**5.3 Echocardiogram**

The echocardiographic findings are diverse with low sensitivity and specificity; however, they are useful for follow-up of patients to monitor progression of the disease [3]. The alterations that stand out include anomalies of the segmental and global contractility (usually following a non-coronary epicardial pattern), thickening or thinning of the interventricular septum (especially toward the base), diastolic dysfunction, and ventricular hypertrophy which can simulate a hypertrophic cardiomyopathy and aneurysms [4]. In recent studies, interest has grown in utility of longitudinal deformity of the left ventricle via Speckle-tracking analysis to identify patients with cardiac sarcoidosis; this can be a useful tool in the early diagnosis and the follow-up of the disease [21].

**115**

and claustrophobia.

*5.4.2 Fluorodeoxyglucose positron 18 emission tomography*

Patients with extracardiac compromise

tions, pre-syncope, or syncope

caution and with the diagnostic criteria used as a pattern [26].

tained or non-sustained ventricular tachycardia

*Cardiac Sarcoidosis*

**Table 1.**

*DOI: http://dx.doi.org/10.5772/intechopen.85310*

**5.4 Advanced cardiovascular imaging**

*Prevalence of ECG abnormalities.*

*5.4.1 Nuclear magnetic resonance imaging*

Nuclear magnetic resonance imaging is one of the most useful imaging techniques for the assessment of cardiac sarcoidosis. There is no pattern that can be defined as typical; however, the delayed enhancement of the gadolinium is patched (and does not follow a vascular pattern); it compromises the myocardium and the subepicardium, unlike acute myocardial infraction that compromises the subendocardium; it usually affects the basal segments of the septum and the inferolateral wall. Left ventricle involvement is more common. Transmural and right ventricle compromise is infrequent; however, these findings do not rule out the presence of the cardiac sarcoidosis. Some series report a negative predictive value up to 100% with epidemiological limitations with respect to the gold pattern. For this reason, although a negative cardiac resonance image is not common, cardiac compromise due to this pathology cannot be disregarded, especially if the probability and clinical suspicion are high [22, 23]. The superiority of the cardiac nuclear magnetic resonance imaging in the diagnosis of sarcoidosis was proven by Ichinose et al. [24]; he found sensitivity from 75 to 100% and specificity from 39 to 78%. He showed that the NMRI is superior to SPECT with thallium and gallium [25]. The increase in the T2 signal correlated in some subjects with inflammation and major adverse events; NMRI continues to be studied [20, 22]. The limitations of NMRI include patients with implanted cardiac devices (relative), chronic renal disease (stage 4/5),

**Presentation Prevalence (%)** Atrioventricular block 26–67 Bundle block 12–61 Atrial arrhythmias 23–25 Ventricular arrhythmias 11–73

This imaging technique is useful in cardiac sarcoidosis for the identification of possible areas with active inflammatory processes; an algorithm has been proposed as a response test to treatment [3]. As a diagnostic guide, a meta-analysis concluded 89% sensibility and 78% specificity; however, these results should be viewed with

Advanced cardiovascular imaging is advised in the following clinical contexts [27]:

• Presence of more than one of the following symptoms: 2 weeks + of palpita-

• One or more of the following anomalies in the electrocardiogram: complete block of right or left branch, presence of unexplained pathologic Q waves in two or more leads, atrioventricular block at any degree of severity, and sus-


#### **Table 1.**

*Sarcoidosis and Granulomatosis - Diagnosis and Management*

conditions that might compromise the lung in a similar way [17].

Chest image continues to be the initial study; it is used to identify the typical anomalies of cardiac sarcoidosis; chest images are reported as abnormal in up to 95% of the cases [16] reserving high-resolution tomography for those cases in which the thorax image is normal or presents atypical findings. Image analysis should always take into consideration the multiple differential diagnoses, infections, or

The electrocardiogram is abnormal in the majority of patients with symptomatic cardiac sarcoidosis, compared with patients that have a silent compromise in which

In the screening of asymptomatic patients with extracardiac sarcoidosis con-

• Presence of Q wave in two or more adjacent leads in the absence of myocardial

• Fragmented QRS in two or more adjacent leads in the absence of myocardial

**Table 1** summarizes the ECG manifestations with variable prevalence according

As noted before, up to 34% of cases show malfunction in atrioventricular conduction (57% of patients being reversible in some series after immunosuppression therapy) [19]. Other alterations identified are changes in the ST T wave and rarely

Ambulatory electrocardiographic monitoring which continues for 24–48 h (Holter) is useful for identification of arrhythmias, as well as their response to

The echocardiographic findings are diverse with low sensitivity and specificity; however, they are useful for follow-up of patients to monitor progression of the disease [3]. The alterations that stand out include anomalies of the segmental and global contractility (usually following a non-coronary epicardial pattern), thickening or thinning of the interventricular septum (especially toward the base), diastolic dysfunction, and ventricular hypertrophy which can simulate a hypertrophic cardiomyopathy and aneurysms [4]. In recent studies, interest has grown in utility of longitudinal deformity of the left ventricle via Speckle-tracking analysis to identify patients with cardiac sarcoidosis; this can be a useful tool in the early

**5.1 Chest image**

**5.2 Electrocardiogram and Holter**

• Right or left branch block

infarction

infarction

epsilon waves [4].

treatment [20].

**5.3 Echocardiogram**

the abnormality does not go above 9% [4, 18].

firmed via biopsy [19], the most suggestive findings are:

• One or more signals of a signal-averaged ECG

• One or more premature ventricular complexes

to the course of the cardiac sarcoidosis [19].

diagnosis and the follow-up of the disease [21].

• Atrial arrhythmia (atrial tachycardia or atrial fibrillation)

**114**

*Prevalence of ECG abnormalities.*
