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Cardiac Involvement in Patients With Pulmonary Sarcoidosis Assessed at Two University Medical Centers in the Netherlands^*

^* From the Departments of Cardiology (Drs. Smedema, Dassen, Crijns, and Gorgels), Radiology (Dr. Snoep), and Nuclear Medicine (Dr. van Kroonenburgh), University Hospital Maastricht, Maastricht; and Department of Cardiology and Radiology (Dr. van Geuns), Erasmus Medical Centre, Rotterdam, the Netherlands.

Correspondence to: J. P. Smedema, MD, MMed(Int), Department of Cardiology, University Hospital Maastricht, Dr Debyelaan 25, 6202 AZ Maastricht, the Netherlands; e-mail: j.smedema{at}cardio.azm.nl

Study objectives: We aimed to determine cardiac involvement in patients with pulmonary sarcoidosis (PS) followed up at two university medical centers in the Netherlands.

Design: We reviewed the findings in consecutive patients assessed by our departments during 1998 to 2004, and classified them as patients who had presented with symptoms of cardiac sarcoidosis (CS) [group A], and those who had been screened for this condition (group B).

Setting: Two university medical centers in the Netherlands.

Patients: One hundred one patients (69 men [mean age, 47.6 years] and 32 women [mean age, 47.3 years]) with biopsy-proven PS.

Interventions: Twelve-lead ECG (n = 101), ambulatory ECG (n = 74), echocardiography (n = 80), ²⁰¹Tl single-photon emission CT (n = 61), cardiac MRI (n = 87), coronary angiography to exclude coronary artery disease (n = 17), and endomyocardial biopsy (n = 9).

Measurements: ECG, structural, and functional cardiac abnormalities according to the modified guidelines of the Japanese Ministry of Health and Welfare (1993).

Results: Sixteen of 19 patients in group A and 3 of 82 patients in group B received a diagnosis of CS. During a mean follow-up of 1.7 years (range, 3 months to 4 years), four patients in group A died (20%) and nine patients received a pacemaker and/or an implantable cardioverter-defibrillator (47%), while the patients in group B had an uncomplicated course.

Conclusions: Once symptomatic CS develops in PS patients, the prognosis becomes very grim. In contrast, the prognosis in asymptomatic cardiac involvement in PS patients is good. Considering the poor prognosis of symptomatic CS, pulmonologists should consider regular screening of their PS patients for cardiac involvement with straightforward detection methods.

Key Words: cardiac sarcoidosis • heart failure • MRI • myocardial fibrosis • sudden death • ventricular tachycardia

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