Ohira Hiroshi, Sato Takahiro, Manabe Osamu, Oyama-Manabe Noriko, Hayashishita Akiko, Nakaya Toshitaka, Nakamura Junichi, Suzuki Naoko, Sugimoto Ayako, Furuya Sho, Tsuneta Satonori, Watanabe Taku, Tsujino Ichizo, Konno Satoshi
Dept of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan.
Dept of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan.
ERJ Open Res. 2022 May 9;8(2). doi: 10.1183/23120541.00516-2021. eCollection 2022 Apr.
Although screening with 12-lead electrocardiography and transthoracic echocardiography for cardiac involvement has been recommended for patients with biopsy-proven extracardiac sarcoidosis, cardiac sarcoidosis has been reported even in patients with normal electrocardiography and echocardiography findings. We investigated the prevalence and characteristics of these patient cohorts.
We studied 112 consecutive patients (age, 55±17 years, 64% females) with biopsy-proven extracardiac sarcoidosis who had undergone F-fluorodeoxyglucose positron emission tomography and cardiac magnetic resonance imaging for cardiac sarcoidosis evaluation. The patients were categorised as those showing normal findings both in electrocardiography and transthoracic echocardiography (normal group) and those showing abnormal findings in one or both examinations (abnormal group).
33 (29%) and 79 (71%) patients were categorised into the normal and abnormal groups, respectively, of which 6 (18%) and 43 (54%) patients, respectively, were diagnosed with cardiac sarcoidosis (p<0.01). Of these six patients in the normal group, two with multiple-organ sarcoidosis showed clinical deterioration of cardiac involvement and required steroid therapy; three with small cardiac involvement showed natural remission over follow-up assessments; and one underwent steroid therapy and showed an improvement in the left ventricular ejection fraction to within normal limits.
The prevalence of cardiac sarcoidosis in patients with biopsy-proven extracardiac sarcoidosis and normal electrocardiography and transthoracic echocardiography findings was ∼20%. Electrocardiography and transthoracic echocardiography may not detect cardiac sarcoidosis in patients without conduction and morphological abnormalities. However, some of these patients may subsequently show clinically manifested cardiac sarcoidosis. Physicians should be mindful of this population.
尽管对于经活检证实有心脏外结节病的患者，推荐采用12导联心电图和经胸超声心动图进行心脏受累情况筛查，但即使心电图和超声心动图检查结果正常的患者中也有心脏结节病的报道。我们对这些患者队列的患病率和特征进行了调查。
我们研究了112例连续的经活检证实有心脏外结节病的患者（年龄55±17岁，64%为女性），这些患者接受了氟脱氧葡萄糖正电子发射断层扫描和心脏磁共振成像以评估心脏结节病。患者被分为心电图和经胸超声心动图检查结果均正常的患者（正常组）以及一项或两项检查结果异常的患者（异常组）。
分别有33例（29%）和79例（71%）患者被归入正常组和异常组，其中分别有6例（18%）和43例（54%）患者被诊断为心脏结节病（p<0.01）。在正常组的这6例患者中，2例有多器官结节病的患者出现了心脏受累的临床恶化，需要接受类固醇治疗；3例有轻微心脏受累的患者在随访评估中自然缓解；1例接受了类固醇治疗，左心室射血分数改善至正常范围。
经活检证实有心脏外结节病且心电图和经胸超声心动图检查结果正常的患者中，心脏结节病的患病率约为20%。心电图和经胸超声心动图可能无法检测出无传导和形态异常患者的心脏结节病。然而，这些患者中的一些人随后可能会出现有临床表现的心脏结节病。医生应关注这一人群。
