Cardiac sarcoidosis

Hiramastu S, Tada H, Naito S, Oshima S, Taniguchi K. Steroid treatment deteriorated ventricular tachycardia in a patient with right ventricle-dominant cardiac sarcoidosis. Int J Cardiol 2009 132(2) e85-7. 

Takashige N, Naruse TK, Matsumori A, et al. Genetic polymorphisms at the tumour necrosis factor loci (TNFA and TNFB) in cardiac sarcoidosis. Tissue Antigens 1999 54(2) 191-193. 

Naruse TK, Matsuzawa Y, Ota M, et al. HLA-DQB1 0601 is primarily associated with the susceptibility to cardiac sarcoidosis. Tissue Antigens 2000 56(l) 52-57. 

The dose of glucocorticoids varies widely. Most studies have used initial doses of 20 to 40 mg/day of prednisone or its equivalent and then decrease the dose as tolerated. For pulmonary sarcoidosis, there is no clear-cut evidence for any particular initial dose of prednisone (21). In cardiac sarcoidosis, survival rates did not differ among patients treated with initial dose of >30-mg prednisone daily compared with lower doses (33). 

Yazaki Y, Isohe M, Hiroe M, et al. Prognostic determinants of long-term survival in Japanese patients with cardiac sarcoidosis treated with prednisone. Am J Cardiol 2001 88 1006-1010. 

Iwai K, Sekiguti M, Hosoda Y, et al. Racial difference in cardiac sarcoidosis incidence observed at autopsy. Sarcoidosis 1994 11(1) 26-31. 

Takeda N, Yokoyama I, Hiroi Y, et al. Positron emission tomography predicted recovery of complete A-V nodal dysfunction in a patient with cardiac sarcoidosis. Circulation 2002 105(9) 1144-1145. 

Although 25% of patients show evidence of granulomatous inflammation affecting the heart on autopsy (108), only 5% of patients with sarcoidosis have signs or symptoms of cardiac involvement pre-mortem (109). Sarcoidosis also seems to be much more common in the Japanese. In the United States, 13% to 50% of sarcoidosis deaths have been attributed to cardiac involvement (110, 111) compared to 85% in Japan (112,113). ACCESS (an American study with few individuals of Japanese descent) did not demonstrate a predilection for the presence or cardiac sarcoidosis at diagnosis or its development over time on the basis of race, age, or gender (28,114). 

Each of these noninvasive tests have a different sensitivity and specificity. Unfortunately, an algorithm for the diagnosis of cardiac sarcoidosis has not been determined because of the diagnostic limitations of the gold standard, which is endomyocardial biopsy. Moreover, when noninvasive tests are compared with each other within the same clinical trials, there is a poor concordance of the tests such that a negative result on any one test does not ensure the possibility of another test being positive (120,133,135). 

These data suggest that symptomatic cardiac sarcoidosis should be treated aggressively and early. Subjects should be monitored closely for the development of... 

Figure 10 See color insert.) (A) A cardiac PET scan from a patient with mild cardiac sarcoidosis presenting with asymptomatic premature ventricular contractions. The PET scan reveals localized ventricular uptake. (B) A cardiac PET scan from a patient with severe cardiac sarcoidosis presenting with severe left ventricular dysfunction and ventricular arrhythmias. He developed a left ventricular thrombus from a wall motion abnormality and had an internal automatic defibrillator placed that fired several times before his disease was controlled.

The managemait of asymptomatic cardiac sarcoidosis is controversial. One study demonstrated that sarcoidosis patioits with asymptomatic cardiac involvement had an excellent prognosis without therapy (142). However only three3 such patients were found out of 82 patients screened, making this conclusion suspect. 

Tachibana T, Ohmori F, Ueda E. Clinical study on cardiac sarcoidosis. Ann NY Acad Sci 1986 465 530-542. 

Fasano R, Rimmerman CM, Jaber WA. Cardiac sarcoidosis a cause of infiltrative cardiomyopathy. Cleve Clin J Med 2004 71 483 88. 

Desai MY, Fallert MA. Rapidly progressing congestive heart failure due to cardiac sarcoidosis involving papillary muscles a case report and brief review of the literature. Cardiol Rev 2003 11 163-168. 

Sekiguchi M, Yazaki Y, Isobe M, et al. Cardiac sarcoidosis diagnostic, prognostic, and therapeutic considerations. Cardiovasc Drugs Ther 1996 10 495-510. 

Chapelon-Abric C, de Zuttere D, DuHaut P, et al. Cardiac sarcoidosis a retrospective study of 41 cases. Medicine 2004 83 315-334. 

Judson MA. Cardiac sarcoidosis there is no instant replay. Chest 2005 128 3-6 (editorial). 

Uemura A, Morimoto S, Hiramitsu S, et al. Histologic diagnostic rate of cardiac sarcoidosis evaluation of endomyocardial biopsies. Am Heart J 1999 138 299-302. 

Umetani K, Ishihara T, Sawanobori T, et al. Successfully treated complete atrioventricular block with corticosteroid in a patient with cardiac sarcoidosis usefulness of Gallium-67 and thallium-201 scintigraphy. Intern Med 2000 39 245-248. 

Nakazawa A, Ikeda K, Ito Y, et al. Usefulness of dual Ga and Tc-sestamibi single-photon-emission scanning in the diagnosis of cardiac sarcoidosis. Chest 2004 126 1372-1376. 

Doherty MJ, Kumar K, Nicholson AA, et al. Cardiac sarcoidosis the value of magnetic resonance imagine in diagnosis and assessment of response to treatment. Respir Med 1998 92 697-699. 

Shitnada T, Shitnada K, Sakane T, et al. Diagnosis of cardiac sarcoidosis and evaluation of the effects of steroid therapy by gadoUnium-DPTA-enhanced magnetic resonance imaging. Am J Med 2001 110 520-527. 

Bagg SA, Gordon LL, Judson MA. Diagnostic yield of non invasive tests for cardiac sarcoidosis. Proc Am Thorac Soc 2005 2 A864(abstr). 

Hiraga H, Yuwai K, Hiroe M, et al. Guideline for the Diagnosis of Cardiac Sarcoidosis Study Report on Diffuse Pulmonary Diseases [Japanese]. Toyko, Japan Ministry of Health and Welfare 1993 23-24. 

Mezaki T, Chinushi M, Washizuka T, et al. Discrepancy between inducibility of ventricular tachycardia and activity of cardiac sarcoidosis requirement of defibrillator implantation for the inactive stage of cardiac sarcoidosis. Intern Med 2001 40 731-735. 

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