Department of Cardiology, Royal Brisbane and Women' s Hospital, Butterfield Street, Herston, Queensland, Australia.
Eur Heart J Cardiovasc Imaging. 2012 Feb;13(2):E3. doi: 10.1093/ejechocard/jer184. Epub 2011 Oct 11.
Sarcoidosis is a multisystem granulomatous disease of unknown atiology and cardiac involvement can occur. Echocardiographic abnormalities, such as left ventricular dysfunction, segmental wall thinning, ventricular aneurysm, or valvular abnormalities are often subtle until the later stages of the disease. However, sarcoid has a predilection to cause ventricular arrhythmias or conduction system abnormalities in the early stages and hence may develop palpitations, syncope, or sudden death before structural abnormalities are detected. If patients with early cardiac sarcoid are identified, they respond well to corticosteroid therapy, and defibrillator implantation may reduce the risk of sudden death from malignant arrhythmias. We present a case of a patient with cardiac sarcoid, manifesting as conduction system disease. Cardiac magnetic resonance imaging demonstrated a sarcoid granuloma within the LV septum. Although the standard echocardiographic evaluation was unremarkable, this area corresponded to abnormal strain imaging on echo. Similarly, while conventional echocardiographic measurements failed to demonstrate a response to steroid therapy, strain imaging showed improved regional myocardial function. This coincided with improvement in the conduction abnormalities. This case study showed the potential of strain imaging in demonstrating cardiac involvement from sarcoidosis and in assessing the therapeutic response to corticosteroid therapy.
结节病是一种病因不明的多系统肉芽肿性疾病，可累及心脏。心脏超声异常，如左心室功能障碍、节段性壁变薄、室壁瘤或瓣膜异常，通常在疾病的晚期才变得明显。然而，结节病早期就容易引起室性心律失常或传导系统异常，因此在结构异常被发现之前，可能会出现心悸、晕厥或猝死。如果能识别出早期心脏结节病患者，他们对皮质类固醇治疗反应良好，植入除颤器可能会降低恶性心律失常导致猝死的风险。我们报告一例表现为传导系统疾病的心脏结节病患者。心脏磁共振成像显示左心室间隔有一个结节病肉芽肿。尽管标准超声心动图检查无明显异常，但该区域与超声心动图上的异常应变成像相对应。同样，虽然常规超声心动图测量未能显示对类固醇治疗的反应，但应变成像显示局部心肌功能改善。这与传导异常的改善相吻合。本病例研究显示了应变成像在显示结节病引起的心脏受累以及评估皮质类固醇治疗反应方面的潜力。
