Cardiac sarcoidosis: a retrospective study of 41 cases.
This retrospective study concerned 18 female and 23 male patients with cardiac sarcoidosis (CS). The average age at CS diagnosis was 38 years. CS was observed in white (73% of cases) and in black or Caribbean patients (27% of cases). All patients had extracardiac histologic proof of sarcoid tissue. In 63% of cases, the CS arose during the follow-up of systemic sarcoidosis. Systemic sarcoidosis was not specific except for a high frequency of neurosarcoidosis. Revealing cardiac signs were clinical in 63% of cases and electrical in 22%. In most patients these signs were associated with an abnormal echocardiography (77%) and/or a defect on thallium-201 or sestamibi imaging (75%). Thirty-nine patients received steroid therapy (initial dose mostly equal to 1 mg/kg per day), associated in 13 cases with another immunosuppressive treatment. In 26% of cases the immunosuppressive treatment was associated with a specific cardiac treatment. In the long-term follow-up (average follow-up, 58 mo), 87% of the cases showed an improvement, and 54% were cured from a clinical and laboratory point of view (electrocardiogram, 24-hour monitoring, echocardiography, radionuclide imaging). There was no sudden death. Two patients worsened, which can be explained in 1 case by very late treatment and in the other case by lack of treatment, except for a pacemaker. Our experience leads us to treat CS with corticosteroids as soon as possible and to use another immunosuppressive treatment where there is an insufficient therapeutic response or where there are contraindications to corticosteroids.
Chapelon-Abric
Catherine
C
From Service de Médecine Interne (CC-A, PD, BW, DLTH, CdG, TP, PG, JCP), Hôpital de la Pitié, Paris; Service de Physiologie-Explorations Fonctionnelles (DdZ), Hôpital Bichât, Paris; Service de Médecine Interne (PV), Centre Hospitalier de Compiegne, Compiegne; and Service de Médecine Interne (OB), Hôpital Foch, Suresnes, France.
de Zuttere
Dominique
D
Duhaut
Pierre
P
Veyssier
Pierre
P
Wechsler
Bertrand
B
Huong
Du Le Thi
DLT
de Gennes
Christian
C
Papo
Thomas
T
Blétry
Olivier
O
Godeau
Pierre
P
Piette
Jean-Charles
JC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D001706:Biopsy; D044383:Black People / Q000706:statistics & numerical data; D001772:Blood Cell Count; D001799:Blood Sedimentation; D009202:Cardiomyopathies / Q000145:classification / Q000175:diagnosis* / Q000188:drug therapy*; D002317:Cardiovascular Agents / Q000627:therapeutic use; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology / Q000652:urine; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D007703:Peptidyl-Dipeptidase A / Q000097:blood; D012189:Retrospective Studies; D012507:Sarcoidosis / Q000175:diagnosis* / Q000188:drug therapy*; D016896:Treatment Outcome; D044465:White People / Q000706:statistics & numerical data
D002317:Cardiovascular Agents; D007166:Immunosuppressive Agents; D000469:Alkaline Phosphatase; D007703:Peptidyl-Dipeptidase A