The Work‐Up and Management of Patients with Apparent or Subclinical Cardiac Sarcoidosis: With Emphasis on the Associated Heart Rhythm Abnormalities

Abstract

In patients with newly diagnosed AV block and/or ventricular tachycardia, cardiac sarcoidosis should always be considered in the differential diagnosis. In addition to the pacemaker implant, cardiac resynchronization therapy (CRT) should be selected for severe heart failure patients who have class III or IV heart failure, LVEF <or=35%, and a complete LBBB pattern. If the disease activity is high, corticosteroid therapy is recommended. Patients with extracardiac sarcoidosis need to be closely followed for potential cardiac involvement, as the mortality in sarcoidosis depends on cardiac involvement. Early diagnosis and treatment of cardiac sarcoidosis is essential. Positron emission tomography (PET) and cardiac magnetic resonance imaging (MRI) are considered to have high sensitivity for cardiac involvement, and are the preferred imaging modalities. However, even in the era of new technology, such as PET and cardiac MRI, early diagnosis of cardiac sarcoidosis is still difficult.

Hospitalization Rates, Prevalence of Cardiovascular Manifestations, and Outcomes Associated With Sarcoidosis in the United States

“…The availability of these guidelines has also been complemented with rapid and landmark advances in myocardial imaging modalities. The development of the guidelines and imaging techniques has undoubtedly served to enhance the early detection of sarcoidosis, thus increasing the incidence of this disease 10, 11, 26, 27…”

“…In 2006, the Japan Society of Sarcoidosis and Other Granulomatous Disorders revised their diagnostic guidelines for cardiac sarcoidosis by creating “histologic” and “clinical” groups 11, 12. Rather than placing additional emphasis on histologic diagnoses of cardiac sarcoidosis, the updated guidelines highlighted the presence of cardiovascular manifestations (eg, atrioventricular block and ventricular arrhythmias) to diagnose sarcoidosis with presumed cardiac involvement 11, 12.…”

Cardiovascular magnetic resonance imaging and clinical performance of somatostatin receptor positron emission tomography in cardiac sarcoidosis

“…Conventional transthoracic echocardiography failed to recognize CS persistence. Neither reduction in LVEF < 40% (enlisted as a diagnostic criterion within the current HRS expert consensus statement12) nor regional wall motion abnormalities or wall thickening (as specified by the revised JMHWG13) showed significant distributive differences between persistently CS‐positive and CS‐negative patients.…”

“…Pathological electrocardiographic findings comprehended those described to be general risk stratifiers for sudden cardiac death,11 those integrated in the Heart Rhythm Society's (HRS's) expert consensus statement on the diagnosis and management of CS‐associated arrhythmias,12 and those exposed in the revised Japanese Ministry of Health and Welfare Guidelines (JMHWG) 13…”

“…Standard echocardiographic views were obtained with the patient in the left lateral decubitus position in 2D and colour tissue Doppler imaging modes and by use of a commercially available ultrasound scanner (Vivid 7, General Electric Medical Health, Waukesha, WI, USA; iE 33, Philips Medical Systems, Koninklijke N.V., Hamburg, Germany). Pathological echocardiographic results were pre‐defined in line with the HRS consensus statement12 and the revised JMHWG 13. Accordant with electrocardiographic analysis, all echocardiographic studies were performed by versed cardiologists.…”