Cardiac MRI or FDG-cPET are the tests of choice for diagnosis of cardiac sarcoidosis but are expensive so screening a patient for risk can be helpful.
Patient selection: patient with sarcoidosis and >= 18 years old
Major criteria (scored 5 points):
(1) ventricular tachycardia
(2) second-degree type II AV block
(3) third-degree AV block
(4) LV systolic dysfunction with ejection fraction < 55% (on echo)
(5) monomorphic VT (on electrophysiology)
Minor criteria (scored 3 points):
(1) abnormal voltage mapping (on electrophysiology)
(2) conduction delays (on electrophysiology)
Minor criteria (scored 2 points):
(1) left bundle branch block (LBBB)
(2) supraventricular arrhythmia
(3) abnormal domain on signal-averaged ECG
(4) reverse SPECT perfusion defect (stress images show greater perfusion than images at rest)
Minor criteria (scored 1 point):
(1) diastolic dysfunction
(2) wall thinning (on echo)
(3) right ventricular systolic dysfunction
(4) right bundle branch block (RBBB)
(5) first-degree AV block
(6) wall motion abnormalities (on echo)
Other minor criteria from Table 1 (presumably 1 point):
(1) premature ventricular contraction (PVC)
(2) polymorphic VT on electrophysiology
(3) other AV block
(4) conduction delays
total score =
= SUM(points for all abnormalities present)
Interpretation:
• minimum score: 0
• The presence of >= 2 major findings (score >= 10) was associated with probable cardiac sarcoidosis.
• Some patients with a score of 0 have abnormal cardiac MRI or FDG-cPET.
