Kumar Devesh, Madan Karan, Jagia Priya, Patel Chetan, Lakshmy R, Roy Ambuj
Department of Cardiology, Cardiothoracic Centre, All India Institute of Medical Sciences, Room No. 20, 7th Foor, New Delhi, 110029, India.
Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India.
Int J Cardiovasc Imaging. 2025 Jul;41(7):1397-1405. doi: 10.1007/s10554-025-03429-3. Epub 2025 May 30.
Cardiac involvement worsens the prognosis of patients with sarcoidosis. Early diagnosis and treatment of cardiac involvement may improve patient outcomes. Diagnostic algorithms are a gateway to advanced imaging. Heart Rhythm Society (HRS) screening algorithm is commonly used and comprises the presence of cardiac symptoms, electrocardiography and conventional echocardiography. In this study, we aimed to test whether the addition of global longitudinal strain and biomarkers (Troponin & NT Pro-BNP) can improve the detection rate of cardiac involvement (AIIMS screening algorithm). A total of 100 patients with biopsy-proven sarcoidosis were screened for cardiac involvement. This included cardiac symptoms, NT-Pro-BNP levels, Troponin I levels, electrocardiography, and echocardiography including global longitudinal strain (GLS). Patients who were positive for any underwent cardiac MRI or radionuclide cardiac imaging to confirm the presence of cardiac sarcoidosis. Of the 100 patients screened, 23% had cardiac symptoms, 23% had ECG changes, 16% had abnormalities on conventional echocardiography, 32% of patients had abnormal GLS, 16% and 19% of patients were positive for Troponin I and NT-Pro BNP respectively. The HRS and AIIMS screening algorithms detected cardiac involvement in 24 (24%) and 32 (32%) of patients, respectively. Among these patients, 23/24 and 30/32 were confirmed to have cardiac involvement by advanced cardiac imaging. Thus, the AIIMS screening algorithm increased detection of cardiac involvement by 30%. The proposed AIIMS screening algorithm enhances the detection of cardiac involvement in patients with sarcoidosis and should be tested in a larger study.
心脏受累会使结节病患者的预后恶化。早期诊断和治疗心脏受累情况可能会改善患者的预后。诊断算法是进行高级成像检查的途径。心脏节律协会（HRS）筛查算法常用，包括心脏症状、心电图和传统超声心动图检查。在本研究中，我们旨在测试添加整体纵向应变和生物标志物（肌钙蛋白和N末端脑钠肽前体）是否能提高心脏受累的检出率（全印医学科学研究所筛查算法）。总共对100例经活检证实为结节病的患者进行了心脏受累筛查。这包括心脏症状、N末端脑钠肽前体水平、肌钙蛋白I水平、心电图以及包括整体纵向应变（GLS）的超声心动图检查。任何一项检查呈阳性的患者均接受心脏磁共振成像或放射性核素心脏成像检查以确认是否存在心脏结节病。在筛查的100例患者中，23%有心脏症状，23%有心电图改变，16%在传统超声心动图检查中有异常，32%的患者整体纵向应变异常，分别有16%和19%的患者肌钙蛋白I和N末端脑钠肽前体呈阳性。HRS和全印医学科学研究所筛查算法分别在24例（24%）和32例（32%）患者中检测到心脏受累。在这些患者中，23/24和30/32经高级心脏成像检查确诊有心脏受累。因此，全印医学科学研究所筛查算法使心脏受累的检出率提高了30%。所提出的全印医学科学研究所筛查算法提高了结节病患者心脏受累的检出率，应在更大规模研究中进行测试。
