Assessment of cardiac involvement in patients with sarcoidosis

Background: Cardiac involvement remains an important prognostic factor in patients with sarcoidosis. However, early diagnosis of cardiac sarcoidosis has been difficult because the clinical manifestations are not specific and the sensitivity and specificity of the diagnostic modalities are limited. Methods: Patients with biopsy proven sarcoidosis were prospectively recruited from the outpatient clinic of sarcoidosis and underwent a full cardiopulmonary monitoring including pulmonary function tests, a 12-lead electrocardiography, echocardiography, a 24-hour ambulatory ECG and cardiac magnetic resonance imaging (MRI) when appropriate. Cardiac involvement was assessed based on known established Japanese Ministry of Health (JMH) criteria and on modified criteria using MRI as a major criterion for cardiac sarcoidosis. All consecutive patients were followed for 5 years for major adverse events. Results: Seventy patients (43 female) were enrolled with median age 49.96±12.83 years old and disease duration 4.44±5.27 years. Cardiac involvement was identified with the modified criteria in 27 patients (38.5%) while 10 (14.3%) patients were found based on the JMH criteria, showing a more than two-fold higher rate for the MRI group (p=0.005). On follow-up, 9 patients had adverse events including 5 cardiac deaths. All patients with cardiac cause of death had cardiac sarcoidosis based on the modified criteria. Conclusion: Evaluation of myocardial involvement in sarcoidosis with the use of MRI as a major criterion appears to be more sensitive than current consensus criteria and associated with future adverse events including cardiac death. Cardiac MRI evaluation may be of great importance in the early diagnosis of cardiac sarcoidosis.