Diagnostik und Therapie der kardialen Sarkoidose^[*]

 

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Zusammenfassung

Während 90 % aller Sarkoidose-Patienten eine parenchymatöse Beteiligung der Lunge aufweisen, ist die kardiale Sarkoidose (in weniger als 10 % der Fälle klinisch manifest) selten. Generell können alle Strukturen des Herzens von der Granulom-Bildung betroffen sein. Meist jedoch ist das Myokard des linken Ventrikels sowie das Reizleitungssystem beeinträchtigt. Klinisch manifestiert sich die kardiale Sarkoidose als dilatative Kardiomyopathie oder in Form von Herzrhythmusstörungen wie Vorhofflimmern und/oder ventrikulärer Tachykardien. Das Spektrum reicht von der benignen, subklinischen Manifestation als Zufallsbefund bis zur lebensbedrohlichen Komplikation. Diagnostische Schritte und therapeutische Empfehlungen zur kardialen Sarkoidose liegen im deutschsprachigen Raum bisher nicht vor. Die vorliegende Arbeit ist eine Expertenstellungnahme unter dem Schirm der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin (DGP) und der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung (DGK). Die nachstehenden Empfehlungen ersetzen jedoch nicht die ärztliche Begutachtung des individuellen Patienten und Anpassung der Diagnostik und Therapie an dessen spezifische Situation.

Abstract

Sarcoidosis is a multisystemic granulomatous disorder which affects the respiratory system in the majority of the cases. Cardiac manifestations are found in up to 10 % of the affected cohort and show a large heterogeneity based on the ethnic background. Cardiac sarcoidosis are not only found in patients with rhythmogenic heart disease such as atrial and ventricular fibrillation but also in all phenotypes of cardiomyopathies. The overall morbidity and mortality caused by cardiac sarcoidois in Germany is unclear and no large prospective international studies are published on this topic. This consensus paper on diagnostic and therapeutic algorithms in cardiac sarcoidosis is based on a current literature search and forms a expert opinion statement under the hospices of the “Deutsche Gesellschaft für Pneumologie” and “Deutsche Gesellschaft für Kardiologie”. It is the rationale of this statement to offer algorithms to facilitate clinical decision-making based on the individual case.

^* Dieses Konsensuspapier erscheint zeitgleich in den Fachzeitschriften „Pneumologie“ und „Der Kardiologe“.

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