Cardiac sarcoidosis

Mitchell, Daniell; Bois, Roland M. du; Oldershaw, Paul

doi:10.1136/bmj.314.7077.320

Cited by 33 publications

(12 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Therefore, treatment decisions and monitoring will often require a close coordination between them. 69 Despite the fact that data available in the literature on the treatment of CS stem mainly from retrospective series and case reports, we will try to give an answer to the following practical questions: Who needs treatment ? With what regimens?…”

Section: Treatment Managementmentioning

confidence: 99%

Cardiac Sarcoidosis

Nunès

Freynet

Naggara

et al. 2010

Semin Respir Crit Care Med

View full text Add to dashboard Cite

Cardiac involvement is undeniably one of the most challenging issues in sarcoidosis. Although autopsy studies reveal heart lesions in 20 to 30% of sarcoid patients, fewer than 5% suffer from clinical disease. Cardiac sarcoidosis (CS) has a predilection for the myocardium, but the pericardium and endocardium may also be affected. CS manifestations are various and most frequently include the following: (1) aberrations of atrioventricular or intraventricular conduction, either silent or symptomatic; (2) ventricular arrhythmias; (3) subacute congestive heart failure; and (4) sudden death. CS must be detected in all sarcoid patients by means of detailed medical history, physical examination, and resting electrocardiogram (ECG) at first evaluation and during follow-up. In patients with suspected CS, further investigations are aimed at evaluating diagnosis and cardiac consequences. Unfortunately, no gold standard exists that would allow CS diagnosis with a level of confidence. Endomyocardial biopsy is an invasive procedure that lacks sensitivity. Patients need, at a minimum, specialized cardiologic advice, echocardiography, and 24-hour ambulatory ECG. Other diagnostic tools include thallium, technetium, and gallium scintigraphy, and more recently, 18F-fluorodeoxyglucose positron emission tomography and cardiac magnetic resonance (CMR). The respective role of these new imaging tools in the diagnostic approach remains to be defined. CMR has the advantage of not exposing patients to radiation, but it is not feasible in those with cardiac devices. In Western countries, heart involvement accounts for 13 to 25% of sarcoidosis-related deaths, and it is the leading cause of mortality in Japan. The main prognostic indicators are New York Heart Association functional class, left ventricular enlargement, and sustained ventricular tachycardia. Treatment is based on systemic corticosteroids with an initial dose between 30 mg/day and 1 mg/kg/day (which is usually maintained for at least 24 months), specific cardiologic agents, and the placement of a pacemaker or implantable cardiac defibrillator in case of an atrioventricular block or severe intractable ventricular arrhythmias. Cardiac transplantation is exceptionally required.

show abstract

Section: Treatment Managementmentioning

confidence: 99%

Cardiac Sarcoidosis

Nunès

Freynet

Naggara

et al. 2010

Semin Respir Crit Care Med

View full text Add to dashboard Cite

show abstract

“…One quarter of patients with sarcoidosis have cardiac lesions, but there is a poor correlation between symptoms and myocardial involvement even in the most advanced cases, and hence SCD may be the first manifestation (505). In proven cases of cardiac sarcoidosis, supraventricular and ventricular arrhythmias occur frequently (73%) and bundlebranch block is present in about two thirds of patients.…”

Section: Sarcoidosismentioning

confidence: 99%

ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death

Zipes¹,

Camm²,

Borggrefe³

et al. 2006

Circulation

1,204

671

View full text Add to dashboard Cite

“…1 Although cardiac involvement is responsible for as many as 85% of deaths from sarcoidosis, 2 unfortunately it remains difficult to diagnose before death. 1 Even considering the dramatic effect of early corticosteroid administration, 3 the difficulty in diagnosis of this disease particularly in the early stage challenges improving the prognosis of cardiac sarcoidosis.…”

mentioning

confidence: 99%

Early detection of cardiac involvement in patients with sarcoidosis by a non-invasive method with ultrasonic tissue characterisation

Hyodo

Hozumi²,

Takemoto³

et al. 2004

Heart

View full text Add to dashboard Cite

Objectives: To clarify the value of cycle dependent variation of myocardial integrated backscatter (CV-IB) analysis, which non-invasively measures acoustic properties of the myocardium, for early detection of cardiac involvement in patients with sarcoidosis. Methods: The study population consisted of 22 consecutive patients with biopsy proven sarcoidosis who did not have any abnormal findings on conventional two dimensional echocardiogram. Cardiac sarcoidosis was diagnosed by radionuclide testing including thallium-201 scintigraphy, gallium-67 scintigraphy, and cardiac fluorine-18-deoxyglucose positron emission tomography. The magnitude and delay of the CV-IB were analysed in the basal mid septum and the basal mid posterior wall of the left ventricle of all patients. Results: The patients were divided into two groups: 8 patients with cardiac involvement and 14 patients without cardiac involvement. In the basal septum, a major reduction in the magnitude (mean (SD) 1.8 (4.4) v 6.6 (1.3) , p = 0.012) and an increase in the time delay (1.3 (0.5) v 1.0 (0.1), p = 0.038) of CV-IB were observed in patients with cardiac sarcoidosis even in the absence of two dimensional echocardiographic abnormalities. The sensitivity for detecting cardiac involvement was such that the magnitude of CV-IB in the basal septum discriminated 75% of patients with cardiac sarcoidosis from those with non-cardiac sarcoidosis, whereas two dimensional echocardiographic parameters did not discriminate between these two groups. Conclusions: The CV-IB is decreased in the basal septum in patients with cardiac sarcoidosis even in the absence of two dimensional echocardiographic abnormalities. Analysis of CV-IB may be a useful method to detect early myocardial involvement in patients with sarcoidosis.

show abstract

Cardiac sarcoidosis

Cited by 33 publications

References 16 publications

Cardiac Sarcoidosis

Cardiac Sarcoidosis

ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death

Early detection of cardiac involvement in patients with sarcoidosis by a non-invasive method with ultrasonic tissue characterisation

Contact Info

Product

Resources

About