Response to steroid therapy in cardiac sarcoidosis: insights from myocardial strain.

Sarcoidosis is a multisystem granulomatous disease of unknown atiology and cardiac involvement can occur. Echocardiographic abnormalities, such as left ventricular dysfunction, segmental wall thinning, ventricular aneurysm, or valvular abnormalities are often subtle until the later stages of the disease. However, sarcoid has a predilection to cause ventricular arrhythmias or conduction system abnormalities in the early stages and hence may develop palpitations, syncope, or sudden death before structural abnormalities are detected. If patients with early cardiac sarcoid are identified, they respond well to corticosteroid therapy, and defibrillator implantation may reduce the risk of sudden death from malignant arrhythmias. We present a case of a patient with cardiac sarcoid, manifesting as conduction system disease. Cardiac magnetic resonance imaging demonstrated a sarcoid granuloma within the LV septum. Although the standard echocardiographic evaluation was unremarkable, this area corresponded to abnormal strain imaging on echo. Similarly, while conventional echocardiographic measurements failed to demonstrate a response to steroid therapy, strain imaging showed improved regional myocardial function. This coincided with improvement in the conduction abnormalities. This case study showed the potential of strain imaging in demonstrating cardiac involvement from sarcoidosis and in assessing the therapeutic response to corticosteroid therapy.