title: Cardiac manifestations of sarcoidosis: diagnosis and management.
abstract: Approximately 5% of patients with sarcoidosis will have clinically manifest cardiac involvement presenting with one or more of ventricular arrhythmias, conduction abnormalities, and heart failure. Cardiac presentations can be the first (and/or an unrecognized) manifestation of sarcoidosis in a variety of circumstances. Cardiac symptoms are usually dominant over extra-cardiac as most patients with clinically manifest disease have minimal extra-cardiac disease and up to two-thirds have isolated cardiac sarcoidosis (CS). It is estimated that another 20-25% of pulmonary/systemic sarcoidosis patients have asymptomatic cardiac involvement (clinically silent disease). The extent of left ventricular dysfunction seems to be the most important predictor of prognosis among patients with clinically manifest CS. In addition, the extent of myocardial late gadolinium enhancement is emerging as an important prognostic factor. The literature shows some controversy regarding outcomes for patients with clinically silent CS and larger studies are needed. Immunosuppression therapy (usually with corticosteroids) has been suggested for the treatment of clinically manifest CS despite minimal data supporting it. Fluorodeoxyglucose Positron Emission Tomography imaging is often used to detect active disease and guide immunosuppression. Patients with clinically manifest disease often need device therapy, typically with implantable cardioverter defibrillators.
authors.affiliation: Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, Canada K1Y 4 W7.
authors.forename: David H
authors.initials: DH
authors.lastname: Birnie
authors.affiliation: Division of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Riina
authors.initials: R
authors.lastname: Kandolin
authors.affiliation: Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, ON, Canada K1Y 4 W7.
authors.forename: Pablo B
authors.initials: PB
authors.lastname: Nery
authors.affiliation: Division of Cardiology, Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Markku
authors.initials: M
authors.lastname: Kupari
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D001706:Biopsy / Q000379:methods; D009202:Cardiomyopathies / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D017147:Defibrillators, Implantable; D042241:Early Diagnosis; D004452:Echocardiography; D005260:Female; D019788:Fluorodeoxyglucose F18; D005544:Forecasting; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D017410:Practice Guidelines as Topic; D011379:Prognosis; D019275:Radiopharmaceuticals; D018570:Risk Assessment / Q000379:methods; D012507:Sarcoidosis / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D055815:Young Adult
chemical_list: D015415:Biomarkers; D007166:Immunosuppressive Agents; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: Atrio-ventricular block; Cardiac sarcoidosis; Clinically manifest; Clinically silent; Heart failure; Sudden cardiac death; Ventricular arrhythmias