Prospective study of cardiac sarcoid mimicking arrhythmogenic right ventricular dysplasia.
BACKGROUND
Case studies indicate that cardiac sarcoid may mimic the clinical presentation of arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C); however, the incidence and clinical predictors to diagnose cardiac sarcoid in patients who meet International Task Force criteria for ARVD/C are unknown.


RESULTS
Patients referred for evaluation of left bundle branch block (LBBB)-type ventricular arrhythmia and suspected ARVD/C were prospectively evaluated by a standardized protocol including right ventricle (RV) cineangiography-guided myocardial biopsy. Sixteen patients had definite ARVD/C and four had probable ARVD/C. Three patients were found to have noncaseating granulomas on biopsy consistent with sarcoid. Age, systemic symptoms, findings on chest X-ray or magnetic resonance imaging (MRI), type of ventricular arrhythmia, RV function, ECG abnormalities, and the presence or duration of late potentials did not discriminate between sarcoid and ARVD/C. Left ventricular dysfunction (ejection fraction <50%) was present in 3/3 patients with cardiac sarcoid, but only 2/17 remaining patients with definite or probable ARVD/C (P = 0.01).


CONCLUSIONS
In this prospective study of consecutive patients with suspected ARVD/C evaluated by a standard protocol including biopsy, the incidence of cardiac sarcoid was surprisingly high (15%). Clinical features, with the exception of left ventricular dysfunction and histological findings, did not discriminate between the two entities.
Vasaiwala
Smit C
SC
Cardiovascular Institute, Loyola University Medical Center, Maywood, Illinois 60153, USA.
Finn
Cynthia
C
Delpriore
Jeanne
J
Leya
Fred
F
Gagermeier
James
J
Akar
Joseph G
JG
Santucci
Peter
P
Dajani
Khaled
K
Bova
Davide
D
Picken
Maria M
MM
Basso
Cristina
C
Marcus
Frank
F
Wilber
David J
DJ
D000293:Adolescent; D000328:Adult; D019571:Arrhythmogenic Right Ventricular Dysplasia / Q000473:pathology*; D009202:Cardiomyopathies / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D011446:Prospective Studies; D012507:Sarcoidosis / Q000473:pathology*; D055815:Young Adult