Evaluation of contemporary echocardiography for the detection of cardiac sarcoidosis

Abstract Background The ability of echocardiography (TTE) to diagnose cardiac sarcoidosis (CS) has traditionally been limited by its low sensitivity. We sought to determine the optimal TTE parameters to detect cardiac involvement in sarcoidos is with the inclusion of strain and 3DE to standard conventional TTE data. Methods Consecutive patients referred for evaluation of suspected CS were prospectively recruited and underwent symptom evaluation, 12-lead ECG, ambulatory ECG monitoring, TTE with 3DE and strain, cardiac magnetic resonance and 18F-FDG-PET. We identified the TTE phenotype most likely to identify CS. We evaluated the ability of a novel multi-parametric approach to screen for cardiac involvement among sarcoidosis patients and compared this to existing criteria. Results Of the 181 patients recruited (mean age 55 ± 11 years, 60% male, mean LVEF 57 ± 10%), 106 (59%) were diagnosed with CS. The strongest TTE parameters to predict CS were the presence of a dilated LV cavity (end-diastolic/end-systolic ≥ 71/28ml/m2 females; ≥80/32ml/m2 males), LVEF < 50%, RWMA involving multiple myocardial territories and basal septal thinning. This ‘probable CS’ TTE model had 96% specificity, 33% sensitivity and 92% PPV for the diagnosis of CS. The strain parameters most specific for a CS diagnosis were LVGLS and LVGCS greater than − 13% and − 15%, respectively. Adding strain or 3D data did not significantly improve the overall diagnostic ability of TTE. The optimal screening strategy for CS among sarcoidosis patients involved evaluation of symptoms, ECG or ambulatory ECG monitoring, and ‘probable CS’ TTE. This approach had a sensitivity of 90%, compared to 77% and 84% for the 2014 Heart Rhythm Society and 2020 American Thoracic Society criteria, respectively. In the asymptomatic patient, the absence of abnormal rhythm data and a normal TTE excluded CS in 94% of patients. Conclusion The presence of LV dilatation, LV systolic impairment, multi-territory RWMA and basal septal thinning are the most specific TTE parameters for the detection of CS. In combination with symptom evaluation and ECG data, comprehensive echocardiography remains a useful screening tool among sarcoidosis patients with suspected cardiac involvement.