Radiographic methods in the diagnosis of cardiac Sarcoidosis: Systematic review
INTRODUCTION: Sarcoidosis is a chronic granulomatous inflammatory disease of unknown etiology that can affect several organs. The cardiac involvement occurs between 20-50% of the patients and the main cardiac sequelae are arrhythmias and heart failure. The diagnosis is based on clinical and imaging presentation, and radiology, in this context, is essential in the evaluation of the disease activity. AIM: To identify the main radiographic methods used in the diagnosis of cardiac sarcoidosis (CS). MATERIAL AND METHODS: This is a systematic review conducted through the search of scientific articles in the databases: VHL and SciELO, with the descriptors "cardiac sarcoidosis" and "diagnostic imaging", published between the years 2018-2020, in Portuguese and English. 106 articles were found, from which the titles and abstracts were read. As inclusion criteria, articles from literature reviews and case reports that approached the researched theme were considered. After reading the publications, 10 articles were considered eligible for this study. RESULTS: The diagnosis of CS is a challenge, being necessary the use of imaging methods for its diagnosis. The echocardiogram is the first exam requested in patients with suspected heart disease. Thus, with the use of this method, one of the studies described abnormalities in up to 77% of patients with CS. Cardiac Magnetic Resonance Imaging (CMR), with the use of contrast, is able to detect the acute inflammatory phase of the disease and the chronic phase, presenting fibrosis and scarring. In addition, in more severe cases, CMR can show diffuse myocardial thickening secondary to massive granulomatous infiltration, resulting in significant contraction abnormalities and heart failure. Endomyocardial Biopsy is considered the gold standard in the diagnosis of the disease, however, it is invasive and of high risk, besides, although it presents high specificity, it has low sensitivity. The electrophysiological study, which verifies the conduction system, indicates a high incidence of electrophysiological alterations (68%) in patients with CS. CONCLUSION: The diagnosis of CS involves clinical manifestations, images and pathological data. Despite the great advance in the use of imaging techniques, the diagnosis of this disease continues to be a challenge, especially considering the low specificity and sensitivity of the methods, besides the fact that the gold standard is an extremely invasive exam. However, CMR is efficient in detecting early signs of the disease, enabling better prognosis. Therefore, the use of different cardiac imaging modalities plays an important role in the diagnosis of CS.
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