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Editorials |

Diagnosis of Cardiac Sarcoidosis : An Imperfect Science, A Hesitant Art

Om P. Sharma, MD, FCCP
Author and Funding Information

Affiliations: Los Angeles, CA
 ,  Dr. Sharma is Professor of Medicine, Keck School of Medicine.

Correspondence to: Om P. Sharma, MD, Room 11-900, LAC + USC Medical Center, 1200 North State St, Los Angeles, CA 90033; e-mail: osharma@hsc.usc.edu



Chest. 2003;123(1):18-19. doi:10.1378/chest.123.1.18
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Bernstein et al1 were the first to recognize cardiac sarcoidosis. Gozo and associates2 were the first to give us the clinical and pathologic description. Hagemann and Wurm3 estimated that the heart was affected in about 5% of patients with chronic sarcoidosis. Later on, autopsy studies indicated that the incidence of subclinical sarcoidosis was much higher than previously realized.4 In a report from Johns Hopkins Hospital (Baltimore, MD),5 myocardial granulomas were seen in 27% of patients, and in 37% of the patients with cardiac involvement there were no clinical signs or symptoms of heart disease. Granulomatous lesions in the heart were found in 24 of 123 patients (19.5%) with sarcoidosis who had autopsies performed at Los Angeles County + University of Southern California Medical Center (Los Angeles, CA).6 The prognosis for patients with clinically diagnosed cardiac sarcoidosis has not been well-investigated.7 Roberts et al8 concluded that survival in most patients was limited to 2 years after the development of cardiac symptoms and signs. Flemming and Bailey9 were a bit more optimistic when they reported that 44% of their series of 250 patients survived for > 5 years. Thus, the prognosis for patients with sarcoidosis was considered dismal. Nevertheless, many of these pessimistic pronouncements were made before the advent of the automatic implantable defibrillator, refined diagnostic techniques, and aggressive use of corticosteriod, immunosuppressive, and immune modulator agents.1011 In any case, in order to increase the survival time of patients with myocardial sarcoidosis, two requirements need to be fulfilled. The diagnosis should be established early and accurately, and the treatment should be aggressive and effective. In the present state of knowledge, both of these conditions have remained only partially realized.

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