journal-title":"Am J Cardiol"}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.64898\/2026.01.30.26345250","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T14:15:18Z","timestamp":1770300918000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.64898\/2026.01.30.26345250"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,3]]},"references-count":37,"URL":"https:\/\/doi.org\/10.64898\/2026.01.30.26345250","relation":{},"subject":[],"published":{"date-parts":[[2026,2,3]]},"subtype":"preprint"}}