Noninvasive Diagnosis of Cardiac Sarcoidosis Using Microvolt T-Wave Alternans

• Matsumoto Shin

  Division of Cardiology, Department of Internal Medicine, Nippon Medical School, Tama Nagayama Hospital

• Hirayama Yoshiyuki

  Division of Cardiology, Department of Internal Medicine, Nippon Medical School

• Saitoh Hirokazu

  Division of Cardiology, Department of Internal Medicine, Nippon Medical School, Tama Nagayama Hospital

• Ino Takeshi

  Division of Cardiology, Department of Internal Medicine, Nippon Medical School, Tama Nagayama Hospital

• Miyauchi Yasushi

  Division of Cardiology, Department of Internal Medicine, Nippon Medical School

• Iwasaki Yu-ki

  Division of Cardiology, Department of Internal Medicine, Nippon Medical School

• Yasutake Masahiro

  Division of Cardiology, Department of Internal Medicine, Nippon Medical School

• Seino Yoshihiko

  Division of Cardiology, Department of Internal Medicine, Nippon Medical School Chiba Hokusoh Hospital

• Atarashi Hirotsugu

  Division of Cardiology, Department of Internal Medicine, Nippon Medical School, Tama Nagayama Hospital

• Katoh Takao

  Division of Cardiology, Department of Internal Medicine, Nippon Medical School

• Mizuno Kyoichi

  Division of Cardiology, Department of Internal Medicine, Nippon Medical School

抄録

Sarcoidosis is a systemic granulomatous disorder whose prognosis worsens when the heart is involved, and early diagnosis is important. Endomyocardial biopsy is the most helpful diagnostic examination, but suffers from low sensitivity and low specificity. Microvolt T wave alternans (MVTWA) is utilized in noninvasive examinations to detect beat-to-beat changes in the shape of the T wave at the microvolt level. Such beat-to-beat T wave changes arise from beat-to-beat changes in the transmural gradient of action potential duration. We speculate that the granulomatous changes of cardiac sarcoidosis produce cell-to-cell uncoupling and augment the transmural gradients of action potential duration. <br>To examine the clinical significance of MVTWA in the prediction of cardiac involvement in sarcoidosis patients, we obtained MVTWA in a total of 35 sarcoidosis patients with and without cardiac involvement. All patients underwent electrocardiography (ECG), ambulatory electrocardiography, chest radiography, transthoracic echocardiography, and MVTWA examination using a CH 2000 system. We diagnosed cardiac sarcoidosis in 7 patients according to the accepted diagnostic criteria. MVTWA was detected in 6 out of 7 cardiac sarcoidosis patients (85.7%) as opposed to in 2 out of 28 patients without cardiac involvement (7.1%). The difference between the two groups was statistically significant (P < 0.001). The sensitivity and specificity of MVTWA in cardiac sarcoidosis detection were 85.7% and 92.8%, respectively. The positive and negative predictive values were 75% and 96.3%, respectively, with an overall accuracy of 91.4%.<br>Noninvasive examination of MVTWA using a CH 2000 is a useful diagnostic tool for detecting cardiac involvement in patients with sarcoidosis.

収録刊行物

• International Heart Journal

  International Heart Journal 50 (6), 731-739, 2009

  一般社団法人 インターナショナル・ハート・ジャーナル刊行会

キーワード

• Sarcoidosis
• Cardiac sarcoidosis
• T wave alternans
• Arrhythmia

詳細情報

• CRID: 1390001205226629120
• NII論文ID: 130000120856
• DOI: 10.1536/ihj.50.731
• ISSN: 13493299
• ISSN: 13492365
• Web Site: http://www.jstage.jst.go.jp/article/ihj/50/6/50_6_731/_pdf
• Web Site: https://search.jamas.or.jp/link/ui/2010112523
• 本文言語コード: en
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