title: Sarcoidosis-associated pulmonary hypertension.
abstract: OBJECTIVE
  Pulmonary hypertension is a serious complication of sarcoidosis. This review discusses clinical characteristics of patients with sarcoid-associated pulmonary hypertension (SAPH) and pitfalls in the diagnosis, and highlights potential therapies.
  
  
  RESULTS
  SAPH is common in patients with advanced disease, but it can occur in patients with minimal disease burden. Risk factors for SAPH include restrictive lung physiology, hypoxemia, advanced Scadding chest X-ray stage, and low carbon monoxide diffusion capacity. Echocardiogram is a good initial screening tool in the diagnosis of pulmonary hypertension, but right heart catheterization is necessary to confirm the diagnosis. Treatment with pulmonary vasodilators, including endothelin antagonists, can lead to improvements in pulmonary hemodynamics in some patients but may not improve their exercise capacity. Forced vital capacity is an important predictor of exercise performance in patients with SAPH. Clinical observations and response to specific therapies for pulmonary hypertension suggest the presence of different SAPH phenotypes.
  
  
  CONCLUSIONS
  Patients who complain of persistent dyspnea should be screened for the presence of pulmonary hypertension. The prognosis of SAPH is poor and it is prudent to consider referral of these patients for lung transplantation. In some patients with SAPH, treatment with anti-inflammatory agents and pulmonary vasodilators can lower pulmonary arterial pressures, improve dyspnea and functionality, and enhance overall quality of life.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Medical Director, Lung Transplant Program, Temple University School of Medicine, Philadelphia, PA 19140, USA. cordovf@tuhs.temple.edu
authors.forename: Francis C
authors.initials: FC
authors.lastname: Cordova
authors.forename: Gilbert
authors.initials: G
authors.lastname: D'Alonzo
mesh_terms: D006328:Cardiac Catheterization; D019468:Disease Management; D004452:Echocardiography; D016232:Endothelins / Q000037:antagonists & inhibitors; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D017565:Sarcoidosis, Pulmonary / Q000150:complications*; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D016232:Endothelins; D014665:Vasodilator Agents