LaLoggia Michael, Jhawar Nikita, Nakhoul Charbel, Kumar Anupam, Wang Harry
Department of Medicine, Cooper University Hospital, Camden, New Jersey, USA.
Cooper Heart Institute, Cooper University Hospital, Camden, New Jersey, USA.
JACC Case Rep. 2025 Sep 18:105482. doi: 10.1016/j.jaccas.2025.105482.
Clinically significant cardiac sarcoidosis is rare, seen in 5% of patients with sarcoidosis. Predominant right ventricular (RV) dysfunction is seen even less often.
A 59-year-old man presented to the emergency department from his outpatient cardiologist's office with high-grade atrioventricular block and signs of right-sided heart failure. Transthoracic echocardiogram showed normal left ventricular systolic function, with severe RV enlargement and dysfunction. Right heart catheterization revealed mild postcapillary pulmonary hypertension and disproportionate RV dysfunction. A transbronchial biopsy of mediastinal lymph nodes showed noncaseating granulomas, consistent with sarcoidosis.
RV dysfunction in sarcoidosis is most often secondary to lung disease or left heart disease. In general, RV systolic dysfunction is associated with higher all-cause mortality in patients with sarcoidosis.
TAKE-HOME MESSAGE: In patients with cardiac sarcoidosis and predominant RV dysfunction, clinical context along with multimodal imaging, particularly cardiac magnetic resonance imaging, can be useful to reach a diagnosis and provide prognostic value.
具有临床意义的心脏结节病较为罕见，在结节病患者中占5%。以右心室（RV）功能障碍为主的情况更为少见。
一名59岁男性从其门诊心脏病专家办公室被送往急诊科，伴有高度房室传导阻滞和右心衰竭体征。经胸超声心动图显示左心室收缩功能正常，但右心室严重扩大且功能障碍。右心导管检查显示轻度毛细血管后肺动脉高压和不成比例的右心室功能障碍。纵隔淋巴结经支气管活检显示非干酪样肉芽肿，符合结节病表现。
结节病中的右心室功能障碍最常见是继发于肺部疾病或左心疾病。一般来说，右心室收缩功能障碍与结节病患者的全因死亡率较高相关。
对于患有心脏结节病且以右心室功能障碍为主的患者，结合临床情况及多模态成像，尤其是心脏磁共振成像，有助于做出诊断并提供预后价值。
