斑点追踪超声心动图作为一种有效的筛查工具，用于评估印度系统性肉样瘤病患者的心脏受累情况：一项前瞻性观察性研究。

Speckle-Tracking Echocardiography as an Effective Screening Tool for Cardiac Involvement Among Patients With Systemic Sarcoidosis in an Indian Cohort: A Prospective Observational Study.

机构信息

Department of Pulmonary Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.

Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.

出版信息

Echocardiography. 2024 Nov;41(11):e15957. doi: 10.1111/echo.15957.

DOI:10.1111/echo.15957

PMID:39494981

Abstract

INTRODUCTION

Diagnosing cardiac sarcoidosis (CS) is challenging due to the lack of a sensitive gold standard diagnostic test. Although advanced imaging techniques like cardiac magnetic resonance imaging (MRI) (cardiovascular magnetic resonance [CMR]) and fluorodeoxyglucose positron emission tomography (FDG-PET) CT are promising, they are limited by their availability and cost. Two-dimensional speckle-tracking echocardiography (2D-STE) is emerging as a valuable tool for the early detection of CS.

METHODS

This single-center observational study assessed cardiac involvement and the utility of STE as a screening tool for diagnosing CS among newly diagnosed, histologically confirmed, treatment-naïve patients with systemic sarcoidosis in an Indian cohort.

RESULTS

The study included 48 newly diagnosed sarcoidosis patients with a median age of 42.5 years (interquartile range [IQR] 34-53.5), of whom 52.1% were female. FDG-PET CT findings suggested cardiac involvement in 21 patients, while CMR findings were positive in 11 patients. All patients had normal 12-lead ECGs and echocardiograms. Twenty-five patients met the HRS 2014 criteria for CS diagnosis. The median (IQR) left ventricular global longitudinal strain (LV GLS) was -15.4 (-16.2, -13.4) in the probable CS group and -17.9 (-19.4, -17.4) in the non-CS group. An LV GLS cutoff of >-17.3 showed a sensitivity of 80.00% and a specificity of 82.61% (p < 0.001, area under the curve [AUC] = 0.790) for CS diagnosis. A right ventricular global longitudinal strain (RV GLS) cutoff of >-21.4 showed a sensitivity of 68.00% and a specificity of 78.26% (p < 0.017, AUC = 0.692). They both have very high negative predictive value (98.7% and 97.9%) and thus useful for ruling out the cardiac involvement than confirming it.

CONCLUSION

STE effectively screens for cardiac involvement in sarcoidosis patients, ruling out CS diagnosis.

摘要

简介

由于缺乏敏感的金标准诊断测试，诊断心脏结节病（CS）具有挑战性。尽管先进的成像技术，如心脏磁共振成像（MRI）（心血管磁共振[CMR]）和氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）CT 具有很大的应用前景，但它们受到可用性和成本的限制。二维斑点追踪超声心动图（2D-STE）作为 CS 的早期检测工具正在兴起。

方法

这项单中心观察性研究评估了心脏受累情况，以及 STE 作为印度队列中初诊、组织学确诊、未经治疗的系统性结节病患者 CS 诊断筛查工具的效用。

结果

该研究纳入了 48 名新诊断的结节病患者，中位年龄为 42.5 岁（四分位距 [IQR] 34-53.5），其中 52.1%为女性。FDG-PET CT 检查提示 21 例患者存在心脏受累，而 CMR 检查结果阳性 11 例。所有患者的 12 导联心电图和超声心动图均正常。25 例患者符合 HRS 2014 诊断 CS 的标准。在可能的 CS 组中，左心室整体纵向应变（LV GLS）的中位数（IQR）为-15.4（-16.2，-13.4），在非 CS 组中为-17.9（-19.4，-17.4）。LV GLS 截断值> -17.3 对 CS 诊断的敏感性为 80.00%，特异性为 82.61%（p < 0.001，曲线下面积[AUC] = 0.790）。右心室整体纵向应变（RV GLS）截断值> -21.4 对 CS 诊断的敏感性为 68.00%，特异性为 78.26%（p < 0.017，AUC = 0.692）。它们的阴性预测值均非常高（98.7%和 97.9%），因此对于排除 CS 诊断而非确认 CS 诊断非常有用。