When would you consider referring a patient with suspected cardiac sarcoidosis based on PET and MRI for endomyocardial biopsy given degree of patchy involvement, as opposed to initiating empiric immunosuppressive therapies?

Would you consider starting empiric immunosuppressive therapy for a patient with suspected cardiac sarcoidosis based on PET and MRI findings, without a tissue diagnosis?

• Yes, if non-invasive imaging criteria strongly suggest cardiac sarcoidosis
• Yes, but only if there is also evidence of likely extra-cardiac involvement by imaging
• No, I would first seek a definitive tissue diagnosis through endomyocardial biopsy or other methods such as bronchoscopy with EBUS
• Other