LAUSR

Sarcoidosis is a multi-systemic granulomatous disease of unknown etiology. Cardiac sarcoidosis (CS) has proven to be a clinically significant cause of unexplained ventricular dysfunction, atrioventricular block (AVB) and ventricular tachyarrhythmias (VT). Studies have suggested that clinically manifest cardiac involvement occurs in only 5% of patients with sarcoidosis. However, recent imaging studies have shown that cardiac involvement can be observed in up to 54.9% of patients with extracardiac sarcoidosis, mostly clinically silent, but that can eventually manifest into life-threatening arrhythmias. The purpose of this study was to evaluate the routine use of cardiac testing in patients with sarcoidosis. We aimed to evaluate the frequency with which clinical evaluation and cardiac testing are routinely utilized, the results of these tests, and how these results impacted downstream management. This study was carried out in a tertiary hospital, assessing referred patients with suspected cardiac sarcoidosis. Clinically manifest CS was defined as the presence of ventricular systolic dysfunction, AVB or sustained VT. The cardiac involvement was evaluated with Late gadolinium-enhanced MRI and PET-CT with FDG. The diagnosis of cardiac sarcoidosis was performed using the criteria of the HRS. All patients had a biopsy with a histopathology suggestive of Sarcoidosis. Forty-one patients with sarcoidosis were evaluated. CS was confirmed in 46% (N=19), with exclusive cardiac involvement in 10% (N=2). The mean age was 53±9.6 years old and 53% (N=10) were female. Clinically manifest CS was present in 63% (N=12). The most prevalent initial cardiac manifestation was left ventricular dysfunction, in 58% (N=7), usually in the silent form (71%), with VT in 25% (N=3) and AVB in 17% (N=2). All patients with cardiac silent form had PET-CT with FDG or MRI suggestive of CS. The sensitivity of the MRI and PET-CT with FDG was 75% and 82%, respectively, while the concomitant performance of the two methods had a sensitivity of 100%, considering the HRS criteria as gold standard. Cardiac involvement in patients with sarcoidosis is high and has important prognostic implications. With the enhancement of imaging tests, diagnosis of CS has significantly increased. PET-CT with FDG and MRI are very useful and effective in the evaluation of patients with CS.