Title: A systematic review on screening tools for cardiac sarcoidosis
Objective: Cardiac sarcoidosis is an underrecognised and difficult to diagnose manifestation of sarcoidosis and is one of the leading causes of death in these patients. Our objective is to evaluate the evidence related to screening for cardiac sarcoidosis in patients with known extracardiac sarcoidosis.
Methods: A systematic literature review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. Two databases (MEDLINE and EMBASE) were searched for all original quantitative research studies of adult patients with known extracardiac sarcoidosis who were screened for cardiac sarcoidosis through electrocardiography (ECG), ambulatory electrocardiography (Holter), echocardiography, or cardiac magnetic resonance imaging (CMR). Data from the included studies was extracted and due to study heterogeneity, narrative summaries were used to present data.
Results: Among 660 references, eight studies with a total of 2004 patients were identified that screened for cardiac sarcoidosis. CMR had the highest sensitivity, specificity and positive likelihood ratio for the detection of cardiac sarcoidosis. Screening with cardiac symptoms, ECG, Holter, echocardiography in isolation was not sensitive nor specific. Combined screening using cardiac symptoms alongside ECG, Holter and/or echocardiogram did improve the sensitivity but had lowered specificity.
Conclusions: Current data for the use of ECG, Holter, and echocardiogram as screening tools is inhomogenous and limited. The current data suggests that CMR is the most valuable tool for the screening of cardiac sarcoidosis. Further research is required to develop a validated screening tool to assess for cardiac sarcoidosis.