Mehta Davendra, Lubitz Steven A, Frankel Zev, Wisnivesky Juan P, Einstein Andrew J, Goldman Martin, Machac Josef, Teirstein Alvin
Zena and Michael Wiener Cardiovascular Institute, Department of Radiology, Mount Sinai School of Medicine, New York, NY.
Zena and Michael Wiener Cardiovascular Institute, Department of Radiology, Mount Sinai School of Medicine, New York, NY.
Chest. 2008 Jun;133(6):1426-1435. doi: 10.1378/chest.07-2784. Epub 2008 Mar 13.
Cardiac sarcoidosis (CS) causes substantial morbidity and sudden death. Early diagnosis and risk stratification are warranted.
Ambulatory patients with sarcoidosis were interviewed to determine whether they experienced palpitations, syncope, or presyncope, and were evaluated with ECG, Holter monitoring, and echocardiography (transthoracic echocardiogram [TTE]). Those with symptoms or abnormal results were studied with cardiac MRI (CMRI) or positron emission tomography (PET) scanning. The diagnosis of CS was based on abnormalities detected by these imaging studies. Patients with CS were referred for risk stratification by electrophysiology study (EPS).
Among the 62 patients evaluated, the prevalence of CS was 39%. Patients with CS had more cardiac symptoms than those without CS (46% vs 5%, respectively; p < 0.001), and were more likely to have abnormal Holter monitoring findings (50% vs 3%, respectively; p < 0.001) and TTE findings (25% vs 5%, respectively; p = 0.02). The degree of pulmonary impairment did not predict CS. Two of the 17 patients who underwent EPS had abnormal test findings and received implantable cardioverter-defibrillators. No patients died, had ventricular arrhythmias that triggered defibrillator therapy, or had heart failure develop during almost 2 years of follow-up. This diagnostic approach was more sensitive than the established criteria for identifying CS.
CS is common among patients with sarcoidosis. A structured clinical assessment incorporating advanced cardiac imaging with PET scanning or CMRI is more sensitive than the established criteria for the identification of CS. Sarcoidal lesions seen on CMRI or PET scanning do not predict arrhythmias in ambulatory patients with preserved cardiac function, who appear to be at low risk for short-term mortality.
心脏结节病（CS）可导致严重发病和猝死。早期诊断和风险分层很有必要。
对门诊结节病患者进行访谈，以确定他们是否有心悸、晕厥或接近晕厥的症状，并通过心电图、动态心电图监测和超声心动图（经胸超声心动图 [TTE]）进行评估。有症状或检查结果异常的患者接受心脏磁共振成像（CMRI）或正电子发射断层扫描（PET）检查。CS的诊断基于这些影像学检查发现的异常。CS患者被转介进行电生理检查（EPS）以进行风险分层。
在评估的62例患者中，CS的患病率为39%。CS患者比无CS患者有更多的心脏症状（分别为46%和5%；p < 0.001），并且更有可能有动态心电图监测异常结果（分别为50%和3%；p < 0.001）和TTE检查结果异常（分别为25%和5%；p = 0.02）。肺部损害程度不能预测CS。17例接受EPS检查的患者中有2例检查结果异常并接受了植入式心脏复律除颤器。在近2年的随访中，没有患者死亡、发生触发除颤器治疗的室性心律失常或出现心力衰竭。这种诊断方法比既定的CS识别标准更敏感。
CS在结节病患者中很常见。结合PET扫描或CMRI等先进心脏成像的结构化临床评估比既定的CS识别标准更敏感。在心脏功能保留的门诊患者中，CMRI或PET扫描所见的结节样病变不能预测心律失常，这些患者似乎短期死亡风险较低。
