The ECG in sarcoidosis – a marker of cardiac involvement? Current evidence and clinical implications

Willy, Kevin; Dechering, Dirk G.; Reinke, Florian; Bögeholz, Nils; Frommeyer, Gerrit; Eckardt, Lars

doi:10.1016/j.jjcc.2020.07.006

Cited by 15 publications

(14 citation statements)

References 43 publications

(48 reference statements)

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“…Granulomatous cardiomyopathy should be suspected in patients presenting with ventricular arrhythmias (VA) in the absence of ischemia or an established cause of the VAs (dyselectrolytemia, channelopathies, structural heart disease, drugs and toxins) irrespective of the cardiac function. Additional pointers to the presence of GM are the presence of conduction disturbances, fractionated QRS, ventricular arrhythmias with multiple morphologies or pleomorphic VAs [ 3 ]. The presence of systemic disease such as pulmonary disease, cutaneous manifestations such as erythema nodosum and lymphadenopathy are auxiliary clinical findings that can aid in the diagnosis of this condition.…”

Section: Clinical Diagnosis Of Granulomatous Cardiomyopathymentioning

confidence: 99%

Diagnosis and management of Granulomatous Myocarditis

Kumar

Narasimhan

2022

Indian Pacing and Electrophysiology Journal

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Section: Clinical Diagnosis Of Granulomatous Cardiomyopathymentioning

confidence: 99%

Diagnosis and management of Granulomatous Myocarditis

Kumar

Narasimhan

2022

Indian Pacing and Electrophysiology Journal

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“…(5) Moreover, and even though pulmonary sarcoidosis is a leading cause of death, the presence of CS is strongly associated with mortality and is the second most frequent cause of death in patients with sarcoidosis. (6, 7) Given that granulomatous scars form in the myocardium and coexisting inflammation can be a substrate for macro-reentry arrhythmia in patients with CS, these patients are considered to be at a high risk for ventricular arrhythmia and sudden cardiac death (SCD). (8)…”

Section: Introductionmentioning

confidence: 99%

Relationship of mild to moderate impairment of left ventricular ejection fraction with fatal ventricular arrhythmic events in cardiac sarcoidosis

Akama

Fujimoto

Matsue

et al. 2023

Preprint

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Background: Current guidelines recommend placing an implantable cardiac defibrillator for patients with cardiac sarcoidosis (CS) and severely impaired left ventricular ejection fraction (LVEF) of ≤35%. In this study, we aimed to explore the association between mild or moderate LVEF impairment and fatal ventricular arrhythmic event (FVAE). Methods: Here, 401 patients with CS without sustained ventricular arrhythmia at diagnosis were retrospectively analyzed. The primary endpoint was an FVAE, which was defined as the combined endpoint of documented ventricular tachycardia or ventricular fibrillation and sudden cardiac death. Two cut-off points for LVEF were used; sex-specific lower threshold of normal range of LVEF, 52% for men and 54% for women, and LVEF of 35% which is used in the current guidelines. Results: During a median follow-up of 3.2 years, 58 FVAEs were observed, and the 5- and 10-year estimated incidences of FVAE were 16.8% and 23.0%, respectively. All patients were classified into three groups according to LVEF: impaired LVEF group, mild to moderate impairment of LVEF group, and maintained LVEF group. Multivariable competing risk analysis showed that both the impaired LVEF group (HR: 3.02, 95% CI: 1.25-7.32) and the mild to moderate impairment of LVEF group (HR: 2.12, 95% CI: 1.02-4.40) were associated with a higher incidence of FVAE than the maintained LVEF group after adjustment for covariates. Conclusions: Patients with CS are at a high risk of FVAEs, regardless of documented ventricular arrhythmia at the time of diagnosis. In patients with CS, even mild to moderate impairment of LVEF is associated with FVAEs.

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“…Another ECG feature deserving a separate note, is the Epsilon wave, which may be present in cardiac sarcoidosis, placing a diagnostic challenge to differentiate form arrhythmogenic right ventricular cardiomyopathy (ARVC). 15 Finally, the critical evaluation of ECG modification during treatment is important to assess the benefit of immunosuppression on cardiac involvement, 16 and this is complementary to PET-TC.…”

Section: Introductionmentioning

confidence: 99%

Pragmatic electrocardiogram tracings in non-ischaemic dilated cardiomyopathy: diagnostic and prognostic role

Pezzato

Milandri²,

Tortorici³

et al. 2023

European Heart Journal Supplements

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Dilated cardiomyopathy (DCM) is a primitive heart muscle disease characterized by a great heterogeneous aetiology and prognostic outcome. Dilated cardiomyopathy is an umbrella term encompassing different aetiologies that might require specific treatments. It principally affects young and male adults, with high-risk arrhythmic competitive risk. Unfortunately, the prevention of major ventricular arrhythmic events remains a clinical challenge. In the era of advanced multimodality imaging and widely available genetic testing, electrocardiogram (ECG) continues to represent a reliable diagnostic tool, for specific work up of every single patient. However, approaching DCM patients, only a cardiomyopathy-oriented reading makes the role of ECG central in the management of DCM, both for diagnosis, prognosis, and therapeutic management. In this paper, we present four ECGs of four different DCM patients, in order to guide a cardiomyopathy-oriented ECG reading, emphasizing its impact in an early, cost-effective, and personalized diagnostic and prognostic work up in this specific setting.

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The ECG in sarcoidosis – a marker of cardiac involvement? Current evidence and clinical implications

Cited by 15 publications

References 43 publications

Diagnosis and management of Granulomatous Myocarditis

Diagnosis and management of Granulomatous Myocarditis

Relationship of mild to moderate impairment of left ventricular ejection fraction with fatal ventricular arrhythmic events in cardiac sarcoidosis

Pragmatic electrocardiogram tracings in non-ischaemic dilated cardiomyopathy: diagnostic and prognostic role

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