ECG-based identification of cardiac involvement in patients with Sarcoidosis

Background Cardiac sarcoidosis (CS) is associated with adverse clinical outcomes. Early identification of patients with CS is crucial for timely therapeutic intervention. While cardiovascular magnetic resonance imaging (CMR) and positron emission tomography (PET) are promising diagnostic modalities, their widespread application is limited. Conventional electrocardiography (ECG) is a widely accessible and cost-effective alternative; however, it has demonstrated low specificity and sensitivity for diagnosing CS. A more specific and sensitive ECG marker for CS is therefore desirable.

Atrial cardiomyopathy is frequently apparent in patients with atrial fibrillation and heart failure, which can result from inflammation and fibrosis—processes also pertinent to sarcoidosis. An atrial cardiomyopathy can be assessed noninvasively through the measurement of the amplified P-wave duration.

The aim of the current study is therefore to investigate if analysis of p wave duration can be used as novel and more specific ECG marker to identify cardiac involvement in patients with sarcoidosis.

Methods We prospectively enrolled patients with sarcoidosis from December 2022 to August 2024. A digital 12-lead ECG was obtained from all participants. In patients exhibiting sinus rhythm at the time of study inclusion, the duration of recorded sinus P-waves was analyzed after amplification of the ECG to 80 mm/mV and 175 mm/s.

Results A total of 237 patients with sarcoidosis were included (48% female, 52% male; mean age 57±10 years). Cardiac sarcoidosis was diagnosed in 37 patients (16%). The median P-wave duration was 123 ms (interquartile range: 113-130 ms). Patients with CS exhibited a significantly prolonged P-wave duration compared to those without cardiac involvement (130 ms [119-150 ms] versus 121 ms [112-128 ms], p<0.001). Furthermore, there was a statistically significant increase in the risk of cardiac involvement, estimated at 5% for each millisecond increase in amplified P-wave duration (p<0.001).

Conclusion The analysis of amplified P-wave duration identified cardiac involvement in patients with sarcoidosis, suggesting its potential as a novel ECG parameter for the noninvasive identification of at-risk patients.

Publikationsverlauf

Artikel online veröffentlicht:
18. März 2025