Screening for cardiac involvement in patients with sarcoidosis using AIIMS algorithm.

Cardiac involvement worsens the prognosis of patients with sarcoidosis. Early diagnosis and treatment of cardiac involvement may improve patient outcomes. Diagnostic algorithms are a gateway to advanced imaging. Heart Rhythm Society (HRS) screening algorithm is commonly used and comprises the presence of cardiac symptoms, electrocardiography and conventional echocardiography. In this study, we aimed to test whether the addition of global longitudinal strain and biomarkers (Troponin & NT Pro-BNP) can improve the detection rate of cardiac involvement (AIIMS screening algorithm). A total of 100 patients with biopsy-proven sarcoidosis were screened for cardiac involvement. This included cardiac symptoms, NT-Pro-BNP levels, Troponin I levels, electrocardiography, and echocardiography including global longitudinal strain (GLS). Patients who were positive for any underwent cardiac MRI or radionuclide cardiac imaging to confirm the presence of cardiac sarcoidosis. Of the 100 patients screened, 23% had cardiac symptoms, 23% had ECG changes, 16% had abnormalities on conventional echocardiography, 32% of patients had abnormal GLS, 16% and 19% of patients were positive for Troponin I and NT-Pro BNP respectively. The HRS and AIIMS screening algorithms detected cardiac involvement in 24 (24%) and 32 (32%) of patients, respectively. Among these patients, 23/24 and 30/32 were confirmed to have cardiac involvement by advanced cardiac imaging. Thus, the AIIMS screening algorithm increased detection of cardiac involvement by 30%. The proposed AIIMS screening algorithm enhances the detection of cardiac involvement in patients with sarcoidosis and should be tested in a larger study.