Cardiac Involvement In Neurosarcoidosis: A Single Center Investigation
Sama Noroozi Gilandehi1, Ka-Ho Wong1, Melissa Wright1, Jennifer Lord1, Josef Stehlik 2, Line Kemeyou2, Stacey Clardy1
1Department of Neurology, University of Utah, Salt Lake City UT, USA, 2Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah, Salt Lake City UT, USA
Objective:
Describe the frequency of coexistent cardiac disease in a cohort of Neurosarcoidosis (NS) patients.
Background:
Sarcoidosis is a multisystem granulomatous inflammatory disease. We report the incidence of cardiac sarcoidosis in our NS cohort and examined the frequency of other cardiac diseases in the cohort.

 

Design/Methods:
Of 64 probable/definite NS patients in the University of Utah cohort, 52 patients had at least one electrocardiogram (ECG) and were included in analysis.
Results:

Of 52 NS patients with ECG, 65% were female with average age 60.9 (38-84). 58% had a BMI>30. Symptoms suggestive of cardiac dysfunction included: leg swelling (50%), palpitations (46%), chest pain (44%) and dyspnea (44%). Ten patients (19%) had at least one myocardial infarction confirmed by cardiology.  ECG abnormalities included non-specific T wave change (40%), right bundle branch block (RBBB) (19%), AV block (16%), and QT prolongation (12%). 10 patients had sinus tachycardia, 5 had sinus bradycardia, and 1 each had ventricular tachycardia (VT) and non-sustained VT. Six patients required implantable cardioverter-defibrillator placement and one required a pacemaker.

Cardiac MRI on 17 patients (33%) revealed 3 (17%) with diffuse myocardial enhancement possibly suggesting cardiac sarcoidosis (CS). All had leg swelling, plus one each with orthopnea, syncope, or dyspnea. Myocardial PET scan was performed on 9 NS patients, confirming 3 known CS, and revealing one newly diagnosed CS, who had leg swelling and dyspnea.  2 additional patients had ICD placement after detection of high-grade AV block and persistent atrial fibrillation, respectively, but no evidence of CS on cardiac MRI. Of 6 confirmed CS patients, 3 patients manifested initially as NS.

Conclusions:
Of 52 NS patients, 12% had cardiologist-confirmed CS. Non-sarcoid cardiac illness was also common, emphasizing the need for comprehensive cardiac evaluation in NS. Research is needed to determine if sarcoid-related morbidity may contribute to increased all-cause cardiac disease.
10.1212/WNL.0000000000202326