Diagnostic challenges in isolated cardiac sarcoidosis
Gregorio Tersalvi1, Valentina A Rossi2, Moritz Hundertmark3
1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
ESC Heart Failure
|June 3, 2026
Summary
Diagnosing isolated cardiac sarcoidosis (iCS) is difficult. Combining advanced imaging, biopsy, and genetic tests improves diagnosis and risk assessment for this challenging heart condition.
Area of Science:
- Cardiology
- Immunology
- Medical Diagnostics
Background:
- Isolated cardiac sarcoidosis (iCS) is a challenging diagnosis with poor prognosis.
- Diagnosis relies on excluding other conditions and integrating multiple tests, each with limitations.
Purpose of the Study:
- To review current diagnostic strategies for iCS.
- To highlight limitations and suggest future research directions for improved diagnosis and risk stratification.
Main Methods:
- Review of multimodality imaging (cardiac MRI, PET).
- Discussion of endomyocardial biopsy, electroanatomic mapping, and genetic testing.
- Evaluation of circulating biomarkers and their role.
Main Results:
- Multimodality imaging offers complementary assessments of cardiac inflammation, fibrosis, and function.
- Biopsy techniques and genetic testing aid in histological yield and excluding other cardiomyopathies.
- Biomarkers are nonspecific but can supplement imaging.
Conclusions:
- A multimodal, probability-based diagnostic framework is most promising for iCS.
- Future research should focus on harmonized imaging, novel tracers, and molecular profiling.
- Improved diagnostic accuracy is crucial for earlier risk stratification and therapy guidance.
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