Cardiac sarcoidosis (CS) is associated with high morbidity and sudden death. Currently, cardiac magnetic resonance (CMR) is the most sensitive method for the diagnosis of CS, however as CMR is being positive relatively late, new imaging methods to improve the early diagnosis of CS are lacking.

of this study was to assess the role of left ventricular (LV) strain estimated by 2D speckle tracking imaging in patients with newly diagnosed sarcoidosis without cardiac involvement according to the current guidelines.

We performed a prospective cohort study including 10 patients with newly diagnosed sarcoidosis and normal cardiac function as assessed by classic echocardiography and CMR and 10 healthy age- and gender- matched controls. All patients underwent a comprehensive LV strain echocardiographic study. Speckle tracking analysis was performed by 2 experienced cardiologists blinded to each other and to clinical data. Mean age of patients was 53±14 years old (5 women). All patients presented mediastinal lymphadenopathy, 1 had renal involvement and 4 had pulmonary manifestations. Compared with controls, LV longitudinal strain was reduced: long axis longitudinal (-16.1±2.8% vs -21.7±2.2%, p<0.001), 4-chamber LV longitudinal strain (-15±2.8% vs -22.3±1.6%, p<0.001), 2-chamber LV longitudinal strain (-15.8±3.2% vs -20±1.4%, p<0.001) and overall global LV longitudinal strain (-14.4±2.5% vs -21.7±1.4%, p<0.0001). Circumferential LV strain was preserved in patients compared to controls (-21.7±5.4% vs -23.3±2.7%, p=0.5).

In this pilot study, Speckle-tracking echocardiography revealed impaired LV longitudinal strain in 100% of patients with normal CMR. Decreased longitudinal LV strain could represent an early sign of myocardial involvement in sarcoidosis patients. Therefore further assessment of cardiac deformation imaging in the setting of sarcoidosis is needed to improve the diagnosis of CS (figure above).