Cardiac involvement in Caucasian patients with pulmonary sarcoidosis

Abstract

Background: Cardiac Sarcoidosis (CS), is a potentially life-threatening condition. Patients with sarcoidosis display a heterogeneous clinical picture and detection and prognostic impact of cardiac involvement may vary with ethnic/genetic factors and/or other disease characteristics, The aim of this study was therefore to identify risk factors of cardiac involvement in caucasian patients with sarcoidosis. Methods: A cohort of 1017 caucasian patients with sarcoidosis, were screened with ECG at disease onset and investigated for CS according to clinical routine. In a subgroup of 36 sarcoidosis patients, who had an abnormal ECG and/or symptoms indicating possible cardiac involvement, a more extensive investigation program were performed. Clinical variables and genetic HLA typing data were also collected. Results: An abnormal ECG was recorded at initial presentation in 166 of the 1017 patients and CS was diagnosed in 23 (13.9%) of them, compared to one (0.1%) of the 851 sarcoidosis patients with a normal ECG (p<0.0001). The risk for CS was higher in patients with a pathologic ECG combined with cardiac related symptoms (11/40) (27.5%) compared to those with pathologic ECG changes without symptoms (11/126) (8.7%) (p<0.01). In the subgroup investigated with the extended test program, 8/21 (38.1%) patients with a pathologic ECG had CS compared to none of the 15 patients with a normal ECG, irrespective of symptoms indicative of CS. Furthermore, Lofgrens syndrome patients had a reduced risk for CS (p<0.05). No sudden cardiac deaths were recorded during follow-up. Conclusion: CS is very rare in caucasian sarcoidosis patients with a normal ECG at disease onset but warrants consideration in patients with an abnormal ECG in particular in the presence of cardiac related symptoms. Sudden cardiac deaths in caucasian patients with sarcoidosis are very rare.