PT  - JOURNAL ARTICLE
AU  - Hiroshi Ohira
AU  - Takahiro Sato
AU  - Osamu Manabe
AU  - Noriko Oyama-Manabe
AU  - Akiko Hayashishita
AU  - Toshitaka Nakaya
AU  - Junichi Nakamura
AU  - Naoko Suzuki
AU  - Ayako Sugimoto
AU  - Sho Furuya
AU  - Satonori Tsuneta
AU  - Taku Watanabe
AU  - Ichizo Tsujino
AU  - Satoshi Konno
TI  - Underdiagnosis of cardiac sarcoidosis by ECG and echocardiography in cases of extracardiac sarcoidosis
AID  - 10.1183/23120541.00516-2021
DP  - 2022 Apr 01
TA  - ERJ Open Research
PG  - 00516-2021
VI  - 8
IP  - 2
4099  - http://openres.ersjournals.com/content/8/2/00516-2021.short
4100  - http://openres.ersjournals.com/content/8/2/00516-2021.full
SO  - erjor2022 Apr 01; 8
AB  - Background Although screening with 12-lead electrocardiography and transthoracic echocardiography for cardiac involvement has been recommended for patients with biopsy-proven extracardiac sarcoidosis, cardiac sarcoidosis has been reported even in patients with normal electrocardiography and echocardiography findings. We investigated the prevalence and characteristics of these patient cohorts.Methods We studied 112 consecutive patients (age, 55±17 years, 64% females) with biopsy-proven extracardiac sarcoidosis who had undergone 18F-fluorodeoxyglucose positron emission tomography and cardiac magnetic resonance imaging for cardiac sarcoidosis evaluation. The patients were categorised as those showing normal findings both in electrocardiography and transthoracic echocardiography (normal group) and those showing abnormal findings in one or both examinations (abnormal group).Results 33 (29%) and 79 (71%) patients were categorised into the normal and abnormal groups, respectively, of which 6 (18%) and 43 (54%) patients, respectively, were diagnosed with cardiac sarcoidosis (p<0.01). Of these six patients in the normal group, two with multiple-organ sarcoidosis showed clinical deterioration of cardiac involvement and required steroid therapy; three with small cardiac involvement showed natural remission over follow-up assessments; and one underwent steroid therapy and showed an improvement in the left ventricular ejection fraction to within normal limits.Conclusions The prevalence of cardiac sarcoidosis in patients with biopsy-proven extracardiac sarcoidosis and normal electrocardiography and transthoracic echocardiography findings was ∼20%. Electrocardiography and transthoracic echocardiography may not detect cardiac sarcoidosis in patients without conduction and morphological abnormalities. However, some of these patients may subsequently show clinically manifested cardiac sarcoidosis. Physicians should be mindful of this population.ECG and transthoracic echocardiography may not detect cardiac sarcoidosis in patients without conduction and morphological abnormalities. Some of these patients may subsequently develop clinically manifested cardiac sarcoidosis. https://bit.ly/3qeQuff