Serum angiotensin converting enzyme, Erythrocyte sedimentation rate and high sensitive-C reactive protein levels in diagnosis of cardiac sarcoidosis- where do we stand?

Abstract

Background Cardiac sarcoidosis (CS) is increasingly being recognized in the last two decades. The diagnosis of CS depends on clustering of multiple symptoms, investigations and demonstration of a non-caseating granuloma on histopathology. Serum Angiotensin Converting Enzyme (SACE) level, one of the serological markers, is often elevated in systemic sarcoidosis. However, the yield of SACE level among patients with isolated or predominant CS is unclear. We conducted a retrospective study to assess the prevalence of elevated SACE level among patients with proven CS. Materials and methods From our Granulomatous myocarditis (GM) registry, 45 biopsy proven CS patients were enrolled. Inclusion criteria : Clinical diagnosis of CS [HRS definition + Lymph Node biopsy/Endomyocardial biopsy (non-caseating granuloma)]. Exclusion criteria - Other causes of GM like cardiac tuberculosis (TB culture/AFB smear -positive) and patients taking medications affecting SACE level. Results Among 143 GM cases, 45 CS were analyzed. Mean age:42 ± 11 years (Range 22–63 years, 19 females). With our laboratory reference of SACE (Normal range: 20–70 U/L), 3 out of 45 (6.7%) patients of CS had elevated SACE. In a comparative analysis we found, Erythrocyte Sedimentation Rate (ESR) and High sensitive-C Reactive Protein (Hs-CRP) are much more sensitive, although not specific for CS. Patients with pulmonary involvement more often had elevated SACE level. Conclusion Serum ACE is elevated only in approximately 6.7% of patients with biopsy proven CS. Hence, it is insensitive serological tool for diagnosis of CS even in the active phase of the disease. In contrast, ESR and Hs-CRP emerges to be more sensitive markers of active CS.

Pan-immune-inflammation value and systemic immune-inflammation index: Are they useful markers in sarcoidosis?

“…Some studies have reported a higher incidence of leukopenia and lymphopenia in patients with sarcoidosis [36,37]. Additionally, other studies have demonstrated significantly higher levels of RDW [38,39], PLR [40,41], NLR [12,42], MPV [24,42], CRP [13,43] and ESR [43] in patients with sarcoidosis compared to healthy subjects. A review published in 2019 identified soluble interleukin-2 receptors, CRP, serum amyloid A, and chitotriosidase as the most effective markers for confirming sarcoidosis (highest sensitivity), while angiotensin-converting enzyme (ACE), gammaglobulins, and lysozyme exhibited the highest specificity values for ruling out sarcoidosis [13].…”

Application of tirofiban in patients with acute myocardial infarction complicated with diabetes and undergoing emergency interventional therapy

“…Consequently, ESR changes can be invoked as a criterion to judge the severity of myocardial inflammation and ischemia. 20 Fibrinogen, an acute reactive protein secreted by liver synthesis, boasts the highest concentration of coagulation proteins. Fibrinogen can be converted to fibrin under the action of thrombin, accelerating the formation of thrombus.…”

Etiology of chronic atrioventricular block in young adults in a public university hospital in India

“…Another study shows that the yield of elevated serum ACE levels is significantly lower and that ESR and hs-CRP are more sensitive markers for diagnosis at initial presentation of sarcoidosis, although not specific. 8 In certain parts of the world, Lyme's disease and Chagas disease are important causes of AV block in young adults. In India, these diseases are almost unknown.…”