心サルコイドーシス重症化の要因と心不全治療の問題点

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  • Factors Leading to Serious Conditions and Clinical Problems on the Treatment of Congestive Heart Failure in Cardiac Sarcoidosis

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We reviewed 23 cardiac sarcoidosis (CS) patients to clarify some factors leading to serious conditions and analyzed clinical problems on the treatment of congestive heart failure. In 4 patients presenting as congestive heart failure and dilated cardiomyopathy (DCM)-like condition, the diagnosis of CS was confirmed several years after the insertion of permanent pacemaker for advanced atrio-ventricular (AV) block. In spite of continuation of corticosteroid, relapse of active CS was noted. Moderate to severe mitral regurgitation occurred in 8 of the 23 patients (34%) during the clinical course. There were 15 patients (65%) with complete AV or bi-fascicular block. Patchy interstitial fibrosis was frequently observed in the biopsied myocardium. According to analysis of echocardiography, thallium-201 scintigraphy and left ventriculography, anteroseptal regions of the heart was more preferentially affected in CS. In conclusion, delayed diagnosis, relapse of active myocardial lesions, and the developement of mitral regurgitation in CS lead to serious conditions. Beta-blocker therapy and partial left ventriculotomy for severe heart failure may be difficult to be performed in CS patients because of the above mentioned clinicopathological characteristics and lesion distribution.

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