Early detection of cardiac involvement in sarcoidosis is difficult but essential to
achieve optimal treatment. Signal-averaged electrocardiography (SAECG) can detect
subtle cardiac electrical abnormalities termed late potentials (LPs) and would be useful for the early diagnosis of cardiac involvement.
This study aims to investigate the prognostic significance of LP in patients with
We prospectively studied 74 patients with pulmonary sarcoidosis without overt electrocardiographic
abnormalities. All participants underwent SAECG, cardiac echocardiography, and 24-hour
ambulatory Holter monitoring. Serum angiotensin-converting enzyme and B-type natriuretic
peptide levels were also evaluated. We followed these patients for the evaluation
of incidence of cardiac events including cardiac death, arrhythmias, and heart failure
requiring hospital admission.
Of the studied population, 29 patients (39.2%) had detectable LP. During a mean follow-up
period of 9.8 years, 8 patients with LPs had cardiovascular events, including development
of complete atrioventricular block (n = 4), ventricular tachycardia (n = 2), and heart
failure (n = 2). Meanwhile, only 1 of 45 patients without LP developed cardiac event
(heart failure). Multivariate analyses revealed that LPs were associated with an increased
risk of developing cardiac events (hazard ratio 9.66; 95% confidence interval 1.20–78.01;
P = .033) whereas age, sex, serum angiotensin-converting enzyme and B-type natriuretic
peptide levels, number of premature ventricular contractions on 24-hour Holter monitoring,
and echocardiographic parameters were not associated with subsequent cardiac events.
SAECG might possibly be useful for the early detection of cardiac sarcoidosis and,
if independently validated, could eventually be considered as a screening test for
further risk stratification.