Risk factors for cardiac involvement in sarcoidosis - A case-control study in 201 Caucasian patients

Cardiac sarcoidosis (CS) is a life-threatening and underdiagnosed manifestation of the disease. The aim of study was to determine the prevalence of CS in a group of patients diagnosed or followed up due to sarcoidosis. A secondary objective was the search for factors associated with heart involvement. Methods and Results: We performed a case-control study (screening analysis) in 201 (all Caucasian) consecutive patients with biopsy-proven sarcoidosis. Numbers patients in stages 0/I/II/III were 2/44/151/4 (1%/22%/75%/2%) respectively. Cardiac magnetic resonance (CMR) imaging was performed to confirm or exclude cardiac involvement in all patients. Finally cardiac involvement was detected by CMR in 49 patients (24.4%). Factors associated with an increased risk of CS (univariate analyses) included: male sex (OR: 2.5; 1.21 to 5.16, p=0.01), cardiac related symptoms (OR: 3.53; 1.81 to 6.89, p=0.0002), multiorgan (extrathoracic) sarcoidosis (OR: 3.48; 1.77 to 6.84, p=0.0003), elevated serum NT-proBNP (OR: 3.82; 1.55 to 9.42, p=0.004), any electrocardiography abnormality (OR: 5.38; 2.48 to 11.67, p=0.0001) and contemporary radiological progression in the lungs (OR: 2.98; 1.52 to 5.84, p=0.001). Abnormalities in echocardiography (OR: 3.12; 1.52 to 6.39, p=0.002) and Holter ECG (OR: 3.67; 1.62 to 8.34, p=0.002) were also risk factors. The most sensitive tests (65%-70%) were: echocardiography and serum ACEu003e52 while the most specific (≥90%) were: abnormalities in electrocardiography and serum NT-proBNP. Echocardiography as single test achieved 69% accuracy. Conclusions: CS was detected in almost 1/4 of sarcoidosis patients. None of single diagnostic tests was sufficiently accurate for CS.