Elsevier

American Heart Journal

Volume 138, Issue 2, August 1999, Pages 299-302
American Heart Journal

Histologic diagnostic rate of cardiac sarcoidosis: Evaluation of endomyocardial biopsies,☆☆,

https://doi.org/10.1016/S0002-8703(99)70115-8Get rights and content

Abstract

Background An early diagnosis of cardiac sarcoidosis is important, particularly when considering the need for administering corticosteroid therapy. However, no reports are available on the success rate of diagnosis on the basis of biopsy findings in patients with cardiac sarcoidosis. This study investigated the diagnostic success rate of histologic evaluation of endomyocardial biopsy specimens in patients with this disease. Methods and Results Right ventricular endomyocardial biopsy was performed in 26 patients in whom cardiac sarcoidosis was strongly suspected according to the Diagnostic Criteria of Sarcoidosis, plus abnormalities on the electrocardiogram, cardiac radionuclide images, or in left ventricular wall motion. A mean of 4.0 sites were sampled per patient. In each case we determined whether a definitive diagnosis of cardiac sarcoidosis could be made histologically. Noncaseating granulomas were found in only 5 (19.2%) of the 26 cases, thus permitting a histologic diagnosis of cardiac sarcoidosis. A histologic diagnosis was made in 4 (36.4%) of 11 patients who exhibited a dilated cardiomyopathy-like clinical picture, in contrast to only 1 (6.7%) of 15 patients in whom conduction disturbances were the major clinical feature and whose left ventricular ejection fraction was within normal limits. Conclusions The diagnostic rate achieved with biopsy in cardiac sarcoidosis is low; the patients with sarcoidosis and evidence of significant cardiac involvement should be treated for cardiac sarcoidosis despite negative myocardial biopsies for this disease. (Am Heart J 1999;138:299-302.)

Section snippets

Patients

The study was composed of 26 Japanese patients (4 men and 22 women, 28 to 74 years of age, mean 56.3 ± 9.2 years; Table I).

. Clinical characteristics

Patient No.Age (y)SexLymphadenopathyTBACELys.BiopsyEye involvementUptake on 67Ga citrate
Pathologic diagnosis group (n = 14)
 154FBH, med(–)21.614.2(+Lung)NoneNP
 244FBH(–)37.6NP(+Lung)NoneBH, med, rt lung field
 353FNone(–)61.5NP(+Skin)UveitisNP
 456FBH, bilat. supCF(–)26.1NP(+Lung)NoneLt hilum, med, lt parietal, bilat supCF
 545FRt hilum, lt groin(–)14.8NP

Results

Noncaseating granulomas were found in only 5 (19.2%) of the 26 cases, thus permitting a histologic diagnosis of cardiac sarcoidosis. Such granulomatous lesions were found in only 9 (8.6%) of the total of 105 biopsy specimens. A histologic diagnosis was made in 4 (36.4%) of 11 patients who showed a DCM-like clinical picture in contrast to only 1 (6.7%) of 15 patients with conduction disturbances as the major clinical feature and an LVEF within the normal limit. However, the difference between

Discussion

A definitive diagnosis of cardiac sarcoidosis requires the histologic examination of tissue specimens obtained by cardiac biopsy. However, in clinical practice, relatively few cases are definitively diagnosed according to histologic evaluation of cardiac biopsy specimens. As a result, steroid therapy is frequently initiated in the absence of any histologic proof.

Sekiguchi et al6 determined the rate of a positive histologic diagnosis by performing sham cardiac biopsies at 10 sites in each of 7

References (8)

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From the Department of Internal Medicine, Fujita Health University School of Medicine, and the Cardiovascular Center, Nagoya Dai-ni Red Cross Hospital.

☆☆

Reprint requests: Shin-ichiro Morimoto, MD, Division of Cardiology, Department of Internal Medicine, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kustukake-cho, Toyoake, Aichi, 470-1192 Japan.

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