Reduced Oxygen Uptake Efficiency Slope in Patients with Cardiac SarcoidosisReport as inadecuate




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Background

The non-invasive diagnosis of cardiac sarcoidosis CS is difficult. Cardiovascular magnetic resonance CMR has become a very valuable diagnostic tool in patients with suspected CS, but usually a combination of different tests is used. Oxygen uptake efficiency slope OUES is a parameter of cardiopulmonary exercise testing CPET, which is used as an indicator for cardiovascular impairment. We investigated the predictive value of OUES for the diagnosis of myocardial involvement in sarcoid patients.

Methods

Retrospectively 37 consecutive patients 44.9±13.8 years with histologically confirmed sarcoidosis and clinical suspicion of heart involvement underwent noninvasive diagnostic testing including CMR. CS was diagnosed according to the guidelines from the Japanese Society of Sarcoidosis and other Granulomatous Disorders with additional consideration of CMR findings. Furthermore, CPET with calculation of predicted OUES according to equations by Hollenberg et al. was carried out.

Results

Patients with CS 11-37; 30% had a worse cardiovascular response to exercise. OUES was significantly lower in CS-group compared to non-CS-group 59.3±19.1 vs 88.0±15.4%pred., p<0.0001. ROC curve method identified 70%pred. as the OUES cut-off point, which maximized sensitivity and specificity for detection of CS 96% sensitivity, 82% specificity, 89% overall accuracy. OUES <70%pred. was the single best predictor of CS Odds ratio: 100.43, 95% CI: 1.99 to 5064, p<0.001 even in multivariate analyses.

Conclusion

OUES assessed in CPET may be helpful in identifying patient with cardiac involvement of sarcoidosis. Patient selection for CMR may be assisted by CPET findings in patients with sarcoidosis.



Author: Wilhelm Ammenwerth, Henrik Wurps, Mark A. Klemens, Catharina Crolow, Jeanette Schulz-Menger, Nicolas Schönfeld, Roland C. Bittne

Source: http://plos.srce.hr/



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