title: Reduced oxygen uptake efficiency slope in patients with cardiac sarcoidosis.
abstract: BACKGROUND
  The non-invasive diagnosis of cardiac sarcoidosis (CS) is difficult. Cardiovascular magnetic resonance (CMR) has become a very valuable diagnostic tool in patients with suspected CS, but usually a combination of different tests is used. Oxygen uptake efficiency slope (OUES) is a parameter of cardiopulmonary exercise testing (CPET), which is used as an indicator for cardiovascular impairment. We investigated the predictive value of OUES for the diagnosis of myocardial involvement in sarcoid patients.
  
  
  METHODS
  Retrospectively 37 consecutive patients (44.9±13.8 years) with histologically confirmed sarcoidosis and clinical suspicion of heart involvement underwent noninvasive diagnostic testing including CMR. CS was diagnosed according to the guidelines from the Japanese Society of Sarcoidosis and other Granulomatous Disorders with additional consideration of CMR findings. Furthermore, CPET with calculation of predicted OUES according to equations by Hollenberg et al. was carried out.
  
  
  RESULTS
  Patients with CS (11/37; 30%) had a worse cardiovascular response to exercise. OUES was significantly lower in CS-group compared to non-CS-group (59.3±19.1 vs 88.0±15.4%pred., p<0.0001). ROC curve method identified 70%pred. as the OUES cut-off point, which maximized sensitivity and specificity for detection of CS (96% sensitivity, 82% specificity, 89% overall accuracy). OUES <70%pred. was the single best predictor of CS (Odds ratio: 100.43, 95% CI: 1.99 to 5064, p<0.001) even in multivariate analyses.
  
  
  CONCLUSIONS
  OUES assessed in CPET may be helpful in identifying patient with cardiac involvement of sarcoidosis. Patient selection for CMR may be assisted by CPET findings in patients with sarcoidosis.
authors.affiliation: Department of Pneumology, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany.
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Ammenwerth
authors.affiliation: Department of Pneumology, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany.
authors.forename: Henrik
authors.initials: H
authors.lastname: Wurps
authors.affiliation: Institute of Radiology and Nuclear Medicine, HELIOS Klinikum Emil von Behring, Berlin, Germany.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Klemens
authors.affiliation: Department of Pneumology, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany.
authors.forename: Catharina
authors.initials: C
authors.lastname: Crolow
authors.affiliation: WG Cardiac MRI ECRC a joint institution of the MDC and Charité Medical University Berlin and HELIOS Klinikum Berlin-Buch Department of Cardiology and Nephrology, Berlin, Germany.
authors.forename: Jeanette
authors.initials: J
authors.lastname: Schulz-Menger
authors.affiliation: Department of Pneumology, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Schönfeld
authors.affiliation: Institute of Radiology and Nuclear Medicine, HELIOS Klinikum Emil von Behring, Berlin, Germany.
authors.forename: Roland C
authors.initials: RC
authors.lastname: Bittner
authors.affiliation: Department of Pneumology, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin, Germany.
authors.forename: Torsten T
authors.initials: TT
authors.lastname: Bauer
mesh_terms: D000328:Adult; D009202:Cardiomyopathies / Q000175:diagnosis* / Q000378:metabolism; D005080:Exercise Test / Q000379:methods* / Q000592:standards; D006801:Humans; D008875:Middle Aged; D016017:Odds Ratio; D010100:Oxygen / Q000493:pharmacokinetics*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012507:Sarcoidosis / Q000175:diagnosis* / Q000378:metabolism
chemical_list: D010100:Oxygen