Two-dimensional echocardiographic findings in systemic sarcoidosis

doi:10.1016/0002-9149(89)90323-8

The American Journal of Cardiology

Volume 63, Issue 7, 15 February 1989, Pages 478-482

https://doi.org/10.1016/0002-9149(89)90323-8 Get rights and content

Abstract

The records of 88 patients with systemic sarcoidosis who underwent 2-dimensional echocardiography were reviewed to define the typical echocardiographic abnormalities in patients with clinical evidence of cardiac involvement. Twelve patients (14%) had echocardiographic evidence of left ventricular systolic dysfunction attributed to cardiac sarcoidosis (segmental hypokinesis in 8 patients and global hypokinesis in 4 patients). A high incidence of congestive heart failure (9 of 12) and conduction system disease (7 of 12) was characteristic of these patients. The remaining 76 patients had normal echocardiograms or abnormalities attributed to nonsarcoid sources. In 8 (11%) of these 76 patients, there were significant clinically unexplained conduction abnormalities likely related to sarcoidosis.

References (21)

WC Roberts et al.
Sarcoidosis of the heart. A clinicopathologic study of 35 necropsy patients (group I) and review of 78 previously described necropsy patients (group II)
Am J Med
(1977)
B Lorell et al.
Cardiac sarcoidosis. Diagnosis with endomyocardial biopsy and treatment with corticosteroids
Am J Cardiol
(1978)
SJ Ratner et al.
Utility of endomyocardial biopsy in the diagnosis of cardiac sarcoidosis
Chest
(1986)
BH Bulkley et al.
The use of 201-thallium for myocardial perfusion imaging in sarcoid heart disease
Chest
(1977)
EL Kinney et al.
Thallium-scan myocardial defects and echocardiographic abnormalities in patients with sarcoidosis without clinical cardiac dysfunction. An analysis of 44 patients
Am J Med
(1980)
RF Lewin et al.
Echocardiographic evaluation of patients with systemic sarcoidosis
Am Heart J
(1985)
R Lemery et al.
Cardiac sarcoidosis: a potentially treatable form of myocarditis
LB Tan et al.
Left ventricular diastolic characteristics of cardiac sarcoidosis
Am J Cardiol
(1986)
RA Nishimura et al.
Prognostic value of predischarge 2-dimensional echocardiogram after acute myocardial infarction
Am J Cardiol
(1984)
E Stein et al.
Asymptomatic electrocardiographic alterations in sarcoidosis
Am Heart J
(1973)

There are more references available in the full text version of this article.

Cited by (160)

Imaging of Cardiac Sarcoidosis: An Update and Future Aspects
2024, Seminars in Nuclear Medicine
Cardiac sarcoidosis (CS), an increasingly recognized disease of unknown etiology, is associated with significant morbidity and mortality. Given the limited diagnostic yield of traditional endomyocardial biopsy (EMB), there is increasing reliance on multimodality cardiovascular imaging in the diagnosis and management of CS, with EMB being largely supplanted by the use of ¹⁸F-fluorodeoxyglucose (FDG-PET) and cardiac magnetic resonance imaging (CMR). This article aims to provide a comprehensive review of imaging modalities currently utilized in the screening, diagnosis, and monitoring of CS, while highlighting the latest developments in each area.
Echocardiography in inflammatory heart disease: A comparison of giant cell myocarditis, cardiac sarcoidosis, and acute non-fulminant myocarditis
2023, IJC Heart and Vasculature
Giant cell myocarditis (GCM) and cardiac sarcoidosis (CS) are, in contrast to acute non-fulminant myocarditis (ANFM), rare inflammatory diseases of the myocardium with poor prognosis. Although echocardiography is the first-line diagnostic tool in these patients, their echocardiographic appearance has so far not been systematically studied.
We assessed a total of 71 patients with endomyocardial biopsy-proven GCM (n = 21), and CS (n = 25), as well as magnetic resonance-verified ANFM (n = 25). All echocardiographic examinations, performed upon clinical presentation, were reanalysed according to current guidelines including a detailed assessment of right ventricular (RV) dysfunction.
In comparison with ANFM, patients with either GCM or CS were older (mean age (±SD) 55 ± 12 or 53 ± 8 vs 25 ± 8 years), more often of female gender (52% or 24% vs 8%), had more severe clinical symptoms and higher natriuretic peptide levels. For both GCM and CS, echocardiography revealed more frequently signs of left ventricular (LV) dysfunction in form of a reduced ejection fraction (p < 0.001), decreased cardiac index (p < 0.001) and lower global longitudinal strain (p < 0.001) in contrast to ANFM. The most prominent increase in LV end-diastolic volume index was observed in CS. In addition, RV dysfunction was more frequently found in both GCM and CS than in ANFM (p = 0.042).
Both GCM and CS have an echocardiographic and clinical appearance that is distinct from ANFM. However, the method cannot further differentiate between the two rare entities. Consequently, echocardiography can strengthen the initial clinical suspicion of a more severe form of myocarditis, thus warranting a more rigorous clinical work-up.
Myocarditis in systemic immune-mediated diseases: Prevalence, characteristics and prognosis. A systematic review
2022, Autoimmunity Reviews
Citation Excerpt :
According to several necropsy reports, about 20-28% of sarcoid patients in the United States and the United Kingdom showed histological evidence of cardiac granuloma with even a higher (50-78%) frequency among Japanese patients [5,6]. However, cardiac sarcoidosis (CS) is often unrecognized ante mortem and clinical studies discovered only a small amount of cardiac involvement (2-7%) in sarcoidosis patients [7], while occult involvement at autopsy was detected in over 20% of patients [8–11]. Table 1 lists studies reporting on cardiac involvement among sarcoidosis patients.
Many systemic immune-mediated diseases (SIDs) may involve the heart and present as myocarditis with different histopathological pictures, i.e. lymphocytic, eosinophilic, granulomatous, and clinical features, ranging from a completely asymptomatic patient to life-threatening cardiogenic shock or arrhythmias. Myocarditis can be part of some SIDs, such as sarcoidosis, systemic lupus erythematosus, systemic sclerosis, antiphospholipid syndrome, dermato-polymyositis, eosinophilic granulomatosis with polyangiitis and other vasculitis syndromes, but also of some organ-based immune-mediated diseases with systemic expression, such as chronic inflammatory bowel diseases.
The aim of this review is to describe the prevalence, main clinical characteristics and prognosis of myocarditis associated with SIDs.
Sarcoidosis-Related Cardiomyopathy: Current Knowledge, Challenges, and Future Perspectives State-of-the-Art Review
2022, Journal of Cardiac Failure
The prevalence of sarcoidosis-related cardiomyopathy is increasing. Sarcoidosis impacts cardiac function through granulomatous infiltration of the heart, resulting in conduction disease, arrhythmia, and/or heart failure. The diagnosis of cardiac sarcoidosis (CS) can be challenging and requires clinician awareness as well as differentiation from overlapping diagnostic phenotypes, such as other forms of myocarditis and arrhythmogenic cardiomyopathy. Clinical manifestations, extracardiac involvement, histopathology, and advanced cardiac imaging can all lend support to a diagnosis of CS. The mainstay of therapy for CS is immunosuppression; however, no prospective clinical trials exist to guide management. Patients may progress to developing advanced heart failure or ventricular arrhythmia, for which ventricular assist device therapies or heart transplantation may be considered. The existing knowledge gaps in CS call for an interdisciplinary approach to both patient care and future investigation to improve mechanistic understanding and therapeutic strategies.
Ten Questions Cardiologists Should Be Able to Answer About Cardiac Sarcoidosis: Case-Based Approach and Contemporary Review
2021, CJC Open
Sarcoidosis is an inflammatory multisystemic disease of unknown etiology characterized by the formation of noncaseating epithelioid cell granulomas. Cardiac sarcoidosis might be life-threatening and its diagnosis and treatment remain a challenge nowadays. The aim of this review is to provide an updated overview of cardiac sarcoidosis and, through 10 practical clinical questions and real-life challenging case scenarios, summarize the main clinical presentation, diagnostic criteria, imaging findings, and contemporary treatment.
La sarcoïdose est une maladie inflammatoire multisystémique de cause inconnue, caractérisée par la formation de granulomes non caséeux composés de cellules épithélioïdes. La sarcoïdose cardiaque est une pathologie potentiellement mortelle qui demeure, à ce jour, difficile à diagnostiquer et à traiter. L'objectif de cet article est de présenter les données les plus à jour concernant la sarcoïdose cardiaque et de résumer, à l'aide de 10 questions cliniques et de cas réels, la présentation clinique, les critères diagnostiques, les trouvailles à l'imagerie et le traitement contemporain.
Imaging and Quantification of Cardiac Sarcoidosis
2020, Seminars in Nuclear Medicine
Cardiac sarcoidosis (CS) refers to the increasingly recognized cardiac involvement of an incompletely understood systemic disease entity-sarcoidosis. Endomyocardial biopsy can provide definitive diagnosis but is limited by its invasiveness and poor sensitivity. In the absence of a reliable gold standard, a combination of clinical, electrocardiographic, imaging, and histologic criteria are relied upon to provide probabilistic diagnosis. Within the last few years, societal documents have included advanced cardiovascular imaging modalities, ¹⁸F-FDG-PET/CT and cardiac magnetic resonance in their diagnostic algorithms. The current article provides a review of the imaging modalities used for screening and detection of CS, highlighting the principal findings of each with a specific focus on quantification, whenever applicable, and concluding with a proposed approach to the imaging of patients with suspected CS.

View all citing articles on Scopus

¹: Dr. Burstow is supported in part by a research fellowship from the Institute for Cardiovascular Research, Brisbane, Australia, and a Travel Grant from the National Heart Foundation of Australia.

View full text

Two-dimensional echocardiographic findings in systemic sarcoidosis

Abstract

Am J Med

Am J Cardiol

Chest

Chest

Am J Med

Am Heart J

Am J Cardiol

Am J Cardiol

Am Heart J