Chest
Clinical InvestigationsUtility of Endomyocardial Biopsy in the Diagnosis of Cardiac Sarcoidosis
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MATERIAL AND METHODS
By reviewing the discharge diagnoses of all patients hospitalized at the Medical Center between January 1, 1979 and September 30, 1984, we collected the names of all patients with a diagnosis of sarcoidosis. Sarcoidosis was diagnosed by the attending pulmonologist on the basis of a characteristic clinical picture,5 exclusive of heart disease, in conjunction with granulomas on transbronchial lung biopsy and/or bronchoalveolar lavage findings typical of sarcoidosis. This list was compared with
RESULTS
There were 213 patients with sarcoidosis hospitalized during the study period. Of these, 20 underwent cardiac catheterization. Seven had severe coronary artery disease, one had valvular heart disease, one had congenital heart disease, and one underwent catheterization for evaluation of vasodilator therapy for pulmonary hypertension. None of these patients was clinically believed to have cardiac sarcoidosis, and none was biopsied. Thus, these ten patients have not been included in this study.
DISCUSSION
Prior to the advent of endomyocardial biopsy, cardiac sarcoidosis in the living patient could be diagnosed only on clinical grounds. Cardiomegaly, congestive heart failure, valvular disease, ST and T-wave abnormalities, heart block, conduction defects or arrhythmias may suggest cardiac sarcoidosis in the proper clinical setting.4, 6, 12, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25 Unfortunately, only 5 percent of patients with cardiac sarcoidosis have clinical signs of heart disease.26 Since
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Supported in part by National Institutes of Health Grant HL
Presented in part at the national meeting of the American Heart Association, Washington, D.C., November, 1985.
Manuscript received March 4; revision accepted May 22.