Noninvasive Diagnosis of Cardiac Sarcoidosis Using Microvolt T-Wave Alternans

Matsumoto, Shin; Hirayama, Yoshiyuki; Saitoh, Hirokazu; T, Ino; Miyauchi, Yasushi; Iwasaki, Yu‐ki; Yasutake, Masahiro; Seino, Yoshihiko; Atarashi, Hirotsugu; Katoh, Takao; Mizuno, Kyoichi

doi:10.1536/ihj.50.731

Cited by 10 publications

(4 citation statements)

References 16 publications

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“…This test in a recent small 35-patient study revealed ability to detect cardiac sarcoidosis with 85.7% sensitivity and 92.8% specificity. 19 Echocardiography, Holter monitoring, SAECG, and MVTWA are all relatively inexpensive and readily available tools that can help to risk-stratify patients early for the need for further diagnostic evaluation. gold standard for diagnosis of cardiac involvement in sarcoidosis.…”

Section: Clinical Manifestations and Electrocardiogram Findingsmentioning

confidence: 99%

Cardiac Sarcoid: A Clinician's Review on How to Approach the Patient With Cardiac Sarcoid

Mantini

Williams

Stewart

et al. 2012

Clinical Cardiology

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Cardiac sarcoid is an infiltrative, granulomatous disease of the myocardium. It is more prevalent entity than once believed, especially subclinical disease. It affects heart mechanics causing ventricular failure, and disrupts the cardiac electrical system leading to third degree heart block, malignant ventricular arrhythmias, and sudden cardiac death. This makes early diagnosis and treatment of this devastating disease essential. Based on reviewed literature this paper proposes step‐wise diagnostic and therapeutic algorithms for patients with suspected cardiac sarcoidoisis who do or do not have prior history of systemic sarcoidosis. Clin. Cardiol. 2012 DOI: 10.1002/clc.21982The authors have no funding, financial relationships, or conflicts of interest to disclose.Special thanks to Dr. Maziar Zafari for his help with the editing process.

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Section: Clinical Manifestations and Electrocardiogram Findingsmentioning

confidence: 99%

Cardiac Sarcoid: A Clinician's Review on How to Approach the Patient With Cardiac Sarcoid

Mantini

Williams

Stewart

et al. 2012

Clinical Cardiology

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“…There have been few reports on TWA in sarcoidosis. Although one study reported the utility of TWA for detecting cardiac involvement in patients with sarcoidosis, their sample size was similarly small 25 . A large‐scale study is required to evaluate the utility of TWA in patients with sarcoidosis.…”

Section: Discussionmentioning

confidence: 99%

Detection of cardiac involvement in pulmonary sarcoidosis using high‐resolution Holter electrocardiogram

Maru

Yodogawa

Tanaka

et al. 2021

Journal of Arrhythmia

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Background Early detection of cardiac involvement in patients with sarcoidosis is important but currently unresolved. The aim of this study was to elucidate the utility of frequency domain microvolt T‐wave alternans (TWA), signal‐averaged ECG (SAECG), and heart rate turbulence (HRT) using 24‐hour Holter ECG for detecting cardiac involvement in patients with pulmonary sarcoidosis. Methods This study consisted of consecutive 40 pulmonary sarcoidosis patients (11 males, 62 ± 13 years) who underwent 24‐hour Holter monitoring with and without cardiac involvement. All patients underwent frequency domain TWA, SAECG, and HRT using 24‐hour Holter monitoring. Patients with atrial fibrillation pacing or wide QRS electrocardiogram were excluded. Results After 14 patients were excluded, a total of 26 patients (six males, 59 ± 14 years) were evaluated. Seven patients had cardiac involvement (cardiac sarcoidosis [CS] group). On the Holter SAECG, duration of low‐amplitude signals <40 μV in the terminal filtered QRS complex (LAS40) was significantly higher, and root mean square voltage of the terminal 40 ms of the filtered QRS complex (RMS40) was significantly lower in the CS group compared with the non‐CS group (LAS40: 61.4 ± 35.9 vs 37.6 ± 9.2 ms; P = .018, RMS40: 11.4 ± 10.3 vs 23.6 ± 13.2 ms; P = .023). Prevalence of positive late potential (LP) was also significantly higher in the CS group than that in the non‐CS group (85.7% vs 31.5%; P = .026). The sensitivity, specificity, positive, and negative predictive values of LP for identifying patients with cardiac involvement were 85.7%, 68.4%, 50.0%, and 92.8%, respectively. Conclusion Holter SAECG may be useful for detecting cardiac involvement in patients with pulmonary sarcoidosis.

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“…Other repolarization abnormalities reported in some studies include increased QT dispersion ( 135 ), the presence of microvolt T-wave alternans ( 136 ), higher T-wave amplitude in lead aVR ( 137 ), T-wave inversion ( 128 ), and a longer interval of T-peak to T-end ( 126 ).…”

Section: Ecg In Acquired Forms Of Cardiomyopathy: Sarcoidosismentioning

confidence: 99%

The pivotal role of ECG in cardiomyopathies

Silvetti

Lanza

Romeo

et al. 2023

Front. Cardiovasc. Med.

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Cardiomyopathies are a heterogeneous group of pathologies characterized by structural and functional alterations of the heart. Recent technological advances in cardiovascular imaging offer an opportunity for deep phenotypic and etiological definition. Electrocardiogram (ECG) is the first-line diagnostic tool in the evaluation of both asymptomatic and symptomatic individuals. Some electrocardiographic signs are pathognomonic or fall within validated diagnostic criteria of individual cardiomyopathy such as the inverted T waves in right precordial leads (V1–V3) or beyond in individuals with complete pubertal development in the absence of complete right bundle branch block for the diagnosis of arrhythmogenic cardiomyopathy of the right ventricle (ARVC) or the presence of low voltages typically seen in more than 60% of patients with amyloidosis. Most other electrocardiographic findings such as the presence of depolarization changes including QRS fragmentation, the presence of epsilon wave, the presence of reduced or increased voltages as well as alterations in the repolarization phase including the negative T waves in the lateral leads, or the profound inversion of the T waves or downsloping of the ST tract are more non-specific signs which can however raise the clinical suspicion of cardiomyopathy in order to initiate a diagnostic procedure especially using imaging techniques for diagnostic confirmation. Such electrocardiographic alterations not only have a counterpart in imaging investigations such as evidence of late gadolinium enhancement on magnetic resonance imaging, but may also have an important prognostic value once a definite diagnosis has been made. In addition, the presence of electrical stimulus conduction disturbances or advanced atrioventricular blocks that can be seen especially in conditions such as cardiac amyloidosis or sarcoidosis, or the presence of left bundle branch block or posterior fascicular block in dilated or arrhythmogenic left ventricular cardiomyopathies are recognized as a possible expression of advanced pathology. Similarly, the presence of ventricular arrhythmias with typical patterns such as non-sustained or sustained ventricular tachycardia of LBBB morphology in ARVC or non-sustained or sustained ventricular tachycardia with an RBBB morphology (excluding the “fascicular pattern”) in arrhythmogenic left ventricle cardiomyopathy could have a significant impact on the course of each disease. It is therefore clear that a learned and careful interpretation of ECG features can raise suspicion of the presence of a cardiomyopathy, identify diagnostic “red flags” useful for orienting the diagnosis toward specific forms, and provide useful tools for risk stratification. The purpose of this review is to emphasize the important role of the ECG in the diagnostic workup, describing the main ECG findings of different cardiomyopathies.

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Noninvasive Diagnosis of Cardiac Sarcoidosis Using Microvolt T-Wave Alternans

Cited by 10 publications

References 16 publications

Cardiac Sarcoid: A Clinician's Review on How to Approach the Patient With Cardiac Sarcoid

Cardiac Sarcoid: A Clinician's Review on How to Approach the Patient With Cardiac Sarcoid

Detection of cardiac involvement in pulmonary sarcoidosis using high‐resolution Holter electrocardiogram

The pivotal role of ECG in cardiomyopathies

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