Reduced oxygen uptake efficiency slope in patients with cardiac sarcoidosis.

Wilhelm Ammenwerth,Catharina Crolow,Torsten T Bauer,Henrik Wurps,Roland C Bittner,Nicolas Schönfeld,Jeanette Schulz-Menger,Mark A Klemens

doi:10.1371/journal.pone.0102333

Abstract

BackgroundThe non-invasive diagnosis of cardiac sarcoidosis (CS) is difficult. Cardiovascular magnetic resonance (CMR) has become a very valuable diagnostic tool in patients with suspected CS, but usually a combination of different tests is used. Oxygen uptake efficiency slope (OUES) is a parameter of cardiopulmonary exercise testing (CPET), which is used as an indicator for cardiovascular impairment. We investigated the predictive value of OUES for the diagnosis of myocardial involvement in sarcoid patients.MethodsRetrospectively 37 consecutive patients (44.9±13.8 years) with histologically confirmed sarcoidosis and clinical suspicion of heart involvement underwent noninvasive diagnostic testing including CMR. CS was diagnosed according to the guidelines from the Japanese Society of Sarcoidosis and other Granulomatous Disorders with additional consideration of CMR findings. Furthermore, CPET with calculation of predicted OUES according to equations by Hollenberg et al. was carried out.ResultsPatients with CS (11/37; 30%) had a worse cardiovascular response to exercise. OUES was significantly lower in CS-group compared to non-CS-group (59.3±19.1 vs 88.0±15.4%pred., p<0.0001). ROC curve method identified 70%pred. as the OUES cut-off point, which maximized sensitivity and specificity for detection of CS (96% sensitivity, 82% specificity, 89% overall accuracy). OUES <70%pred. was the single best predictor of CS (Odds ratio: 100.43, 95% CI: 1.99 to 5064, p<0.001) even in multivariate analyses.ConclusionOUES assessed in CPET may be helpful in identifying patient with cardiac involvement of sarcoidosis. Patient selection for CMR may be assisted by CPET findings in patients with sarcoidosis.

Highlights

Sarcoidosis is a multisystemic disease of unknown origin in usually young patients
Demographic, clinical and diagnostic findings for the groups with cardiac sarcoidosis (11/37, 30%) and without cardiac sarcoidosis are shown in Tables 2 and 3
The radiographic distribution of pulmonary stages was unevenly distributed with more advanced stages among patients with cardiac involvement (p = 0.031)

Summary

Introduction

Sarcoidosis is a multisystemic disease of unknown origin in usually young patients. Lung (90%), liver (30–40%), skin (20– 35%), eyes (20–30%), musculoskeletal (2–38%) and nervous system (1–5%) are the organs most commonly affected. The Japanese Ministry of Health and Welfare published in 1993 guidelines for diagnosing cardiac sarcoidosis [6], which were revised in 2006 by the Japanese Society of Sarcoidosis and other Granulomatous Disorders (Table 1) [7]. These guidelines combine the results of various diagnostic tests and provide an useful framework, for patients with proven systemic sarcoidosis in whom cardiac involvement is suspected. Cardiovascular magnetic resonance imaging (CMR) has become a diagnostic tool of growing impact for noninvasive assessment of myocardial inflammation in patients with suspected cardiac sarcoidosis[8,9,10,11]. We investigated the predictive value of OUES for the diagnosis of myocardial involvement in sarcoid patients

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