title: Cardiac involvement in patients with sarcoidosis: diagnostic and prognostic value of outpatient testing.
abstract: BACKGROUND
  Cardiac sarcoidosis (CS) causes substantial morbidity and sudden death. Early diagnosis and risk stratification are warranted.
  
  
  METHODS
  Ambulatory patients with sarcoidosis were interviewed to determine whether they experienced palpitations, syncope, or presyncope, and were evaluated with ECG, Holter monitoring, and echocardiography (transthoracic echocardiogram [TTE]). Those with symptoms or abnormal results were studied with cardiac MRI (CMRI) or positron emission tomography (PET) scanning. The diagnosis of CS was based on abnormalities detected by these imaging studies. Patients with CS were referred for risk stratification by electrophysiology study (EPS).
  
  
  RESULTS
  Among the 62 patients evaluated, the prevalence of CS was 39%. Patients with CS had more cardiac symptoms than those without CS (46% vs 5%, respectively; p < 0.001), and were more likely to have abnormal Holter monitoring findings (50% vs 3%, respectively; p < 0.001) and TTE findings (25% vs 5%, respectively; p = 0.02). The degree of pulmonary impairment did not predict CS. Two of the 17 patients who underwent EPS had abnormal test findings and received implantable cardioverter-defibrillators. No patients died, had ventricular arrhythmias that triggered defibrillator therapy, or had heart failure develop during almost 2 years of follow-up. This diagnostic approach was more sensitive than the established criteria for identifying CS.
  
  
  CONCLUSIONS
  CS is common among patients with sarcoidosis. A structured clinical assessment incorporating advanced cardiac imaging with PET scanning or CMRI is more sensitive than the established criteria for the identification of CS. Sarcoidal lesions seen on CMRI or PET scanning do not predict arrhythmias in ambulatory patients with preserved cardiac function, who appear to be at low risk for short-term mortality.
authors.affiliation: Zena and Michael Wiener Cardiovascular Institute, Department of Radiology, Mount Sinai School of Medicine, New York, NY.
authors.forename: Davendra
authors.initials: D
authors.lastname: Mehta
authors.affiliation: Zena and Michael Wiener Cardiovascular Institute, Department of Radiology, Mount Sinai School of Medicine, New York, NY. Electronic address: steven.lubitz@mssm.edu.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Lubitz
authors.affiliation: Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY.
authors.forename: Zev
authors.initials: Z
authors.lastname: Frankel
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Radiology, Mount Sinai School of Medicine, New York, NY.
authors.forename: Juan P
authors.initials: JP
authors.lastname: Wisnivesky
authors.affiliation: Cardiology Division, Department of Medicine, Columbia University Medical Center, New York, NY.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Einstein
authors.affiliation: Zena and Michael Wiener Cardiovascular Institute, Department of Radiology, Mount Sinai School of Medicine, New York, NY.
authors.forename: Martin
authors.initials: M
authors.lastname: Goldman
authors.affiliation: Department of Medicine, and Division of Nuclear Medicine, Department of Radiology, Mount Sinai School of Medicine, New York, NY.
authors.forename: Josef
authors.initials: J
authors.lastname: Machac
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Radiology, Mount Sinai School of Medicine, New York, NY.
authors.forename: Alvin
authors.initials: A
authors.lastname: Teirstein
mesh_terms: D000553:Ambulatory Care; D009202:Cardiomyopathies / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D011379:Prognosis; D011446:Prospective Studies; D012507:Sarcoidosis / Q000150:complications*; D011795:Surveys and Questionnaires