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Abstract
Sarcoidosis is a chronic multi-system disorder with an unknown etiology that can affect the cardiac tissue, resulting in Cardiac Sarcoidosis (CS). The majority of these CS cases are clinically silent, and when there are symptoms, the symptoms are vague and can have a lot in common with other common cardiac diseases. These symptoms can range from arrhythmias to heart failure. If CS goes undetected, it can lead to detrimental outcomes for patients. Diagnosis depends on timely utilization of imaging modalities and non-invasive testing, while in some cases, it does necessitate biopsy. Early diagnosis and treatment with immunosuppressive agents are crucial, and it is essential that follow-up testing be performed to ensure resolution and remission. This manuscript provides an in-depth review of CS and the current literature regarding CS diagnosis and treatment.
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Sedaghat-Hamedani F, Kayvanpour E, Hamed S, Frankenstein L, Riffel J, Gi WT, Amr A, Shirvani Samani O, Haas J, Miersch T, Herpel E, Kreusser MM, Ehlermann P, Katus HA, Meder B. The chameleon of cardiology: cardiac sarcoidosis before and after heart transplantation. ESC Heart Fail 2019; 7:692-696. [PMID: 31802644 PMCID: PMC7160489 DOI: 10.1002/ehf2.12581] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/01/2019] [Accepted: 11/11/2019] [Indexed: 12/17/2022] Open
Abstract
Cardiac sarcoidosis is a chronic inflammatory disease with a large spectrum of symptoms that can mimic diseases such as dilated, hypertrophic, or arrhythmogenic cardiomyopathies. It can be asymptomatic but can also present with ventricular arrhythmias, conduction disease, and heart failure (HF) or even sudden cardiac death (SCD). We present here the case of a patient transplanted due to end‐stage arrhythmogenic right ventricular cardiomyopathy (ARVC), fulfilling the task force criteria. A few years after successful heart transplantation (HTX), the patient developed similar symptoms and morphofunctional changes of the heart, which led to critical re‐evaluation of his primary diagnosis.
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Affiliation(s)
- Farbod Sedaghat-Hamedani
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany.,German Centre for Cardiovascular Research (DZHK), DZHK (German Centre for Cardiovascular Research), Heidelberg, Germany
| | - Elham Kayvanpour
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany.,German Centre for Cardiovascular Research (DZHK), DZHK (German Centre for Cardiovascular Research), Heidelberg, Germany
| | - Sonja Hamed
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany
| | - Lutz Frankenstein
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany
| | - Johannes Riffel
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany
| | - Weng-Tein Gi
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany.,German Centre for Cardiovascular Research (DZHK), DZHK (German Centre for Cardiovascular Research), Heidelberg, Germany
| | - Ali Amr
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany.,German Centre for Cardiovascular Research (DZHK), DZHK (German Centre for Cardiovascular Research), Heidelberg, Germany
| | - Omid Shirvani Samani
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany.,German Centre for Cardiovascular Research (DZHK), DZHK (German Centre for Cardiovascular Research), Heidelberg, Germany
| | - Jan Haas
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany.,German Centre for Cardiovascular Research (DZHK), DZHK (German Centre for Cardiovascular Research), Heidelberg, Germany
| | - Tobias Miersch
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany
| | - Esther Herpel
- Tissue Bank of the National Center for Tumor Diseases (NCT), Heidelberg, Germany.,Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael M Kreusser
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany.,German Centre for Cardiovascular Research (DZHK), DZHK (German Centre for Cardiovascular Research), Heidelberg, Germany
| | - Philipp Ehlermann
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany.,German Centre for Cardiovascular Research (DZHK), DZHK (German Centre for Cardiovascular Research), Heidelberg, Germany
| | - Hugo A Katus
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany.,German Centre for Cardiovascular Research (DZHK), DZHK (German Centre for Cardiovascular Research), Heidelberg, Germany
| | - Benjamin Meder
- Department of Medicine III, University of Heidelberg, Heidelberg, Germany.,German Centre for Cardiovascular Research (DZHK), DZHK (German Centre for Cardiovascular Research), Heidelberg, Germany.,Department of Genetics, Stanford University, Stanford, CA, 94305, USA
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Abstract
OBJECTIVE. This article will review the typical and atypical imaging features of sarcoidosis, identify entities that may be mistaken for sarcoidosis, and discuss patterns and clinical scenarios that suggest an alternative diagnosis. CONCLUSION. Radiologists must be familiar with the characteristic findings in sarcoidosis and be attentive to situations that suggest alternative diagnoses. The radiologist plays a major role in prompt diagnosis and one that may help reduce patient morbidity and mortality.
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay. Heart Rhythm 2019; 16:e128-e226. [DOI: 10.1016/j.hrthm.2018.10.037] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Indexed: 12/13/2022]
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2019; 140:e382-e482. [DOI: 10.1161/cir.0000000000000628] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | | | | | | | - Kenneth A. Ellenbogen
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information
- ACC/AHA Representative
| | - Michael R. Gold
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information
- HRS Representative
| | | | | | - José A. Joglar
- ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | | | | | | | | | | | | | - Cara N. Pellegrini
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information
- HRS Representative
- Dr. Pellegrini contributed to this article in her personal capacity. The views expressed are her own and do not necessarily represent the views of the US Department of Veterans Affairs or the US government
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay. J Am Coll Cardiol 2019; 74:e51-e156. [DOI: 10.1016/j.jacc.2018.10.044] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Polito MV, Stoebe S, Leifels L, Stumpp P, Solty K, Galasso G, Piscione F, Laufs U, Klingel K, Hagendorff A. Cardiac sarcoidosis: a challenging diagnosis. Clin Res Cardiol 2018; 107:980-986. [DOI: 10.1007/s00392-018-1265-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/26/2018] [Indexed: 10/16/2022]
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Abdelhamid MA, Diab HS. The arrhythmic burden in patients with sarcoidosis. Is it a real concern? EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2016. [DOI: 10.1016/j.ejcdt.2015.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Limongelli G, Rea A, Masarone D, Francalanci MP, Anastasakis A, Calabro' R, Giovanna RM, Bossone E, Elliott PM, Pacileo G. Right ventricular cardiomyopathies: a multidisciplinary approach to diagnosis. Echocardiography 2014; 32 Suppl 1:S75-94. [PMID: 25234203 DOI: 10.1111/echo.12399] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The physiological importance of the right ventricle (RV) has been underestimated over the past years. Finally in the early 1950s through the 1970s, cardiac surgeons recognized the importance of RV function. Since then, the importance of RV function has been recognized in many acquired cardiac heart disease. RV can be mainly or together with left ventricle (LV) affected by inherited or acquired cardiomyopathy. In fact, RV morphological and functional remodeling occurs more common during cardiomyopathies than in ischemic cardiomyopathies and more closely parallels LV dysfunction. Moreover, there are some cardiomyopathy subtypes showing a predominant or exclusive involvement of the RV, and they are probably less known by cardiologists. The clinical approach to right ventricular cardiomyopathies is often challenging. Imaging is the first step to raise the suspicion and to guide the diagnostic process. In the differential diagnosis, cardiologists should consider athlete's heart, congenital heart diseases, multisystemic disorders, and inherited arrhythmias. However, a multiparametric and multidisciplinary approach, involving cardiologists, experts in imaging, geneticists, and pathologists with a specific expertise in these heart muscle disorders is required.
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Affiliation(s)
- Giuseppe Limongelli
- Division of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy
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Amin EN, Closser DR, Crouser ED. Current best practice in the management of pulmonary and systemic sarcoidosis. Ther Adv Respir Dis 2014; 8:111-132. [PMID: 25034021 DOI: 10.1177/1753465814537367] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Sarcoidosis is a systemic inflammatory disease of unknown etiology that is characterized by the presence of granulomatous inflammation in affected tissues. It can affect essentially any organ system but shows a predilection for the lungs, eyes, and skin. Accurate epidemiological data are not available in the USA, but sarcoidosis is considered a 'rare disease' (prevalence less than 200,000). However, recent epidemiologic studies indicate that regional prevalence is much higher than previously estimated, especially among African American women. Additionally, mortality rates of patients with sarcoidosis are increasing by 3% per year over the past two decades. The most common causes of death are attributed to progressive lung disease and cardiac sarcoidosis, and the health of the patients is further compromised by other systemic manifestations. As such, the management of sarcoidosis requires a collaborative multidisciplinary approach. We aim to discuss the principles of managing sarcoidosis, including standards of care relating to pulmonary disease as well as recent advances relating to the detection and treatment of extrapulmonary manifestations.
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Affiliation(s)
- Emily N Amin
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Ohio State University, Columbus, OH, USA
| | - Douglas R Closser
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Ohio State University, Columbus, OH, USA
| | - Elliott D Crouser
- 201F Davis Heart and Lung Research Institute, 473 West 12th Avenue, Columbus, OH 43210, USA
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Shafee MA, Fukuda K, Wakayama Y, Nakano M, Kondo M, Hasebe Y, Kawana A, Shimokawa H. Delayed enhancement on cardiac magnetic resonance imaging is a poor prognostic factor in patients with cardiac sarcoidosis. J Cardiol 2012; 60:448-53. [PMID: 22944174 DOI: 10.1016/j.jjcc.2012.08.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Revised: 06/12/2012] [Accepted: 07/25/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Predictors of ventricular arrhythmias (VA) in patients with cardiac sarcoidosis (CS) remain unclear. METHODS AND RESULTS We examined 61 consecutive CS patients who were admitted to our hospital from April 2002 to March 2012 with a mean follow-up period of 45 ± 31 months for the relationship between delayed enhancement on cardiac magnetic resonance imaging (DE-MRI) and VA or a composite endpoint, including VA, heart failure hospitalization, and cardiovascular mortality. Although there was no significant difference in baseline clinical characteristics between patients with VA and those without it, the former group was characterized as compared with the latter by lower left ventricular (LV) ejection fraction (p<0.05), larger LV systolic/diastolic dimensions (both p<0.05), and a significant association with DE-MRI (p<0.05). Furthermore, the patients with DE-MRI (n=26), as compared with those without it (n=11), had a significantly higher composite endpoint event rate (41% vs. 0%, p<0.05) and a trend toward higher VA (29% vs. 0%, p=0.12). Univariate analysis also showed that impaired LV systolic function was significantly associated with composite events on follow-up. CONCLUSIONS These results indicate that the presence of DE-MRI is a significant predictor of VA events and poor outcome in CS patients.
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Affiliation(s)
- Mohamed Abdel Shafee
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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Baughman RP, Lower EE, Gibson K. Pulmonary manifestations of sarcoidosis. Presse Med 2012; 41:e289-302. [DOI: 10.1016/j.lpm.2012.03.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 03/23/2012] [Accepted: 03/28/2012] [Indexed: 10/28/2022] Open
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Bocoum AI, Daumas A, Cammilleri S, Bernard F, Rossi P, Bagneres D, Demoux AL, Aissi K, Dales JP, Berdah S, Chaumoitre K, Frances Y, Granel B. Péricardite récidivante révélant une sarcoïdose systémique. Rev Med Interne 2011; 32:575-9. [DOI: 10.1016/j.revmed.2011.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 01/17/2011] [Accepted: 03/10/2011] [Indexed: 10/17/2022]
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Cottin V. Sarcoïdose pulmonaire : difficultés du diagnostic. Rev Med Interne 2011; 32:93-100. [DOI: 10.1016/j.revmed.2010.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Revised: 06/10/2010] [Accepted: 07/25/2010] [Indexed: 12/31/2022]
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Baughman RP, Nunes H. Complicated Sarcoidosis: Challenges in Dealing with Severe Manifestations. Autoimmune Dis 2011. [DOI: 10.1007/978-0-85729-358-9_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Schteingart MT, Tessler HH. Sarcoidosis. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00115-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mayerhoff RM, Pitman MJ. Atypical and disparate presentations of laryngeal sarcoidosis. Ann Otol Rhinol Laryngol 2010; 119:667-71. [PMID: 21049851 DOI: 10.1177/000348941011901004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sarcoidosis is a multisystem chronic granulomatous disease of unknown cause that typically affects patients between 20 and 40 years of age. Laryngeal involvement most frequently involves the supraglottis and presents with dyspnea. We present a retrospective review of 4 patients with previously undiagnosed sarcoidosis who presented with atypical signs and symptoms of sarcoidosis: dysphonia with isolated vocal fold involvement; cough and globus pharyngeus; pediatric sarcoidosis; and severe bilateral vocal fold paresis and dysphagia. Our aim is to highlight disparate presentations of laryngeal sarcoidosis, as well as the treatment options. Laryngeal sarcoidosis may present with atypical signs and symptoms and occasionally presents in pediatric patients. A high degree of suspicion is necessary for a correct diagnosis in these patients. Early diagnosis and proper management of laryngeal sarcoidosis is important, as the symptoms are debilitating and possibly life-threatening. Treatment may consist of local and systemic chemotherapy, and adjunctive procedures.
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Affiliation(s)
- Ross M Mayerhoff
- Stony Brook University School of Medicine, Stony Brook, New York, USA
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Abstract
Cardiac sarcoidosis is an underdiagnosed disease that may be present in as many as 25% of patients with systemic sarcoidosis. Although most commonly recognized in patients with other manifestations of sarcoidosis, it may occur in isolation and its presence is often not appreciated. Cardiac sarcoidosis may present as asymptomatic left ventricular dysfunction, congestive heart failure, atrioventricular block, atrial or ventricular arrhythmia and sudden death. Although untested in clinical trials, early use of high-dose steroid therapy may halt or reverse cardiac damage. This article reviews the clinical manifestations, diagnosis and treatment of sarcoidosis, with an emphasis on new imaging techniques and therapies.
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Current World Literature. Curr Opin Rheumatol 2010; 22:97-105. [DOI: 10.1097/bor.0b013e328334b3e8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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