Two key biomarkers identified and measured after steroid therapy can accurately predict future heart complications in patients with cardiac sarcoidosis (CS), suggests a new study. The research letter reporting on a prospective cohort study found that elevated levels of both post-treatment FDG-PET standardized uptake value (SUVmax) and urinary 8-hydroxy-2′-deoxyguanosine (U-8-OHdG) were strongly linked with a higher risk of major adverse cardiovascular events (MACE), including cardiac death and ventricular tachycardia. “Post-treatment FDG-PET SUVmax and U-8-OHdG levels serve as powerful, independent predictors of MACE in patients with CS,” wrote the paper’s authors, led by Yusuke Nakashima, MD, from Yamaguchi University School of Medicine in Ube, Japan. “The combined use of these markers provides enhanced risk stratification and facilitates the evaluation of therapeutic responses to corticosteroid therapy.” Corticosteroid therapy The study, which is published in JACC: Cardiovascular Imaging, followed 39 patients with active CS who received corticosteroid therapy and were re-evaluated after 12 months using FDG-PET imaging and urinary oxidative stress markers. Over nearly five years of follow-up, patients whose post-treatment SUVmax exceeded 4.6 or U-8-OHdG surpassed 11.6 ng/mg·creatinine had markedly poorer prognoses. Notably, the incidence rate of MACE rose dramatically among patients with both elevated markers, reaching 40.8 events per 100 patient-years, compared with zero events among those with normal levels. “Cases in which either marker remained above the cutoff value exhibited a significantly higher risk of subsequent events, and the highest event risk was observed in cases when both markers remained above the cutoff values,” the investigators wrote. Monitoring inflammation The authors concluded that monitoring inflammation and oxidative stress after steroid treatment is crucial, even when initial therapy appears successful. They explained that persistent inflammation can promote fibrosis and scar formation in the heart, creating conditions that lead to fatal arrhythmias and heart failure. By integrating imaging findings with biochemical markers such as FDG-PET SUVmax and U-8-OHdG, clinicians can more precisely identify patients who remain at high risk and tailor follow-up care to prevent future cardiac events. Source: Nakashima Y, Kobayashi S, Ishikawa M, et al. Prognostic Markers for Major Adverse Cardiovascular Events in Patients With Cardiac Sarcoidosis Following Steroid Therapy. J Am Coll Cardiol Img. 2025 November 17. (Article in Press). Image Credit: H_Ko – stock.adobe.com