Department of Pulmonary and Critical Care Medicine.
Department of Cardiovascular Medicine, and Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; and.
Ann Am Thorac Soc. 2019 Nov;16(11):1341-1350. doi: 10.1513/AnnalsATS.201902-119CME.
Increasing awareness of cardiac manifestations of sarcoidosis and the widespread availability of advanced imaging tests have led to a tidal wave of interest in a condition that was once considered rare. In this Focused Review, we explore important clinical questions that may confront specialists faced with possible cardiac involvement. In the absence of an ideal reference standard, three main sets of clinical criteria exist: the Japanese Ministry of Health and Welfare, the Heart Rhythm Society, and the World Association for Sarcoidosis and Other Granulomatous Disorders criteria. Once cardiac sarcoidosis is suspected, clinicians should be familiar with the prevalence of the disease in different clinical scenarios. Before obtaining advanced cardiac imaging, electrocardiogram, ambulatory electrocardiogram, echocardiogram, and B-type natriuretic peptide may be useful. The available therapies for cardiac sarcoidosis include immunosuppression, antiarrhythmic medications, heart failure medications, device therapy, ablation therapy, and heart transplantation. Contemporary data suggest that long-term survival in cardiac sarcoidosis is better than previously believed. There is no randomized controlled trial demonstrating benefits of screening, but screening is recommended based on observational data.
对结节病心脏表现的认识不断提高，以及先进影像学检查的广泛应用，使得这种曾经被认为罕见的疾病引起了广泛关注。在本次重点综述中，我们探讨了可能面临心脏受累的专家所面临的一些重要临床问题。在缺乏理想的参考标准的情况下，存在三套主要的临床标准：日本厚生劳动省、心律学会和世界结节病和其他肉芽肿性疾病协会标准。一旦怀疑患有心脏结节病，临床医生应熟悉该疾病在不同临床情况下的流行程度。在获得先进的心脏影像学检查之前，心电图、动态心电图、超声心动图和 B 型利钠肽可能有用。心脏结节病的可用治疗方法包括免疫抑制、抗心律失常药物、心力衰竭药物、器械治疗、消融治疗和心脏移植。现有数据表明，心脏结节病患者的长期生存率优于以往的认识。虽然没有随机对照试验证明筛查的益处，但基于观察性数据，推荐进行筛查。
