We investigated the prevalence of LV strain impairment as estimated by 2D speckle-tracking imaging, Late potentials on signal averaged ECG (SAECG) and QRS fragmentation inpatients with diagnosed sarcoidosis without cardiac involvement according to the current guidelines.

Thirty-three patients with biopsy-proven extracardiac sarcoidosis were analyzed. We performed a prospective case–control longitudinal study including 33 patients with diagnosed extracardiac sarcoidosis and normal cardiac function as assessed by standard transthoracic echocardiography and 33 healthy age- and gender-matched controls. All patients underwent a twelve lead ECG and comprehensive echocardiographic study. Mean age of patients was 45.9±13.4 years old (32 women). Compared with controls, global LV longitudinal strain (LV GLS) was reduced in sarcoidosis patients: (−18.2±2.5 vs −22.4±1.7%, P<0.001). Fragmentation of the QRS complex is also more common in sarcoidosis than non-sarcoidosis patients (66.6% vs 27.3%). However, late potentials on signal averaged ECG were identified in only two patients with extracardiac sarcoidosis.

Speckle-tracking echocardiography revealed decreased longitudinal LV strain in extracardiac sarcoidosis patients. QRS fragmentation was also frequently identified in this population. QRS fragmentation and LV GLS may represent an early marker of myocardial involvement in extracardiac sarcoidosis patients and should be integrated in a more sensitive and simple diagnostic algorithm criterion.