ECG et sarcoïdose
La sarcoïdose est une granulomatose multisystémique de cause inconnue. L'atteinte médiastino-pulmonaire est la plus fréquente mais d'autres organes peuvent être atteintes tels que la peau, les articulations, les yeux, le système nerveux notamment. L'atteinte cardiaque concerne au moins 25% des patients selon les séries [1] et grève le pronostic de la maladie [2]. Les 3 principales manifestations cardiaques de la sarcoïdose sont des troubles de la conduction, des troubles du rythme ventriculaire et l'insuffisance cardiaque. Le diagnostic de la sarcoïdose cardiaque est un enjeu important qui nécessitera la réalisation d'examens d'imagerie tels que l'IRM et le TEP-scanner. L'ECG est un examen de première intention qui pourra donner orienter vers le diagnostic.
Les manifestations ECG de la sarcoïdose : :
- Les blocs atrio-ventriuclaires (BAV).
ECG normal n'exclut pas le diagnostic
The electrocardiogram (ECG) is usually abnormal in patients with clinically manifest disease. Abnormalities include various degrees of conduction block, such as isolated bundle branch block and fascicular block. Right bundle branch block is consistently more common than left in all CS cohorts 24, 25, 26, 27, 28, 29. Also, QRS complex fragmentation, ST–T-wave changes, pathological Q waves (pseudoinfarct pattern), and (rarely) epsilon waves can occur (30). In contrast, the ECG is abnormal in only 3.2% to 8.6% of patients with clinically silent CS (Table 2) 24, 25, 27, 28.
Sarcoidosis is a multisystem granulomatous disease of unknown etiology characterized by noncaseating granulomas. Cardiac involvement is often limiting patients’ prognosis. Cardiac sarcoidosis can manifest with variant cardiac arrhythmias, of which atrioventricular (AV)-block-related bradycardia and ventricular tachycardias are the most common. Although cardiac sarcoidosis remains a histopathological diagnosis, the significance of imaging modalities, especially cardiac magnetic resonance imaging is increasing rapidly but mainly remains reserved for patients with a high suspicion due to a previous arrhythmia or unknown cardiomyopathy. Thus, there is a need for screening in daily clinical practice so that possible characteristic electrocardiographic (ECG) findings may guide the way to detect the disease.
- ↑ Birnie DH, Nery PB, Ha AC, Beanlands RS. Cardiac Sarcoidosis. J Am Coll Cardiol. 2016 Jul 26;68(4):411-21. doi: 10.1016/j.jacc.2016.03.605. PMID: 27443438.
- ↑ Yazaki Y, Isobe M, Hiroe M, Morimoto S, Hiramitsu S, Nakano T, Izumi T, Sekiguchi M; Central Japan Heart Study Group. Prognostic determinants of long-term survival in Japanese patients with cardiac sarcoidosis treated with prednisone. Am J Cardiol. 2001 Nov 1;88(9):1006-10. doi: 10.1016/s0002-9149(01)01978-6. PMID: 11703997.