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SARCOIDOSIS: Davendra Mehta, Steven A. Lubitz, Zev Frankel, Juan P. Wisnivesky, Andrew J. Einstein, Martin Goldman, Josef Machac, and Alvin Teirstein Cardiac Involvement in Patients with Sarcoidosis: Diagnostic and Prognostic Value of Outpatient Testing Chest 2008; 133: 1426-1435 [Abstract] [Full text] [PDF]

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Cardiac involvement in patients with sarcoidosis: Response to Mehta et al

Zaruhi Vardanyan   (16 July 2008)

Cardiac involvement in patients with sarcoidosis: Response to Mehta et al 16 July 2008
Zaruhi Vardanyan, Internal Medicine Lincoln Medical and Mental Health Center Send letter to journal: Re: Cardiac involvement in patients with sarcoidosis: Response to Mehta et al zaruhivardanyan{at}yahoo.com Zaruhi Vardanyan	Regarding study by Mehta et al, I would like to offer following comments. Sensitivity of a new diagnostic approach is usually tested against the best available ‘gold standard’. In this study sensitivity of established modified JMHW diagnostic criteria is being tested against the ‘gold standard’ of the suggested new approach, which creates some uncertainty in its utility. Furthermore, sensitivity of modified JMHW criteria is compared to sensitivity of the new approach, which is doomed to be 100% by the design of the study for the following reason. Diagnosis of cardiac sarcoidosis (CS) was made based on PET scanning and cardiac MRI, which were performed only in subset of patients who had abnormalities on baseline testing. All patients without such abnormalities were considered not having CS without any further testing. Sensitivity of the ‘abnormality found on at least one of the baseline testing’ for diagnosis of CS is calculated from 2x2 table, where patients who were negative on all baseline testing could not be diagnosis-positive by the design of the study. As a result, number of patients testing false-negative in the 2x2 table can be only zero, and calculated sensitivity can be only 100%. In conclusion, clinical implications of developing diagnostic approach with increased sensitivity and decreased specificity for diagnosing CS are unknown as well.