A practical nomogram incorporating frontal QRS-T angle and aldosterone for early identification of cardiac...

Advanced imaging improves detection of cardiac sarcoidosis (CS) but should be reserved for patients with clinical suspicion. Easily obtainable markers may help identify individuals requiring further evaluation.

We investigated whether the frontal QRS-T (fQRST) angle derived from standard ECG, combined with plasma aldosterone, improves risk stratification for cardiac involvement in patients with newly diagnosed sarcoidosis.

In this cohort study, newly diagnosed, treatment-naïve patients with biopsy-proven sarcoidosis underwent standardized assessment including 12-lead ECG and plasma aldosterone measurement. Cardiac involvement was defined according to contemporary consensus criteria. Logistic regression identified independent predictors, model discrimination was assessed by area under the curve (AUC), and a nomogram was constructed from the final multivariable model.

Among 359 patients (39 % men), 21 % had CS, which was more frequent in men than women (29 % vs 15 %, p = 0.006). The fQRS-T angle was higher in CS (37 [13, 59]° vs 22 [9, 37]°, p < 0.001), as were plasma aldosterone levels (156 [108, 245]pg/ml vs 141 [96, 197]pg/ml, p = 0.05). Independent predictors of CS were male sex (OR 2.03, p = 0.007), aldosterone (OR 1.004, p = 0.001), and fQRST angle (OR 1.020, p < 0.001). The combined model yielded an AUC of 0.846 (sensitivity 0.310, specificity 0.962) and was used to construct a nomogram to identify subjects with a higher probability of having CS.

FQRST angle is an independent marker associated with CS. When combined with plasma aldosterone and gender, it enhances specificity for identifying patients needing further evaluation for cardiac involvement.