Ipek Emrah, Demirelli Selami, Ermis Emrah, Yıldırım Erkan, Öztürk Mustafa, Yolcu Mustafa, Araz Ömer, Kalkan Kamuran
Department of Cardiology, Erzurum Training and Research Hospital, Erzurum, Turkey.
Department of Cardiology, Arel University, Medicana Hospital, Istanbul, Turkey.
J Investig Med. 2016 Mar;64(3):759-63. doi: 10.1136/jim-2015-000027. Epub 2016 Feb 12.
The clinical manifestations of cardiac involvement are seen in about 5% of patients with sarcoidosis; however, the incidence of cardiac involvement is higher in the autopsy series. About 14% of patients with pulmonary sarcoidosis (PS) without known cardiac involvement had diastolic dysfunction.We aimed to determine the role of parameters of right ventricular (RV) systolic and diastolic function in patients with PS without evidence of cardiac symptoms. Our study population consisted of 28 patients with grades 1-4 PS and 24 healthy subjects. This study was a clinical prospective cohort study. RV end-diastolic area was found to be significantly higher in the PS group (p=0.032). RV fractional area change (RVFAC) and tricuspid annular plane systolic excursion (TAPSE) were shown to be statistically lower in the PS group as compared to the control group (p<0.001). However, pulmonary arterial systolic pressure was significantly higher in the PS group (p=0.003). The tricuspid E velocity and E/A ratio were found to be significantly lower in the PS group (p=0.025 and 0.009, respectively), while the tricuspid A velocity and myocardial performance index (MPI) were found to be significantly lower in the control group (p=0.034 and 0.007, respectively). Early detection of cardiac involvement in PS is crucial because of the increased morbidity and risk of sudden cardiac death. RV diastolic Doppler parameters, tissue Doppler MPI, RVFAC and TAPSE are practical and cheap techniques in the diagnosis of cardiac involvement in patients with PS. A thorough transthorasic echocardiographic examination including RV systolic and diastolic functions and tissue Doppler MPI should constitute the mainstay of initial management and follow-up in PS.
结节病患者中约5%会出现心脏受累的临床表现；然而，尸检系列中心脏受累的发生率更高。约14%无已知心脏受累的肺结节病（PS）患者存在舒张功能障碍。我们旨在确定右心室（RV）收缩和舒张功能参数在无心脏症状证据的PS患者中的作用。我们的研究人群包括28例1-4级PS患者和24名健康受试者。本研究为临床前瞻性队列研究。发现PS组的RV舒张末期面积显著更高（p=0.032）。与对照组相比，PS组的RV面积变化分数（RVFAC）和三尖瓣环平面收缩期位移（TAPSE）在统计学上更低（p<0.001）。然而，PS组的肺动脉收缩压显著更高（p=0.003）。发现PS组的三尖瓣E峰速度和E/A比值显著更低（分别为p=0.025和0.009），而对照组的三尖瓣A峰速度和心肌性能指数（MPI）显著更低（分别为p=0.034和0.007）。由于发病率增加和心脏性猝死风险，早期发现PS患者的心脏受累至关重要。RV舒张期多普勒参数、组织多普勒MPI、RVFAC和TAPSE是诊断PS患者心脏受累的实用且廉价的技术。包括RV收缩和舒张功能以及组织多普勒MPI的全面经胸超声心动图检查应构成PS初始管理和随访的主要内容。
