Abstract
BackgroundCardiac sarcoidosis (CS) is a potentially life-threatening condition. At present, there is no consensus with regard to the optimal non-invasive clinical evaluation and diagnostic procedures of cardiac involvement in patients with sarcoidosis. The aim of this study in a large homogenous Scandinavian sarcoidosis cohort was therefore to identify risk factors of cardiac involvement in patients with sarcoidosis, and the value of initial routine investigation with ECG and cardiac related symptoms in screening for CS.MethodsIn this retrospective study a cohort of 1017 Caucasian patients with sarcoidosis were included. They were all screened with ECG at disease onset and investigated for CS according to clinical routine.ResultsAn abnormal ECG was recorded in 166 (16.3%) of the 1017 patients and CS was later diagnosed in 22 (13.2%) of them, compared to in 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). Furthermore, patients with Löfgren’s syndrome had a reduced risk for CS compared to those without (p < 0.05) the syndrome.ConclusionsThis study on an unusually large and homogenous sarcoidosis population demonstrate the importance of an abnormal ECG and cardiac related symptoms at disease onset as powerful predictors of a later diagnosis of cardiac sarcoidosis. In contrast, CS is very rare in subjects without symptoms and with a normal ECG. This knowledge is of importance, and may be used in a clinical algorithm, in identifying patients that should be followed and investigated extensively for the presence of CS.
Highlights
Sarcoidosis is an inflammatory disease affecting the lungs and/or intrathoracic lymph nodes in 90% of the cases
There is no consensus with regard to the optimal non-invasive clinical evaluation and diagnostic procedures of patients with suspected cardiac involvement in sarcoidosis, and improvement in patient evaluation strategies might help in defining the patients at high risk of cardiac involvement [9]
Out of the 1017 included patients there were 166 (16.3%) patients with an abnormal ECG. Among these patients there were more males (RR) (1.4) (p < 0.05), more patients with parenchymal lung infiltrates on chest radiography (1.6) (p < 0.01), less patients with Löfgren’s syndrome (LS) (0.7)
Summary
Sarcoidosis is an inflammatory disease affecting the lungs and/or intrathoracic lymph nodes in 90% of the cases. It is characterized by the formation of non-necrotizing granulomas in the affected organs and almost any organ can be affected leading to a highly variable clinical presentation [1,2]. There is no consensus with regard to the optimal non-invasive clinical evaluation and diagnostic procedures of patients with suspected cardiac involvement in sarcoidosis, and improvement in patient evaluation strategies might help in defining the patients at high risk of cardiac involvement [9]. There is no consensus with regard to the optimal non-invasive clinical evaluation and diagnostic procedures of cardiac involvement in patients with sarcoidosis. The aim of this study in a large homogenous Scandinavian sarcoidosis cohort was to identify risk factors of cardiac involvement in patients with sarcoidosis, and the value of initial routine investigation with ECG and cardiac related symptoms in screening for CS
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