Sarcoid Heart Disease: Review of Current Knowledge

Area of Science:

• Cardiology
• Immunology
• Pulmonology

Background:

• Sarcoidosis is a multisystem granulomatous disease of unknown etiology.
• Cardiac involvement significantly worsens prognosis and presents with arrhythmias or heart failure.
• Diagnosis is difficult due to nonspecific symptoms and limitations of endomyocardial biopsy.

Purpose of the Study:

• To review the diagnostic challenges and therapeutic strategies for cardiac sarcoidosis.
• To highlight the roles of advanced imaging modalities in evaluating the disease.
• To discuss current treatment guidelines and response assessment.

Main Methods:

• Review of current literature on cardiac sarcoidosis diagnosis and management.
• Discussion of imaging techniques including 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) and cardiac magnetic resonance imaging (CMR).
• Analysis of treatment outcomes with corticosteroids and steroid-sparing agents like methotrexate.

Main Results:

• Cardiac sarcoidosis diagnosis remains challenging, with biopsy having low sensitivity.
• FDG-PET detects active inflammation, while CMR with late gadolinium enhancement shows fibrosis/necrosis.
• Combination therapy (prednisone + methotrexate) shows long-term improvement compared to prednisone alone.

Conclusions:

• Early and accurate diagnosis of cardiac sarcoidosis is crucial due to high risk of sudden death.
• Multimodality imaging is essential for comprehensive disease assessment.
• Aggressive immunosuppressive therapy, potentially including steroid-sparing agents, is indicated for symptomatic disease.