Tanizawa Kiminobu, Handa Tomohiro, Nagai Sonoko, Yokomatsu Takafumi, Ueda Seigen, Ikezoe Kohei, Ogino Shumpei, Hirai Toyohiro, Izumi Takateru
Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Advanced Medicine for Respiratory Failure, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Respir Investig. 2022 May;60(3):385-392. doi: 10.1016/j.resinv.2022.02.001. Epub 2022 Mar 10.
Basal interventricular septum (IVS) thinning on transthoracic echocardiography (TTE) is highly specific to cardiac sarcoidosis. Although basal IVS thinning is listed as one of the five major diagnostic criteria for cardiac sarcoidosis, its association with long-term cardiac function has not been investigated. This study aimed to evaluate the epidemiology and clinical relevance of basal IVS thinning in a clinic-based cohort of patients with sarcoidosis.
This retrospective observational study was conducted at a general sarcoidosis clinic. The incidence of basal IVS thinning and associations with variables at baseline and a delayed onset of left ventricular (LV) dysfunction (LV ejection fraction [LVEF] < 50%) were analyzed.
Of the 1009 patients, 23 (2.3%) had basal IVS thinning. Basal IVS thinning was associated with cardiac pacemaker (PM) implantation at baseline (adjusted odds ratio = 20.5; 95% confidence interval [CI] = 7.9-53.2; P < 0.01). Of the 768 patients with an LVEF of ≥50% at baseline who underwent one or more longitudinal TTEs after baseline, 36 (4.7%) developed LV dysfunction over a median observation period of 88.9 months. Basal IVS thinning and PM implantation at baseline were the independent predictors of a delayed onset of LV dysfunction (basal IVS thinning, adjusted hazard ratio [HR] = 3.7; 95% CI = 1.5-9.6; PM implantation, adjusted HR = 15.7; 95% CI = 7.4-33.3).
Basal IVS thinning in patients with sarcoidosis can predict a delayed onset of LV dysfunction even when the LV function is preserved at the time of detection.
经胸超声心动图（TTE）显示室间隔基底段变薄对心脏结节病具有高度特异性。尽管室间隔基底段变薄被列为心脏结节病的五项主要诊断标准之一，但其与长期心脏功能的关联尚未得到研究。本研究旨在评估结节病患者临床队列中室间隔基底段变薄的流行病学及临床相关性。
这项回顾性观察性研究在一家普通结节病诊所进行。分析室间隔基底段变薄的发生率以及与基线变量和左心室（LV）功能障碍延迟发作（左心室射血分数[LVEF]<50%）的相关性。
在1009例患者中，23例（2.3%）存在室间隔基底段变薄。室间隔基底段变薄与基线时心脏起搏器（PM）植入相关（校正比值比=20.5；95%置信区间[CI]=7.9-53.2；P<0.01）。在基线时LVEF≥50%且在基线后接受一次或多次纵向TTE检查的768例患者中，36例（4.7%）在中位观察期88.9个月内出现左心室功能障碍。室间隔基底段变薄和基线时PM植入是左心室功能障碍延迟发作的独立预测因素（室间隔基底段变薄，校正风险比[HR]=3.7；95%CI=1.5-9.6；PM植入，校正HR=15.7；95%CI=7.4-33.3）。
结节病患者的室间隔基底段变薄即使在检测时左心室功能正常，也可预测左心室功能障碍的延迟发作。
