Diagnostik und Therapie der kardialen Sarkoidose

Die Sarkoidose ist eine entzündliche Erkrankung unklarer Genese, die durch eine Granulombildung gekennzeichnet ist. Sie kann prinzipiell jedes Organ befallen. Da eine kardiale Sarkoidose eine wesentliche Bedeutung für die Morbidität und Letalität hat, ist deren frühzeitige Diagnose von entscheidender therapeutischer und prognostischer Bedeutung. Dieser Beitrag erläutert die wichtigsten Punkte und Pitfalls in der Diagnostik und Therapie der kardialen Sarkoidose.

Schlüsselwörter

Sarkoidose - Kardiomyopathie - MRT - FDG-PET

• Literatur

• 1 Skowasch D, Gaertner F, Marx N. et al. [Diagnostics and Treatment of Cardiac Sarcoidosis – Consensus Paper of the German Respiratory Society (DGP) and the German Cardiac Society (DGK)]. Pneumologie 2020; 74: 24 doi:10.1055/a-1031-4588
• 2 Handa T, Nagai S, Miki S. et al. Incidence of pulmonary hypertension and its clinical relevance in patients with sarcoidosis. Chest 2006; 129: 1246-1252 doi:10.1378/chest.129.5.1246
• 3 Kim JS, Judson MA, Donnino R. et al. Cardiac sarcoidosis. Am Heart J 2009; 157: 9-21 doi:10.1016/j.ahj.2008.09.009
• 4 Birnie DH, Nery PB, Ha AC. et al. Cardiac Sarcoidosis. J Am Coll Cardiol 2016; 68: 411-421 doi:10.1016/j.jacc.2016.03.605
• 5 Yazaki Y, Isobe M, Hiroe M. et al. Prognostic determinants of long-term survival in Japanese patients with cardiac sarcoidosis treated with prednisone. Am J Cardiol 2001; 88: 1006-1010 doi:10.1016/s0002-9149(01)01978-6
• 6 Al-Khatib SM, Stevenson WG, Ackerman MJ. et al. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death. Circulation 2018; 138: e272-e391 doi:10.1161/CIR.0000000000000549
• 7 Zipse MM, Tzou WS, Schuller JL. et al. Electrophysiologic testing for diagnostic evaluation and risk stratification in patients with suspected cardiac sarcoidosis with preserved left and right ventricular systolic function. J Cardiovasc Electrophysiol 2019; 30: 1939-1948 doi:10.1111/jce.14058
• 8 Furushima H, Chinushi M, Sugiura H. et al. Ventricular tachyarrhythmia associated with cardiac sarcoidosis: its mechanisms and outcome. Clin Cardiol 2004; 27: 217-222 doi:10.1002/clc.4960270409
• 9 Mehta D, Lubitz SA, Frankel Z. et al. Cardiac involvement in patients with sarcoidosis: diagnostic and prognostic value of outpatient testing. Chest 2008; 133: 1426-1435 doi:10.1378/chest.07-2784
• 10 Sharma A, Okada DR, Yacoub H. et al. Diagnosis of cardiac sarcoidosis: an era of paradigm shift. Ann Nucl Med 2020; 34: 87-93 doi:10.1007/s12149-019-01431-z
• 11 Kandolin R, Lehtonen J, Airaksinen J. et al. Usefulness of Cardiac Troponins as Markers of Early Treatment Response in Cardiac Sarcoidosis. Am J Cardiol 2015; 116: 960-964 doi:10.1016/j.amjcard.2015.06.021
• 12 Date T, Shinozaki T, Yamakawa M. et al. Elevated plasma brain natriuretic peptide level in cardiac sarcoidosis patients with preserved ejection fraction. Cardiology 2007; 107: 277-280 doi:10.1159/000095518
• 13 Mankad P, Mitchell B, Birnie D. et al. Cardiac Sarcoidosis. Curr Cardiol Rep 2019; 21: 152 doi:10.1007/s11886-019-1238-1
• 14 Kouranos V, Tzelepis GE, Rapti A. et al. Complementary Role of CMR to Conventional Screening in the Diagnosis and Prognosis of Cardiac Sarcoidosis. JACC Cardiovasc Imaging 2017; 10: 1437-1447 doi:10.1016/j.jcmg.2016.11.019
• 15 Velangi PS, Chen KA, Kazmirczak F. et al. Right Ventricular Abnormalities on Cardiovascular Magnetic Resonance Imaging in Patients With Sarcoidosis. JACC Cardiovasc Imaging 2020;
• 16 Youssef G, Leung E, Mylonas I. et al. The use of 18F-FDG PET in the diagnosis of cardiac sarcoidosis: a systematic review and metaanalysis including the Ontario experience. J Nucl Med 2012; 53: 241-248 doi:10.2967/jnumed.111.090662
• 17 Chiu CZ, Nakatani S, Zhang G. et al. Prevention of left ventricular remodeling by long-term corticosteroid therapy in patients with cardiac sarcoidosis. Am J Cardiol 2005; 95: 143-146 doi:10.1016/j.amjcard.2004.08.083
• 18 Ungprasert P, Ryu JH, Matteson EL. Clinical Manifestations, Diagnosis, and Treatment of Sarcoidosis. Mayo Clin Proc Innov Qual Outcomes 2019; 3: 358-375 doi:10.1016/j.mayocpiqo.2019.04.006
• 19 Muser D, Santangeli P, Liang JJ. et al. Characterization of the Electroanatomic Substrate in Cardiac Sarcoidosis: Correlation With Imaging Findings of Scar and Inflammation. JACC Clin Electrophysiol 2018; 4: 291-303 doi:10.1016/j.jacep.2017.09.175
• 20 Pietinalho A, Hiraga Y, Hosoda Y. et al. The frequency of sarcoidosis in Finland and Hokkaido, Japan. A comparative epidemiological study. Sarcoidosis 1995; 12: 61-67