Enhanced Screening Protocol for Cardiac Sarcoidosis. for Sarcoidosis

No evidence indicates that sarcoidosis can be cured, although many sarcoidosis patients reported a significant improvement in their symptoms after 5- to 7 years of treatment with steroids.

Sarcoidosis, a systemic disease of unknown cause, has been considered as a complication of tuberculosis. Present clinical descriptions of sarcoidosis are not precise, because of the heterogeneity of the disease observed in all patients.

There is no single 'cause' of sarcoidosis, but an association between radiological granulomatous changes and antigen-positive T-helper type 1 (Th1) immune responses has been demonstrated. As such, the most important steps in the pathophysiology of sarcoidosis are the mechanisms involved in the modulation of the Th1 cell response. This in turn can be affected by abnormalities in the genes encoding cytokines, which are known to be involved in the pathogenesis of sarcoidosis. Furthermore, the role of the HLA-DR alpha chain in disease susceptibility and T helper cell cytokine expression is well established.

For at least the last two decades, sarcoidosis has been increasing in incidence and morbidity in the US, in parallel with the increasing incidence of cigarette smoking.

Although some treatments have been used for sarcoidosis, no standard treatment is available. Treatment may include long term corticosteroids, immunosuppressants, and even lung resection. Corticosteroids are effective and well tolerated in cases of pulmonary sarcoidosis\n

Some signs of sarcoidosis that lead to diagnosis include: bilateral hilar lymphadenopathy, erythema nodosum, arthritis or erythema nodosum. In many cases, these signs are encountered in the setting of biopsy proven sarcoidosis. Furthermore, many patients who develop sarcoidosis are under the age of 50 and present with extrapulmonary symptoms not previously associated with sarcoidosis.\n

A cardiac sarcoidosis diagnostic algorithm utilizing ECG/nuclear imaging, endomyocardial and biopsy in patients without overt cardiac disease or abnormal findings on baseline screening ECG, LVEF, echocardiography or stress testing was the best screening tool for cardiac sarcoidosis in our study population. Enhanced ECG/nuclear imaging protocol is recommended for all patients suspected for cardiac disease or abnormal imaging with baseline ECG/nuclear imaging.

The screening protocol used in our institution improved the detection of Cardiac sarcoidosis (CS) by one third. This protocol should be widely adopted and its utility thoroughly evaluated to reduce the under-diagnosis and under-treatment of CS in India.

There is no conclusive research; however, there may be progress. A randomized, placebo-controlled, multicenter, randomized-block, three-arm, multicenter, double-blind, clinical trial of 2-year duration showed reduced disease severity and mortality in 1,034 patients treated with IFN-gamma (Interferon gamma A) when compared to patients who received placebo. The study used IFN-gamma, which is used to treat sarcoidosis. The patients with sarcoidosis, also included, received either interferon gamma or a placebo.

Data from a recent study of our study were similar to those of previous studies in the literature, which showed low cardiac involvement in sarcoidosis. However, the possibility of the existence other, as yet unknown variants of cardiac sarcoidosis is not excluded by our study.

The average age a person gets sarcoidosis by accident is 35 ± 17.4 years. Sarcoidosis affects both males and females equally. Males are affected about 1.2 months earlier than females. Sarcoidosis cases occur not only in adults of 40 to 69 years old. Children who get sarcoidosis are 3/4 males and 3/4 females. Sarcoidosis is an infrequent disease in the pediatric field.