Echocardiographic Manifestations in Patients with Cardiac Sarcoidosis

Abstract

Background Cardiac sarcoidosis is a life-threatening disease with protean clinical manifestations, including congestive heart failure (CHF), conduction disturbance, ventricular arrhythmia and sudden death. Nonetheless, it is difficult to diagnose cardiac sarcoidosis in the clinical setting. Some echocardiographic findings of cardiac sarcoidosis associated with other diagnostic tools ( 201 thallium scintigraphy, 67 gallium citrate scan, serum markers and others) may be helpful upon early suspicion and diagnosis of cardiac sarcoidosis. Materials and Methods Fifty-two patients (36 female) with cardiac sarcoidosis, with a mean age of 48 ± 14 years (range, 21–70 yr), underwent a series of echocardiographic follow-up (mean, 88 ± 48 mo) examinations, and important echocardiographic parameters and findings were recorded. Results There were left ventricular (LV) regional wall motion abnormalities (RWMAs) noted in 40 (localized in 16, multiple in 24), dilatation of the LV with impaired LV contractility in 28, thinning of the basal interventricular septum (IVS) in 27, thinning of LV free wall in 18, apical aneurysm in 12, apical thrombus in two, mimicking hypertrophic cardiomyopathy (HCM) in two, pericardial effusion (PE) in two (with cardiac tamponade in one), and LV wall thinning and aneurysm formation after steroid therapy for cardiac sarcoidosis in two of 43 patients. Conclusion Thinning of the basal IVS or LV free wall is a specific echocardiographic finding of cardiac sarcoidosis. Other echocardiographic findings of cardiac sarcoidosis may mimic coronary artery disease (LV RWMA or apical aneurysm), CHF, or HCM. PE and thinning of the LV wall after steroid therapy were also noted in rare situations.