Prevalence and Correlates of Early Right Ventricular Dysfunction in Sarcoidosis and Its Association with Outcome

Abstract

Right ventricular (RV) function has not been systematically assessed in sarcoidosis. The aim of this study was to assess the prevalence and associates of RV dysfunction in sarcoidosis using global longitudinal peak systolic strain (GLS). Furthermore, whether RV dysfunction was associated with clinical outcomes was investigated. A total of 88 patients with sarcoidosis (mean age, 54±13years; 51% men) without known sarcoid-related or other structural heart disease or alternative etiologies of pulmonary hypertension were retrospectively included. RV GLS was measured using two-dimensional speckle-tracking echocardiography, and patientswere stratified (using a previously defined cutoff value) as having preserved (RV GLS<-19%) or impaired (RV GLS≥-19%) RV function. An age- and gender-matched control group (n=50) was included. The main outcome was all-cause mortality or clinical heart failure (hospitalization or New York Heart Association functional class≥III and/or deterioration by one or more classes). RV GLS was significantly reduced (-20.1±4.6 vs -24.6±1.8%, P=.001) in patients compared with control subjects. Patients with impaired RV function (n=41) were older and had worse pulmonary function, worse left ventricular diastolic function, and lower tricuspid annular plane systolic excursion compared with patients with preserved RV function (n=47). Lower tricuspid annular plane systolic excursion and diabetes were independent correlates of RV GLS. Over a median follow-up period of 37months, 19 clinical end points occurred. Patients with impaired RV function were more likely to experience the clinical end point (log-rank P=.003). RV contractile dysfunction, identified using RV GLS, is common in patients with sarcoidosis without manifest cardiac involvement or pulmonary hypertension and is associated with adverse outcome. RV GLS may therefore be useful to detect sarcoidosis-related RV dysfunction at an earlier and potentially modifiable stage.