CHU Pitié Salpêtrière, Department of Internal Medicine II - Université Pierre et Marie Curie, Paris, France.
Curr Opin Pulm Med. 2013 Sep;19(5):493-502. doi: 10.1097/MCP.0b013e32836436da.
Heart involvement during sarcoidosis is a medical emergency. The review focuses on published data analysis of clinical management and therapy involving a multidisciplinary monitoring of cardiac sarcoidosis.
With the emergence of new modalities, especially MRI and FDG PET scan, cardiac sarcoidosis is most often suspected and confirmed even in atypical cases. Laboratory investigations may help to diagnose and survey. Cardiac sarcoidosis drastically changes functional and vital prognosis. Recent studies define earlier detrimental predictable criteria to underline how beneficial is the combination of immunosuppressive therapy and cardiac treatment to patients. There are no large prospective studies, but case reports and small series support an appropriate therapeutic approach, which includes corticosteroids and immunosuppressive agents.
Our review illustrates the importance of looking for cardiac sarcoidosis in all sarcoidosis patients and to propose more specific and sensitive investigations when suspected on clinical and/or electrical signs. It emphasizes the need for more adapted criteria and even more prognostic criteria to choose the best therapeutic option.
在结节病中,心脏受累是一种医疗急症。本综述重点分析了涉及心脏结节病多学科监测的临床管理和治疗方面的已发表数据。
随着新方法的出现,特别是 MRI 和 FDG PET 扫描,即使在非典型病例中,心脏结节病也常常被怀疑和确诊。实验室检查有助于诊断和监测。心脏结节病极大地改变了功能和预后。最近的研究定义了更早的可预测的不良预后标准,以强调免疫抑制治疗和心脏治疗对患者的益处。目前尚无大型前瞻性研究,但病例报告和小系列支持采用适当的治疗方法,包括皮质类固醇和免疫抑制剂。
我们的综述说明了在所有结节病患者中寻找心脏结节病的重要性,并在出现临床和/或电信号提示时建议进行更具体和敏感的检查。它强调需要更适应的标准,甚至更具预后的标准,以选择最佳的治疗方案。