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Israël-Biet D, Pastré J, Nunes H. Sarcoidosis-Associated Pulmonary Hypertension. J Clin Med 2024; 13:2054. [PMID: 38610818 PMCID: PMC11012707 DOI: 10.3390/jcm13072054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/25/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Sarcoidosis-associated pulmonary hypertension (SAPH) is a very severe complication of the disease, largely impacting its morbidity and being one of its strongest predictors of mortality. With the recent modifications of the hemodynamic definition of pulmonary hypertension (mean arterial pulmonary pressure >20 instead of <25 mmHg,) its prevalence is presently not precisely known, but it affects from 3 to 20% of sarcoid patients; mostly, although not exclusively, those with an advanced, fibrotic pulmonary disease. Its gold-standard diagnostic tool remains right heart catheterization (RHC). The decision to perform it relies on an expert decision after a non-invasive work-up, in which echocardiography remains the screening tool of choice. The mechanisms underlying SAPH, very often entangled, are crucial to define, as appropriate and personalized therapeutic strategies will aim at targeting the most significant ones. There are no recommendations so far as to the indications and modalities of the medical treatment of SAPH, which is based upon the opinion of a multidisciplinary team of sarcoidosis, pulmonary hypertension and sometimes lung transplant experts.
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Affiliation(s)
| | - Jean Pastré
- Service de Pneumologie, Hôpital Européen Georges Pompidou, AP-HP, 75015 Paris, France;
| | - Hilario Nunes
- Service de Pneumologie, Hôpital Avivenne, AP-HP, 93000 Bobigny, France;
- Inserm UMR 1272 “Hypoxie et Poumon”, UFR de Santé, Médecine et Biologie Humaine (SMBH), Université Sorbonne Paris-Nord, 93000 Bobigny, France
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2
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Liu A, Price LC, Sharma R, Wells AU, Kouranos V. Sarcoidosis Associated Pulmonary Hypertension. Biomedicines 2024; 12:177. [PMID: 38255282 PMCID: PMC10813665 DOI: 10.3390/biomedicines12010177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/09/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
In patients with sarcoidosis, the development of pulmonary hypertension is associated with significant morbidity and mortality. The global prevalence of sarcoidosis-associated pulmonary hypertension (SAPH) reportedly ranges between 2.9% and 20% of sarcoidosis patients. Multiple factors may contribute to the development of SAPH, including advanced parenchymal lung disease, severe systolic and/or diastolic left ventricular dysfunction, veno-occlusive or thromboembolic disease, as well as extrinsic factors such as pulmonary vascular compression from enlarged lymph nodes, anemia, and liver disease. Early diagnosis of SAPH is important but rarely achieved primarily due to insufficiently accurate screening strategies, which rely entirely on non-invasive tests and clinical assessment. The definitive diagnosis of SAPH requires right heart catheterization (RHC), with transthoracic echocardiography as the recommended gatekeeper to RHC according to current guidelines. A 6-min walk test (6MWT) had the greatest prognostic value in SAPH patients based on recent registry outcomes, while advanced lung disease determined using a reduced DLCO (<35% predicted) was associated with reduced transplant-free survival in pre-capillary SAPH. Clinical management involves the identification and treatment of the underlying mechanism. Pulmonary vasodilators are useful in several scenarios, especially when a pulmonary vascular phenotype predominates. End-stage SAPH may warrant consideration for lung transplantation, which remains a high-risk option. Multi-centered randomized controlled trials are required to develop existing therapies further and improve the prognosis of SAPH patients.
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Affiliation(s)
| | | | | | | | - Vasileios Kouranos
- Royal Brompton Hospital, Part of Guy’s and St. Thomas’ NHS Foundation Trust, London SW3 6NP, UK; (A.L.); (L.C.P.); (R.S.); (A.U.W.)
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3
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Averjanovaitė V, Gumbienė L, Zeleckienė I, Šileikienė V. Unmasking a Silent Threat: Improving Pulmonary Hypertension Screening Methods for Interstitial Lung Disease Patients. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:58. [PMID: 38256318 PMCID: PMC10820938 DOI: 10.3390/medicina60010058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/23/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024]
Abstract
This article provides a comprehensive overview of the latest literature on the diagnostics and treatment of pulmonary hypertension (PH) associated with interstitial lung disease (ILD). Heightened suspicion for PH arises when the advancement of dyspnoea in ILD patients diverges from the expected pattern of decline in pulmonary function parameters. The complexity of PH associated with ILD (PH-ILD) diagnostics is emphasized by the limitations of transthoracic echocardiography in the ILD population, necessitating the exploration of alternative diagnostic approaches. Cardiac magnetic resonance imaging (MRI) emerges as a promising tool, offering insights into hemodynamic parameters and providing valuable prognostic information. The potential of biomarkers, alongside pulmonary function and cardiopulmonary exercise tests, is explored for enhanced diagnostic and prognostic precision. While specific treatments for PH-ILD remain limited, recent studies on inhaled treprostinil provide new hope for improved patient outcomes.
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Affiliation(s)
| | - Lina Gumbienė
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, LT-03101 Vilnius, Lithuania;
| | | | - Virginija Šileikienė
- Clinic of Chest Diseases, Immunology and Allergology, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, LT-03101 Vilnius, Lithuania;
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4
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Gayen SK, Baughman RP, Nathan SD, Wells AU, Kouranos V, Alhamad EH, Culver DA, Barney J, Carmoma EM, Cordova FC, Huitema M, Scholand MB, Wijsenbeek M, Ganesh S, Birring SS, Price LC, Wort SJ, Shlobin OA, Gupta R. Pulmonary hemodynamics and transplant-free survival in sarcoidosis-associated pulmonary hypertension: Results from an international registry. Pulm Circ 2023; 13:e12297. [PMID: 37840561 PMCID: PMC10568201 DOI: 10.1002/pul2.12297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/17/2023] [Accepted: 10/06/2023] [Indexed: 10/17/2023] Open
Abstract
Pulmonary hypertension (PH) is a risk factor for mortality in patients with sarcoidosis. Severe PH in chronic lung disease has previously been defined as mean pulmonary arterial pressure (mPAP) ≥ 35 mmHg or mPAP 25 ≥ mmHg with cardiac index (CI) ≤ 2 L/min/m2. However, there is no clear definition denoting severity of sarcoidosis-associated PH (SAPH). We aimed to determine pulmonary hemodynamic cut-off values where transplant-free survival was worse among patients with SAPH. This was a retrospective cohort analysis of the Registry of SAPH database focusing on pulmonary hemodynamic predictors of transplant-free survival among patients with precapillary SAPH. Cox regression was performed to determine which pulmonary hemodynamic values predicted death or lung transplantation. Kaplan-Meier survival analysis was performed on statistically significant predictors to determine pulmonary hemodynamic cut-off values where transplant-free survival was decreased. Decreased transplant-free survival occurred among SAPH patients with mPAP ≥ 40 mmHg and SAPH patients with pulmonary vascular resistance (PVR) ≥ 5 Woods units (WU). Transplant-free survival was not decreased in patients who fulfilled prior criteria of severe PH in chronic lung disease. We identified new cut-offs with decreased transplant-free survival in the SAPH population. Neither cut-off of mPAP ≥ 40 mmHg nor PVR ≥ 5 WU has previously been shown to be associated with decreased transplant-free survival in SAPH. These values could suggest a new definition of severe SAPH. Our PVR findings are in line with the most recent European Society of Cardiology/European Respiratory Society guideline definition of severe PH in chronic lung disease.
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Affiliation(s)
- Shameek K. Gayen
- Department of Thoracic Medicine and SurgeryLewis Katz School of Medicine at Temple University HospitalPhiladelphiaPennsylvaniaUSA
| | - Robert P. Baughman
- Department of MedicineUniversity of Cincinnati Medical CenterCincinnatiOhioUSA
| | - Steven D. Nathan
- The Advanced Lung Disease and Transplant ProgramInova Fairfax HospitalFalls ChurchVirginiaUSA
| | - Athol U. Wells
- Interstitial Lung Disease/Sarcoidosis unitRoyal Brompton Hospital, National Heart and Lung Institute, Imperial College LondonLondonUK
| | - Vasilis Kouranos
- Interstitial Lung Disease/Sarcoidosis unitRoyal Brompton Hospital, National Heart and Lung Institute, Imperial College LondonLondonUK
| | - Esam H. Alhamad
- Division of Pulmonary Medicine, College of MedicineKing Saud UniversityRiyadhSaudi Arabia
| | - Daniel A. Culver
- Department of Pulmonary Medicine, and Department of Inflammation and ImmunityCleveland ClinicClevelandOhioUSA
| | - Joseph Barney
- The University of Alabama at Birmingham School of MedicineBirminghamAlabamaUSA
| | - Eva M. Carmoma
- Pulmonary and Critical Care, Mayo ClinicRochesterMinnesotaUSA
| | - Francis C. Cordova
- Department of Thoracic Medicine and SurgeryLewis Katz School of Medicine at Temple University HospitalPhiladelphiaPennsylvaniaUSA
| | - Marloes Huitema
- Department of CardiologySint Antonius HospitalNieuwegeinNetherlands
| | | | - Marlies Wijsenbeek
- Department of Respiratory MedicineCentre of Excellence for Interstitial Lung Diseases and Sarcoidosis, Erasmus Medical CentreRotterdamThe Netherlands
| | - Sivagini Ganesh
- Pulmonary, Critical Care and Sleep MedicineKeck School of Medicine of the University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Surinder S. Birring
- Centre for Human & Applied Physiological SciencesSchool of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College LondonLondonUK
| | - Laura C. Price
- National pulmonary hypertension serviceRoyal Brompton HospitalLondonUK
| | | | - Oksana A. Shlobin
- The Advanced Lung Disease and Transplant ProgramInova Fairfax HospitalFalls ChurchVirginiaUSA
| | - Rohit Gupta
- Department of Thoracic Medicine and SurgeryLewis Katz School of Medicine at Temple University HospitalPhiladelphiaPennsylvaniaUSA
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5
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Abstract
Sarcoidosis has a multitude of manifestations and affects the human body widely. Pulmonary complaints are most common; however, cardiac, optic, and neurologic manifestations carry high mortality and morbidity. Acute presentations in the emergency room can cause life-altering effects if not appropriately diagnosed and treated. Generally, less severe cases of sarcoidosis have a favorable prognosis and can be treated with steroid therapy. Resistant and more severe cases of the disease carry high mortality and morbidity. It is incredibly important to arrange specialty follow-up for these patients when needed. This review focuses on the acute presentations of sarcoidosis.
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Affiliation(s)
- Denrick Cooper
- Department of Emergency Medicine, Ochsner Health System, 1514 Jefferson Hwy, New Orleans, LA 71021, USA.
| | - Salvador Suau
- Emergency Medicine Residency, Department of Emergency Medicine, Ochsner Health System, New Orleans, LA, USA; Ochsner Emergency Department, 1514 Jefferson Hwy, New Orleans, LA 71021, USA
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Gayen S, Mamary AJ. Predictors of hospitalization for respiratory failure among patients with sarcoidosis‐associated pulmonary hypertension. Pulm Circ 2023; 13:e12212. [PMID: 37007935 PMCID: PMC10064856 DOI: 10.1002/pul2.12212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/27/2023] [Accepted: 03/21/2023] [Indexed: 04/03/2023] Open
Abstract
Pulmonary hypertension leads to significant morbidity and mortality in patients with sarcoidosis. In this study, we examined clinical factors associated with the risk of respiratory failure‐related hospitalization in 58 patients with sarcoidosis‐associated pulmonary hypertension. Pulmonary vasodilator therapy and spirometry were associated with reduced risk of hospitalization in this cohort.
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Affiliation(s)
- Shameek Gayen
- Thoracic Medicine and SurgeryLewis Katz School of Medicine at Temple University HospitalPhiladelphiaPennsylvaniaUSA
| | - Albert J. Mamary
- Thoracic Medicine and SurgeryLewis Katz School of Medicine at Temple University HospitalPhiladelphiaPennsylvaniaUSA
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Abstract
INTRODUCTION Advanced pulmonary sarcoidosis refers to phenotypes of pulmonary sarcoidosis that often lead to significant loss of lung function, respiratory failure, or death. Around 20% of patients with sarcoidosis may progress to this state which is mainly driven by advanced pulmonary fibrosis. Advanced fibrosis often presents with associated complications of sarcoidosis including infections, bronchiectasis, and pulmonary hypertension. AREAS COVERED This article will focus on the pathogenesis, natural history of disease, diagnosis, and potential treatment options of pulmonary fibrosis in sarcoidosis. In the expert opinion section, we will discuss the prognosis and management of patients with significant disease. EXPERT OPINION While some patients with pulmonary sarcoidosis remain stable or improve with anti-inflammatory therapies, others develop pulmonary fibrosis and further complications. Although advanced pulmonary fibrosis is the leading cause of death in sarcoidosis, there are no evidence-based guidelines for the management of fibrotic sarcoidosis. Current recommendations are based on expert consensus and often include multidisciplinary discussions with experts in sarcoidosis, pulmonary hypertension, and lung transplantation to facilitate care for such complex patients. Current works evaluating treatments include the use of antifibrotic therapies for treatment in advanced pulmonary sarcoidosis.
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Affiliation(s)
- Rohit Gupta
- Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA, USA
| | - Jin Sun Kim
- Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA, USA
| | - Robert P Baughman
- Department of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
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Vahdatpour C, Epstein S, Jones K, Smoot M, Parker A, Ryan J, Bryant A. A review of cardio-pulmonary microvascular dysfunction in pulmonary hypertension. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 26:100255. [PMID: 38510189 PMCID: PMC10946046 DOI: 10.1016/j.ahjo.2023.100255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/16/2023] [Accepted: 01/19/2023] [Indexed: 03/22/2024]
Abstract
Microvascular dysfunction progressing to pulmonary hypertension can be a primary cause of right ventricular failure or a secondary cause because of an underlying systemic illness. Little is known regarding the etiology and epidemiology of coronary microvascular dysfunction in pulmonary hypertension. Despite this limitation, its presence has been described in patients with pulmonary hypertension. This review focuses on the pathogenesis of cardiac and pulmonary microvascular dysfunction in pulmonary hypertension. Additionally, this review provides a contemporary assessment on the diagnosis and treatment of microvascular dysfunction in patients in pulmonary hypertension. This topic is important to raise awareness of microvascular dysfunction in the coronary and pulmonary circulation, so that future studies will investigate its impact on the pulmonary hypertension patient cohort.
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Affiliation(s)
- Cyrus Vahdatpour
- Department of Pulmonary Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
| | - Samuel Epstein
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Kirk Jones
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Madeline Smoot
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Alex Parker
- Department of Cardiology, University of Florida, Gainesville, FL, USA
| | - John Ryan
- Department of Cardiovascular Medicine, University of Utah, Salt Lake City, UT, USA
| | - Andrew Bryant
- Department of Pulmonary Critical Care and Sleep Medicine, University of Florida, Gainesville, FL, USA
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Lawrie A, Hamilton N, Wood S, Exposto F, Muzwidzwa R, Raiteri L, Beaudet A, Muller A, Sauter R, Pillai N, Kiely DG. Healthcare resource utilization and quality of life in patients with sarcoidosis-associated pulmonary hypertension. Pulm Circ 2022; 12:e12136. [PMID: 36204241 PMCID: PMC9525996 DOI: 10.1002/pul2.12136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/11/2022] [Accepted: 08/15/2022] [Indexed: 11/08/2022] Open
Abstract
A retrospective, observational cohort study was conducted to generate real-world evidence in adult patients diagnosed with sarcoidosis-associated pulmonary hypertension (SAPH) at a referral center in England between 2012 and 2019. Data from the referral center electronic medical record database were linked to the National Health Service Hospital Episode Statistics database to collect and analyze patient demographics, clinical characteristics, comorbidities, treatment patterns, health-related quality of life (HRQoL; assessed using the EmPHasis-10 questionnaire), healthcare resource utilization (HCRU), costs, and survival. Sixty-two patients with SAPH were identified. At diagnosis, 84% were in WHO functional class III and presented with significant pulmonary hemodynamic impairment. Cardiovascular and respiratory comorbidities were commonly reported prediagnosis. Median EmPHasis-10 score at diagnosis was 34, indicative of poor HRQoL. In the 1st year after diagnosis, median (Q1, Q3) per-patient HCRU was 1 (0, 2) all-cause inpatient hospitalizations; 3 (2, 4) same-day hospitalizations; and 9 (6, 11) outpatient consultations. In 24 patients who were hospitalized longer than 1 day in the 1st year after diagnosis, the median duration of hospitalization was 4 days. With a median follow-up of 1.8 years, the median overall survival was 2.9 years. In this cohort of patients with SAPH, poor HRQoL and high HCRU were observed following diagnosis. To our knowledge, this is the first study to report on HRQoL and HCRU in patients with SAPH. More research is needed on treatment options for this population with high unmet needs.
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Affiliation(s)
- Allan Lawrie
- National Heart and Lung Institute, Imperial College LondonLondonUK
- Insigneo Institute for In‐Silico MedicineUniversity of SheffieldSheffieldUK
| | - Neil Hamilton
- Sheffield Pulmonary Vascular Disease UnitSheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire HospitalSheffieldUK
| | - Steven Wood
- Insigneo Institute for In‐Silico MedicineUniversity of SheffieldSheffieldUK
- Scientific Computing, Sheffield Teaching Hospitals NHS Foundation TrustRoyal Hallamshire HospitalSheffieldUK
| | | | | | | | | | | | | | - Nadia Pillai
- Actelion Pharmaceuticals Ltd.AllschwilSwitzerland
| | - David G. Kiely
- Insigneo Institute for In‐Silico MedicineUniversity of SheffieldSheffieldUK
- Sheffield Pulmonary Vascular Disease UnitSheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire HospitalSheffieldUK
- Department of Infection, Immunity and Cardiovascular DiseaseUniversity of SheffieldSheffieldUK
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The role of eCIRP in bleomycin-induced pulmonary fibrosis in mice. PLoS One 2022; 17:e0266163. [PMID: 35377906 PMCID: PMC8979429 DOI: 10.1371/journal.pone.0266163] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 03/15/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE AND DESIGN We examined the role of eCIRP in the pathogenesis of bleomycin-induced pulmonary fibrosis (PF). MATERIAL AND METHODS Publicly available gene expression omnibus datasets were analyzed for the expression of CIRP in lung samples from patients with PF. Wild type (WT) or CIRP-/- mice received daily injections of 10 μg/g bleomycin for 10 days. A subset of bleomycin-injected WT mice was treated with the eCIRP antagonist C23 (8 μg/g/day) from day 10 to day 19. At three weeks, transthoracic echocardiography was performed to measure the degree of pulmonary hypertension, and lung tissues were collected and analyzed for markers of fibrosis. RESULTS Analysis of the mRNA data of human lung samples showed a significant positive correlation between CIRP and α-smooth muscle actin (α-SMA), an important marker of fibrosis. Moreover, the expression of CIRP was higher in patients with acute exacerbation of PF than in patients with stable PF. CIRP-/- mice showed attenuated induction of α-SMA and collagens (Col1a1, Col3a1), reduced hydroxyproline content, decreased histological fibrosis scores, and improved pulmonary hypertension as compared to WT mice. WT mice treated with C23 also had significant attenuation of the above endpoint measure. CONCLUSIONS Our study demonstrates that eCIRP plays a key role in promoting the development of PF, and blocking eCIRP with C23 can significantly attenuate this process.
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Zhang S, Tong X, Zhang T, Wang D, Liu S, Wang L, Fan H. Prevalence of Sarcoidosis-Associated Pulmonary Hypertension: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2022; 8:809594. [PMID: 35111830 PMCID: PMC8801498 DOI: 10.3389/fcvm.2021.809594] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/20/2021] [Indexed: 12/03/2022] Open
Abstract
Background Sarcoidosis-associated pulmonary hypertension (SAPH) is associated with poor prognosis, conferring up to a 10-fold increase in mortality in patients with sarcoidosis, but the actual prevalence of SAPH is unknown. Methods The PubMed, Embase, and Cochrane Library databases were systematically searched for epidemiological studies reporting the prevalence of SAPH up to July 2021. Two reviewers independently performed the study selection, data extraction, and quality assessment. Studies were pooled using random-effects meta-analysis. Results This meta-analysis included 25 high-quality studies from 12 countries, with a pooled sample of 632,368 patients with sarcoidosis. The prevalence of SAPH by transthoracic echocardiography in Europe, the United States and Asia was 18.8% [95% confidence interval (CI): 11.1–26.5%], 13.9% (95% CI: 5.4–22.4%) and 16.2% (95% CI: 7.1–25.4%) separately, and the overall pooled prevalence was 16.4% (95%CI: 12.2–20.5%). By right heart catheterization (RHC), the pooled prevalence of SAPH was 6.4% (95% CI: 3.6–9.1%) in general sarcoidosis population, and subgroup analyses showed that the prevalence of SAPH was 6.7% (95% CI: 2.4–11.0%) in Europe and 8.6% (95% CI: −4.1 to 21.3%) in the United States. Further, the prevalence of pre-capillary PH was 6.5% (95% CI: 2.9–10.2%). For the population with advanced sarcoidosis, the pooled prevalence of SAPH and pre-capillary PH by RHC was as high as 62.3% (95% CI: 46.9–77.6%) and 55.9% (95% CI: 20.1–91.7%), respectively. Finally, the pooled prevalence of SAPH in large databases with documented diagnoses (6.1%, 95% CI: 2.6–9.5%) was similar to that of RHC. Substantial heterogeneity across studies was observed for all analyses (I2 > 80%, P < 0.001). Conclusions The sarcoidosis population has a relatively low burden of PH, mainly pre-capillary PH. However, as the disease progresses to advanced sarcoidosis, the prevalence of SAPH increases significantly.
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12
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Abstract
Sarcoidosis has a multitude of manifestations and affects the human body widely. Pulmonary complaints are most common; however, cardiac, optic, and neurologic manifestations carry high mortality and morbidity. Acute presentations in the emergency room can cause life-altering effects if not appropriately diagnosed and treated. Generally, less severe cases of sarcoidosis have a favorable prognosis and can be treated with steroid therapy. Resistant and more severe cases of the disease carry high mortality and morbidity. It is incredibly important to arrange specialty follow-up for these patients when needed. This review focuses on the acute presentations of sarcoidosis.
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Affiliation(s)
- Denrick Cooper
- Department of Emergency Medicine, Ochsner Health System, 1514 Jefferson Hwy, New Orleans, LA 71021, USA.
| | - Salvador Suau
- Emergency Medicine Residency, Department of Emergency Medicine, Ochsner Health System, New Orleans, LA, USA; Ochsner Emergency Department, 1514 Jefferson Hwy, New Orleans, LA 71021, USA
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13
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Currie BM, Davies EW, Beaudet A, Stassek L, Kleinman L, Baughman RP. Symptoms, impacts, and suitability of the Pulmonary Arterial Hypertension-Symptoms and Impact (PAH-SYMPACT™) questionnaire in patients with sarcoidosis-associated pulmonary hypertension (SAPH): a qualitative interview study. BMC Pulm Med 2021; 21:365. [PMID: 34772372 PMCID: PMC8590341 DOI: 10.1186/s12890-021-01694-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 10/05/2021] [Indexed: 11/27/2022] Open
Abstract
Background Sarcoidosis-associated pulmonary hypertension (SAPH) is a prevalent and serious complication of sarcoidosis. No SAPH-specific self-report instruments for assessing SAPH symptoms and their impact on patients are available to date. This study sought to determine whether the Pulmonary Arterial Hypertension-Symptoms and Impact (PAH-SYMPACT™) questionnaire is suitable for use in patients with SAPH. Methods Patients diagnosed with SAPH participated in qualitative one-on-one telephone interviews to better understand SAPH symptoms and their impacts on patients’ lives and to determine the appropriateness of the PAH-SYMPACT™ for use in patients with SAPH. The interviews comprised concept elicitation, completion of the PAH-SYMPACT™, and cognitive debriefing. Interview transcripts were analyzed by content analysis. Results Eleven patients with SAPH were interviewed between August 2019 and June 2020. In the concept elicitation, all 11 participants endorsed shortness of breath and nine participants (82%) rated it as their “most bothersome or severe” symptom. Impacts endorsed by all 11 participants were difficulty walking uphill or up stairs and difficulty in performing daily activities. Cognitive debriefing indicated that the PAH-SYMPACT™ items were relevant and understandable to most participants and reflected their experiences of SAPH. Participants indicated that no key symptoms or impacts of SAPH were missing. They also reported that the PAH-SYMPACT™ instructions and response options were clear, and that it would be feasible to complete the 11 symptom items and one oxygen use item as part of their daily schedule. Conclusions This study suggests the PAH-SYMPACT™ is suitable for assessing symptoms and their impact in patients with SAPH. However, larger longitudinal studies are needed to confirm that it is fit for use in this patient population and that it can be used to reliably detect temporal changes in patients’ symptom status. Trial registration Not applicable. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01694-1.
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Affiliation(s)
| | - Evan W Davies
- Actelion Pharmaceuticals Ltd, Allschwil, Basel, Switzerland
| | - Amélie Beaudet
- Actelion Pharmaceuticals Ltd, Allschwil, Basel, Switzerland
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Abstract
Sarcoidosis is a multisystem disease of unknown cause with heterogenous clinical manifestations and variable course. Spontaneous remissions occur in some patients while others have progressive disease impacting survival, organ function, and quality of life. Four high-risk sarcoidosis phenotypes associated with chronic inflammation have recently been identified as high-priority areas for research. These include treatment-refractory pulmonary disease, cardiac sarcoidosis, neurosarcoidosis and multiorgan sarcoidosis. Significant gaps currently exist in understanding of these high-risk manifestations of sarcoidosis, including their natural history, diagnostic criteria, biomarkers, and the treatment strategy such as the ideal agent, optimal dose and treatment duration. The use of registries with well-phenotyped patients is a critical first step to study high-risk sarcoidosis manifestations systematically. We review the diagnostic and treatment approach to high-risk sarcoidosis manifestations. Appropriately identifying these disease sub-groups will help enroll well-phenotyped patients in sarcoidosis registries and clinical trials, a necessary step to narrow existing gaps in understanding of this enigmatic disease.
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15
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Alba AC, Gupta S, Kugathasan L, Ha A, Ochoa A, Balter M, Sosa Liprandi A, Sosa Liprandi MI. Cardiac Sarcoidosis: A Clinical Overview. Curr Probl Cardiol 2021; 46:100936. [PMID: 34400001 DOI: 10.1016/j.cpcardiol.2021.100936] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 07/17/2021] [Indexed: 12/26/2022]
Abstract
Cardiac sarcoidosis (CS) with clinical manifestation occurs in about 5-8% of patients with sarcoidosis. CS may be clinically suspected by the presence of ventricular arrhythmia, conduction abnormalities, and heart failure (HF). However, 20%-25% of patients may present with silent CS, having asymptomatic cardiac involvement. The diagnosis of CS is based on findings from nuclear studies, cardiac magnetic resonance, and extra-cardiac tissue biopsy. Due to the inflammatory nature of the disease, immunosuppressive medications are a cornerstone of therapy. The treatment also includes recommended HF medical therapies. Since CS patients are at risk of sudden cardiac death resulting from progression of cardiac dysfunction or the presence of scar originating from fatal arrhythmias, implantable cardioverter-defibrillators should be considered, with special indication beyond accepted recommendations in HF. In CS, the extent of left ventricular dysfunction is the most important mortality predictor. Heart transplant or mechanical circulatory support may represent life saving strategies in selective CS patients.
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Affiliation(s)
- Ana Carolina Alba
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
| | - Shyla Gupta
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Lakshmi Kugathasan
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Andrew Ha
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Alejandro Ochoa
- Echocardiography, Cardioestudio, Clinica Las Vegas, Medellin, Colombia
| | - Meyer Balter
- Division of Respiratory Medicine, Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada
| | - Alvaro Sosa Liprandi
- Department of Cardiology and Heart Failure, Sanatorio Güemes, Buenos Aires, Argentina
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16
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Abstract
PURPOSE OF REVIEW Pulmonary hypertension in sarcoidosis is a well known entity. Sarcoidosis-associated pulmonary hypertension (SAPH) incurs substantial morbidity and mortality. This review examines recent literatures published on epidemiology, prognosis and therapeutic management in SAPH. RECENT FINDINGS Several registries have been published between 2017 and 2020. The consensus conclusion - SAPH is a harbinger for poor prognosis. Several factors were noted for predicting adverse outcome in SAPH like reduced 6-min walk distance and diffusing capacity for carbon monoxide. Given its adverse outcome, experts have now focused on methods for early screening of SAPH in sarcoid patients. The exploration of pulmonary vasodilator drugs in SAPH is ongoing. In recent times, trials have been published utilizing Macitentan and parenteral prostacyclin in severe SAPH. Although these trials show encouraging results, the evidence from these studies are limited to approve these agents as preferred drugs for treating SAPH. A large multicentric trial of drugs used for pulmonary arterial hypertension with meaningful, yet feasible, event driven endpoint is still lacking. Lately, interventional treatment by pulmonary artery balloon pulmonary angioplasty and stenting has gained traction for treating pulmonary artery stenosis and chronic thromboembolic pulmonary hypertension. However, the conclusion is still based on small cohorts or case series. SUMMARY Several registries have highlighted SAPH portends an unfavorable consequence. On the contrary, no published guideline exists to treat SAPH. The precise role of immunosuppressive agents is unclear. The limited evidence favoring use of pulmonary vasodilators arise from small retrospective case series and/or single-center nonrandomized observational studies. Further multicenter randomized research is warranted to better define patient population to treat and how best to treat them.
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17
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Samaranayake CB, McCabe C, Wort SJ, Price LC. Sarcoidosis associated pulmonary hypertension: an update. Curr Opin Pulm Med 2021; 27:285-295. [PMID: 34127623 DOI: 10.1097/mcp.0000000000000793] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Sarcoidosis associated pulmonary hypertension (SAPH) is a well-recognised complication, associated with a seven-fold increase in mortality. This comprehensive review will summarise these recent developments and proposes the use of a phenotype-based management approach in SAPH. RECENT FINDINGS Recent registry-based studies have highlighted the adverse outcomes associated with SAPH and shown that reduced 6-min walk distance and diffusion capacity for carbon monoxide are predictive of poor prognosis. There is increasing interest in methods for early detection of SAPH, although whether early diagnosis impacts on survival remains uncertain. The pathophysiology underpinning SAPH is complex and often incorporates multiple mechanisms. Once the diagnosis is confirmed, understanding the underlying phenotypes of SAPH is key to providing the most effective management plan. There is some evidence that treating patients with precapillary PH with pulmonary vasodilators may improve some haemodynamic and quality life measures. However, more work is needed to determine whether mortality is affected. SUMMARY SAPH is associated with worsened survival. A range of phenotypes are recognised in SAPH. Multimodality risk assessment in patients with SAPH is likely to be important and is an area that requires further work. Published evidence for pulmonary vasodilator therapies in SAPH with a Pulmonary arterial hypertension-like phenotype is encouraging so far, but multiple confounding factors affects the quality of the evidence. The role of immunosuppressive agents for improving pulmonary pressures is unclear. Urgent controlled trials are needed.
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Affiliation(s)
| | - Colm McCabe
- National Pulmonary Hypertension Service, Royal Brompton Hospital.,National Lung and Heart Institute, Imperial College London, London, UK
| | - Stephen John Wort
- National Pulmonary Hypertension Service, Royal Brompton Hospital.,National Lung and Heart Institute, Imperial College London, London, UK
| | - Laura C Price
- National Pulmonary Hypertension Service, Royal Brompton Hospital.,National Lung and Heart Institute, Imperial College London, London, UK
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18
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Correlation between Potential Risk Factors and Pulmonary Embolism in Sarcoidosis Patients Timely Treated. J Clin Med 2021; 10:jcm10112462. [PMID: 34199396 PMCID: PMC8199598 DOI: 10.3390/jcm10112462] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/28/2021] [Accepted: 05/31/2021] [Indexed: 12/21/2022] Open
Abstract
Background. Some studies with inconclusive results have reported a link between sarcoidosis and an increased risk of pulmonary embolism (PE). This study aimed at assessing a possible correlation between potential risk factors and PE in sarcoidosis patients. Methods. A total of 256 sarcoidosis patients (84 males and 172 females; mean age at diagnosis 49 ± 13) were enrolled after giving written informed consent. Clinical evaluations, laboratory and radiology tests were performed to evaluate the presence of pulmonary embolism. Results. Fifteen sarcoidosis patients with PE (4 males and 11 females; mean age at diagnosis 50 ± 11), diagnosed by lung scintigraphy and 241 sarcoidosis patients without PE (80 males and 161 females; mean age at diagnosis 47 ± 13), were observed. There was a statistically significant increase of the presence of antiphospholipid antibodies in the sarcoidosis group with pulmonary embolism. There was no statistically significant difference between the two groups as to smoking habit, obesity or hereditary thrombophilia frequency (p > 0.05, respectively). Conclusions. This study demonstrates a significant correlation between the presence of antiphospholipid antibody positivity and the pulmonary embolism events in our sarcoidosis patients. Furthermore, we propose screening for these antibodies and monitoring, aimed at timely treatment.
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19
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Mathijssen H, Huitema MP, Bakker ALM, Smits F, Mager JJ, Snijder RJ, Grutters JC, Post MC. Clinical Phenotypes of Sarcoidosis-Associated Pulmonary Hypertension. Heart Lung Circ 2021; 30:1502-1508. [PMID: 33933365 DOI: 10.1016/j.hlc.2021.03.279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 02/03/2021] [Accepted: 03/30/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND OBJECTIVE Pulmonary hypertension (PH) is a known complication of pulmonary sarcoidosis and its aetiology is unclear. Different pathophysiological mechanisms in sarcoidosis-associated pulmonary hypertension (SAPH) are known. Clinical phenotyping can aid clinicians in choosing the optimal treatment strategy. This study aimed to describe clinical phenotypes of SAPH and their characteristics. METHODS A retrospective cohort study was performed on all SAPH patients at a tertiary referral centre. All patients were extensively analysed and discussed case by case in a multidisciplinary expert team to determine the most likely pathophysiological mechanism of PH. Patients were then classified into conceptual clinical phenotypes. RESULTS Forty (40) patients with SAPH were identified between 2010 and 2019. Three (3) patients were classified as the postcapillary phenotype. Of the remaining 37 patients with precapillary PH, six were classified as 'compression of pulmonary vasculature', 29 as 'parenchymal', one as 'suspected vasculopathy', and one as 'chronic pulmonary emboli' phenotypes. Of the patients with compression of pulmonary vasculature, four showed compression by fibrotic disease and two by active sarcoidosis-based disease. Within the parenchymal phenotype, 20 patients (69%) showed pulmonary vascular resistance >3.0 Wood Units (WU) and had significantly lower diffusing capacity of the lung for carbon monoxide compared with the nine patients (31%) with pulmonary vascular resistance ≤3.0 WU. CONCLUSION SAPH had multiple pathophysiological mechanisms and clinical phenotypes in this retrospective study. Further studies are necessary to examine how these phenotypes can affect appropriate treatment and prognosis.
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Affiliation(s)
- Harold Mathijssen
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
| | - Marloes P Huitema
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Annelies L M Bakker
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Fokko Smits
- Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Johannes J Mager
- Department of Pulmonology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Repke J Snijder
- Department of Pulmonology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Jan C Grutters
- Department of Pulmonology, St. Antonius Hospital, Nieuwegein, The Netherlands; Department of Pulmonology, Utrecht University Medical Center, Utrecht University, The Netherlands
| | - Marco C Post
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands; Department of Cardiology, Utrecht University Medical Center, Utrecht University, The Netherlands
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20
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Guber E, Wand O, Epstein Shochet G, Romem A, Shitrit D. The Short- and Long-Term Impact of Pulmonary Rehabilitation in Subjects with Sarcoidosis: A Prospective Study and Review of the Literature. Respiration 2021; 100:423-431. [PMID: 33784708 DOI: 10.1159/000514917] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/29/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sarcoidosis is a heterogeneous multisystemic disorder of unknown etiology. Dyspnea and fatigue are two of the most common and debilitating symptoms experienced by subjects with sarcoidosis. There is limited evidence regarding the short- and long-term impact of pulmonary rehabilitation (PR) on exercise capacity and fatigue in these individuals. OBJECTIVE To evaluate the benefit of PR in subjects with pulmonary sarcoidosis at different severity stages and to review the current literature about PR in sarcoidosis. METHODS PR included a 12-week training program of a twice-weekly 90-min workouts. Fifty-two subjects with stable pulmonary sarcoidosis were recruited. Maximal exercise capacity, defined as VO2max, was measured using the cardiopulmonary exercise test (CPET). Pulmonary function tests, 6-min walking distance (6MWD), St. George's Respiratory Questionnaire (SGRQ), and the modified Medical Research Council (mMRC) and Hospital Anxiety and Depression Scale (HADS) questionnaires were given before and after PR and following 6 months (follow-up). RESULTS The PR program significantly increased the VO2max (1.8 ± 2.3 mL/kg/min, p = 0.002), following 12 weeks. mMRC and SGRQ scores were also improved (-0.3 ± 0.8, p = 0.03, and -3.87 ± 10.4, p = 0.03, respectively). The impact of PR on VO2max was more pronounced in subjects with pulmonary parenchymal involvement. The increase in VO2max correlated with initial disease severity (indicated by FEV1/FVC, p = 0.01). Subjects with FEV1/FVC <70% showed greater improvement in 6MWD. 6MWD also improved in those with a transfer coefficient of the lung for CO (KCO) above 80% predicted (p < 0.05). At 6-month follow-up, the VO2max, 6MWD, and SGRQ scores remained stable, thus suggesting lasting effects of PR. CONCLUSION PR is a promising complementary therapeutic intervention for subjects with sarcoidosis. Further study is needed to validate these findings.
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Affiliation(s)
- Elad Guber
- Pulmonary Department, Meir Medical Center, Kfar Saba, Israel
| | - Ori Wand
- Pulmonary Department, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gali Epstein Shochet
- Pulmonary Department, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ayal Romem
- Pulmonary Department, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Shitrit
- Pulmonary Department, Meir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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21
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Lui JK, Mesfin N, Tugal D, Klings ES, Govender P, Berman JS. Critical Care of Patients With Cardiopulmonary Complications of Sarcoidosis. J Intensive Care Med 2021; 37:441-458. [PMID: 33611981 DOI: 10.1177/0885066621993041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sarcoidosis is a systemic inflammatory disease defined by the presence of aberrant granulomas affecting various organs. Due to its multisystem involvement, care of patients with established sarcoidosis becomes challenging, especially in the intensive care setting. While the lungs are typically involved, extrapulmonary manifestations also occur either concurrently or exclusively within a significant proportion of patients, complicating diagnostic and management decisions. The scope of this review is to focus on what considerations are necessary in the evaluation and management of patients with known sarcoidosis and their associated complications within a cardiopulmonary and critical care perspective.
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Affiliation(s)
- Justin K Lui
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA.,Section of Pulmonary, Allergy, Sleep & Critical Care Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Nathan Mesfin
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA.,Section of Pulmonary, Allergy, Sleep & Critical Care Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Derin Tugal
- Section of Cardiovascular Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Elizabeth S Klings
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA.,Section of Pulmonary, Allergy, Sleep & Critical Care Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Praveen Govender
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA.,Section of Pulmonary, Allergy, Sleep & Critical Care Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Jeffrey S Berman
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA.,Section of Pulmonary, Allergy, Sleep & Critical Care Medicine, Boston University School of Medicine, Boston, MA, USA
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22
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Sumimoto K, Taniguchi Y, Emoto N, Hirata KI. Combination therapy with pulmonary arterial hypertension targeted drugs and immunosuppression can be a useful strategy for sarcoidosis-associated pulmonary hypertension: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 5:ytaa454. [PMID: 33554014 PMCID: PMC7850610 DOI: 10.1093/ehjcr/ytaa454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/11/2020] [Accepted: 11/05/2020] [Indexed: 01/25/2023]
Abstract
Background Pulmonary hypertension (PH) is one of the significant complications of sarcoidosis. In the clinical classification of PH proposed in the recent world symposium of PH 2018, sarcoidosis-associated PH is classified in Group 5. The mechanisms of sarcoidosis-associated PH are very heterogeneous. There is no evidence of effective treatment for this condition. Case summary We report a case of a 46-year-old female who developed severe pulmonary hypertension due to sarcoidosis. Her haemodynamics, exercise capacity, and functional class remarkably improved after the treatment with pulmonary arterial hypertension (PAH) targeted drugs including macitentan and tadalafil and secondary immunosuppressive therapy with corticosteroids. Discussion This case emphasizes the importance of considering the underlying mechanisms of sarcoidosis-associated PH in order to choose appropriate treatment.
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Affiliation(s)
- Keiko Sumimoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Yu Taniguchi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Noriaki Emoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Japan
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23
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Thillai M, Atkins CP, Crawshaw A, Hart SP, Ho LP, Kouranos V, Patterson K, Screaton NJ, Whight J, Wells AU. BTS Clinical Statement on pulmonary sarcoidosis. Thorax 2020; 76:4-20. [PMID: 33268456 DOI: 10.1136/thoraxjnl-2019-214348] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Muhunthan Thillai
- Cambridge Interstitial Lung Disease Unit, Royal Papworth Hospital, Cambridge, Cambridgeshire, UK
| | - Christopher P Atkins
- Department of Respiratory Medicine, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK
| | - Anjali Crawshaw
- Interstitial Lung Disease Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, UK
| | - Simon P Hart
- Respiratory Research Group, Hull York Medical School/University of Hull, Cottingham, UK
| | - Ling-Pei Ho
- MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, Oxford, UK.,Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK
| | - Vasileios Kouranos
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, London, UK
| | - Karen Patterson
- Department of Clinical and Experimental Medicine, Brighton and Sussex Medical School, Brighton, UK
| | | | | | - Athol U Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, London, UK
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24
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Crouser ED, Maier LA, Wilson KC, Bonham CA, Morgenthau AS, Patterson KC, Abston E, Bernstein RC, Blankstein R, Chen ES, Culver DA, Drake W, Drent M, Gerke AK, Ghobrial M, Govender P, Hamzeh N, James WE, Judson MA, Kellermeyer L, Knight S, Koth LL, Poletti V, Raman SV, Tukey MH, Westney GE. Diagnosis and Detection of Sarcoidosis. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2020; 201:e26-e51. [PMID: 32293205 PMCID: PMC7159433 DOI: 10.1164/rccm.202002-0251st] [Citation(s) in RCA: 466] [Impact Index Per Article: 116.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: The diagnosis of sarcoidosis is not standardized but is based on three major criteria: a compatible clinical presentation, finding nonnecrotizing granulomatous inflammation in one or more tissue samples, and the exclusion of alternative causes of granulomatous disease. There are no universally accepted measures to determine if each diagnostic criterion has been satisfied; therefore, the diagnosis of sarcoidosis is never fully secure. Methods: Systematic reviews and, when appropriate, meta-analyses were performed to summarize the best available evidence. The evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation approach and then discussed by a multidisciplinary panel. Recommendations for or against various diagnostic tests were formulated and graded after the expert panel weighed desirable and undesirable consequences, certainty of estimates, feasibility, and acceptability. Results: The clinical presentation, histopathology, and exclusion of alternative diagnoses were summarized. On the basis of the available evidence, the expert committee made 1 strong recommendation for baseline serum calcium testing, 13 conditional recommendations, and 1 best practice statement. All evidence was very low quality. Conclusions: The panel used systematic reviews of the evidence to inform clinical recommendations in favor of or against various diagnostic tests in patients with suspected or known sarcoidosis. The evidence and recommendations should be revisited as new evidence becomes available.
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