Chest
Volume 100, Issue 1, July 1991, Pages 44-50
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Clinical Investigations
Subclinical Cardiac Dysfunction in Sarcoidosis

https://doi.org/10.1378/chest.100.1.44Get rights and content

Clinically apparent myocardial disease is infrequent in sarcoidosis. However, autopsy data show myocardial involvement in up to 30 percent of patients. Unexplained exertional symptomatology is a common complaint in patients with sarcoidosis. In this study, we investigated whether abnormal cardiac function might limit exercise performance in patients with sarcoidosis without overt cardiac involvement. We studied exercise responses in 35 patients with sarcoidosis and compared them with 28 untrained controls. Seventy-seven percent of the patients were symptomatic. Pulmonary function test results were lower in the group with sarcoidosis than normal controls, but they were within normal range. Only one patient had evidence of ventilatory limitation to exercise. Sixteen (46 percent) patients had abnormally increased heart rates (HRs) at rest prior to exercise testing and/or with exercise. Rapid HRs were confirmed during daily activities by continuous ambulatory electrocardiographic (ECG) monitoring. Left ventricular ejection fraction (LVEF) was measured to determine if systolic dysfunction could account for abnormal HR responses. Of patients with abnormally increased HRs, five had LVEFs less than 50 percent, and eight had normal LVEFs, of whom 75 percent had tachycardia at rest. Retrospective comparison of HR responses and LVEF between patients who did or did not receive corticosteroids revealed no significant differences between groups. We conclude that abnormal HR responses in patients without evident cardiac sarcoidosis are common and exertional symptoms in this population are often associated with chronotropic abnormalities. The exact mechanisms underlying the chronotropic abnormalities are unclear, but they likely include ventricular systolic dysfunction, sinus node dysfunction from granulomatous infiltration, or combinations of the two.

Section snippets

Subject Selection

Thirty-eight sequential patients were referred to our Respiratory Division with a diagnosis of pulmonary sarcoidosis during the 18month period of the study. Three patients were excluded from the study because of the presence of one or more of the following exclusion criteria: presence of lung disease other than sarcoidosis, the presence of known intrinsic heart disease, systemic hypertension, anemia, diabetes mellitus, pregnancy, or medication use other than corticosteroids. Thirty-five

Subjects' Characteristics, Roentgenographic Stage, and Corticosteroid Treatment Status

The clinical characteristics of patients with sarcoidosis and normal controls are shown in Table 1. The range of time from diagnosis of sarcoidosis in the 35 patients was 1 to 240 months. Mean age and percentage of ideal body weight were significantly greater in the group with sarcoidosis compared with controls. Seventy-seven percent of the patients with sarcoidosis were symptomatic by questionnaire at the time of the study (Table 1). Symptoms included exertional dyspnea in 23, easy

Discussion

This study shows that patients with sarcoidosis frequently have symptomatic limitations to exercise accompanied by abnormal circulatory responses, suggesting that subclinical cardiac involvement in sarcoidosis is a common occurrence that is evident during exercise.

In sarcoidosis, exertional symptoms and limited exercise capacity are common, and they are often attributed solely to pulmonary involvement.17, 18, 19, 20 However, most of the patients in our study had normal results of PFTs with only

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    Recipient of an American Lung Association Research Training Fellowship.

    Sponsored by the Quebec Pulmonary Association.

    §

    Supported by the Medical Research Council of Canada. Manuscript received May 10; revision accepted November 9.

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