Early predictors of systolic right ventricular dysfunction in the diagnostic algorithm in young patients with pulmonary sarcoidosis

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Sarcoidosis can affect not only the lungs, but also the heart, particularly, the right ventricle (RV), by both primary (5-25% of patients) or secondary mechanism due to PH. People of young, working age are at higher risk. Purpose to study global longitudinal strain (GLS), RV ejection fraction in 3D mode (EF-3D), TAPSE and S", pulmonary artery systolic pressure (SPAP) at rest and at peak of exercise in patients with sarcoidosis and to determine the role of these parameters in diagnostic algorithm. Methods. The main group consisted of 66 patients with histologically confirmed stage I-II pulmonary sarcoidosis: 42 men (63.6%) and 24 women (36.4%); mean aged 31.9 ± 5.59 years. The control group included 33 healthy, nonsmoking people: 24 men (72.7%) and 9 women (27.3%); mean aged 30.18 ± 5.3 years. Results. There were no deviations from the normal values of S’and TAPSE at rest, as well as at rest at the peak of exercise in both groups (p> 0.05). EF-3D RV was within the normal values and didn’t differ significantly at rest and at the peak of exercise (p > 0.05). RV GLS in both groups at rest and at the peak of exercise, were also normal. RV GLS in patients with sarcoidosis during exercise didn"t increase, but decreased (p = 0.004): from -22.8 ± 3.4% at rest to -21.2 ± 4.7% at the peak of exercise, by 7% (in control group: -24.1 ± 2.7 to -25.1 ± 3, p = 0.002). Values of SPAP at rest in patients with sarcoidosis was slightly higher than in healthy individuals (28.5 ± 8.3 and 24.8 ± 5.21 mm Hg; p = 0.03), in normal ranges. At the peak of exercise SPAP in patients with sarcoidosis increased greater than in the control group (32.9 ± 10.1 and 48.36 ± 14.4 mm Hg; p = 0.000001). In the control group at rest, the upper quartile of the SPAP was 29 mm Hg, at the peak of exercise - 38 mm Hg. In the main group, these indicators were significantly higher: 35 and 62 mm Hg. In the main group, at the peak of exercise, the SPAP value exceeded the upper quartile of the control group (38 mm Hg) in 79% of cases. These data may indicate the presence of subclinical pulmonary hypertension in the main group. To determine the border of normal and pathology in study groups, the threshold values of the RV GLS were obtained at the peak of exercise by the method of constructing classification trees. For RV GLS at the peak of exercise, this value turned out to be -21.6%. This means that when RV GLS is less than -21.6% in young patients with pulmonary sarcoidosis, the likelihood of subclinical RV dysfunction is 90%. In combination with an increase in SPAP at the peak of exercise more than 39.5 mm Hg these patients have an even higher rank of the significance of RV dysfunction, namely 100%. So, we propose to complete the diagnostic algorithm in patients with pulmonary sarcoidosis by RV GLS SPAP at the peak of exercise for defining the early RV systolic disfunction.