Division of Cardiology, University of Ottawa Heart Institute, The Ottawa Hospital, Ottawa, Ontario, Canada.
Curr Opin Cardiol. 2012 Mar;27(2):181-9. doi: 10.1097/HCO.0b013e32834e4c7c.
Sarcoidosis is a granulomatous disease of unclear cause and variable presentation. Cardiac involvement can result in life-threatening conditions including heart block, ventricular tachycardia, sudden cardiac death, and heart failure. There is no consensus on the diagnosis and management of cardiac sarcoidosis and a practical update is needed to provide clinicians with guidance.
Three recent studies have described cardiac manifestations as the first presentation of sarcoidosis. In one study, cardiac sarcoidosis was found to be the underlying cause in 19% of adults aged less than 55 years presenting with new onset unexplained atrioventricular block. Also, there are increasing reports of patients with isolated cardiac sarcoidosis (i.e., without sarcoid in other organs). Finally, advances in imaging have enhanced our ability to detect myocardial involvement and perhaps follow response to treatment.
Cardiac sarcoidosis should be considered in patients aged less than 55 years presenting with unexplained atrioventricular block and in patients with idiopathic cardiomyopathy and sustained ventricular tachycardia. Much remains to be learned about the condition, including the role of steroids and devices in treatment, and the place of advanced imaging in following the response to treatment. Collaborative multicenter studies are required to answer these important clinical questions.
结节病是一种病因不明、临床表现多样的肉芽肿性疾病。心脏受累可导致危及生命的情况，包括心脏传导阻滞、室性心动过速、心脏性猝死和心力衰竭。目前尚无关于心脏结节病的诊断和治疗的共识，需要进行实用的更新，为临床医生提供指导。
三项最近的研究描述了心脏表现作为结节病的首发表现。在一项研究中，在 19%年龄小于 55 岁的新发原因不明的房室传导阻滞的成年人中，发现心脏结节病是潜在病因。此外，越来越多的报告显示存在孤立性心脏结节病（即无其他器官的结节病）。最后，成像技术的进步提高了我们检测心肌受累并可能随访治疗反应的能力。
对于年龄小于 55 岁的新发不明原因房室传导阻滞的患者，以及特发性扩张型心肌病和持续性室性心动过速的患者，应考虑心脏结节病。关于这种疾病，仍有许多问题有待了解，包括类固醇和器械治疗的作用，以及高级成像在治疗反应随访中的作用。需要进行协作的多中心研究来回答这些重要的临床问题。
