Diagnosis of cardiac sarcoidosis: A crossectional study in 327 consecutive patients

Background: Detection of cardiac involvement in patients with sarcoidosis has major clinical significance due to its poor prognosis. We assessed consecutive sarcoidosis patients with various electrical, functional and structural modalities in order to estimate the true prevalence of cardiac involvement Methods: All consecutive patients without a history of cardiac disease underwent complete respiratory and cardiac workup including cardiac MRI. Cardiac sarcoidosis was clinically assessed according to the 2006 revised Japanese criteria and another criteria set published by Metha et al. Results: A total of 327 patients, including 176 newly diagnosed patients, with biopsy proven sarcoidosis were enrolled in the study. Electrical abnormalities were detected in up to 30% of the patients, whereas 40% of the patients were found with echocardiographic defects and 37% presented with late gadolinium enhancement in cardiac MRI. However, only 32 (9.8%) versus 89 (27.2%) patients were clinically diagnosed with cardiac sarcoidosis, based on the 2006 Japanese Ministry and the revised version proposed by Mehta et al, respectively. Patients with cardiac sarcoidosis were older, with longer disease duration and higher BNP serum levels than the remaining patients. Binary logistic regression analysis showed that BNP and QTc on one hand and DLCO and QT interval were independent determinants of cardiac sarcoidosis based on either criteria set. Conclusion: Currently employed diagnostic criteria of cardiac sarcoidosis need to be re-assessed based on the emerging advances of cardiac imaging modalities, especially MRI. Prospective studies that will evaluate factors important for risk stratification are warrented.