Cardiac Sarcoidosis - Immunosuppression Tapering — EECC MCQ
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Correct answer: A — Gradual taper with serial PET and CMR surveillance
In cardiac sarcoidosis, the duration of immunosuppression is guided by treatment response on serial imaging (FDG-PET for active inflammation, CMR for scar/oedema) and biomarkers. Resolution of FDG uptake indicates suppression of active granulomatous inflammation. The 2023 ESC Cardiomyopathy Guidelines and HRS Expert Consensus recommend gradual tapering of immunosuppression (not abrupt cessation, which risks inflammatory rebound) with serial monitoring. If FDG activity recurs during tapering, dose escalation may be needed. Some patients require long-term low-dose maintenance therapy. The optimal duration of treatment is not established but typically extends for at least 1-2 years. Apply this conclusion only to the clinical circumstances stated, with appropriate specialist review, contraindication checks, shared decision-making and follow-up. Reassess if the physiology, treatment response or competing risk changes. The competing options would require a different haemodynamic profile, diagnosis, procedural indication or risk balance from the one described here.
Reference: ESC (2023): Cardiomyopathies Guidelines; HRS Cardiac Sarcoidosis Consensus: https://www.nice.org.uk/guidance/ng109/chapter/recommendations