Clinical and functional features of the course of respiratory sarcoidosis in real practice

As a rule, heart damage in patients with sarcoidosis of respiratory organs (SOD) is not diagnosed in time, so a very important and urgent task is to identify common heart rhythm and conduction disorders.

The aim of the study was to investigate the main clinical manifestations of sarcoidosis in SOD, depending on the peculiarities of the disease course and to compare the frequency and severity of pulmonary and extrapulmonary manifestations of sarcoidosis, including myocardial lesions and electrocardiographic (ECG) signs of heart rhythm disorders.

Methods. In the period 2006– 2016, the pilot open prospective uncontrolled study conducted at the Pulmonology Department of the Regional State Autonomous Healthcare Institution "Tomsk Regional Clinical Hospital" included patients (n = 84) aged 20–67 years with the diagnosis of SOD. Patients were divided into 2 clinical groups: the 1st comprised 45 (53.5%) patients with a favorable course of sarcoidosis, the second one included 39 (46.4%) patients with an unfavorable course of the disease. A full range of studies was carried out, including the analysis of medical history and clinical and epidemiological data, instrumental methods (including ECG and Holter ECG monitoring (HM), pathomorphological study of lung biopsy samples.

Results. According to the data of frequency analysis of occurrence of pulmonary and extrapulmonary clinical manifestations in ODS, it was shown that the leading clinical manifestations, most frequently occurring in patients of both groups, included asthenia syndrome (72.6%), bronchial syndrome (66.7%) and fever syndrome (33%). In 33% of cases, clinical manifestations of myocardial damage were detected. In 41 (51.2%) patients in both groups, changes on ECG were recorded at rest. Regardless of the course of the disease, in 23.5% of patients of both clinical groups, according to the results of the HM ECG, rhythm and conduction disturbances were found – a combination of ventricular arrhythmias and conduction disorders (ventricular extrasystole and right His bundle branch block of various degrees) and a combination of supraventricular arrhythmias and conduction disturbances (supraventricular extrasystole and right His bundle branch block of various degrees).

Conclusion. Thus, regardless of the severity of the disease course, SOD patients are concerned about complaints from both respiratory system and extrapulmonary manifestations, including cardiac complaints, as well as heart rhythm and conduction disorders (according to the results of ECG and HM ECG), the frequency of which, according to the comparative analysis, has not significantly changed in both clinical groups, which indicates the non-specific character of clinical manifestations. 

1. Terpigorev S.A., El' Zeyn B.A., Vereshchagina V.M., Paleev N.R. [Sarcoidosis and its classification problems]. Vestnik RAMN. 2012; 67 (5): 30–37. DOI: 10.15690/vramn.v67i5.271 (in Russian).

2. Popova E.N., Strizhakov L.A., Sholomova V.I. et al. [Clinical features of cardiac lesion in patients with generalized sarcoidosis]. Terapevticheskiy arkhiv. 2018; 90 (1): 54–59. DOI: 10.26442/terarkh201890154-59 (in Russian).

3. Gaydar E.N., Gorskaya E.V. [Sarcoidosis of respiratory organs]. Glavnyy vrach Yuga Rossii. 2018; 2 (60): 62–65 (in Russian).

4. Rizzato G. Extrapulmonary presentation of sarcoidosis. Curr. Opin. Pulmon. Med. 2001; 7 (5): 295–297. DOI: 10.1097/00063198-200109000-00008.

5. Drent M., Costabel U., eds. Sarcoidosis. Wakefield, UK: The Charlesworth Group; 2005. DOI: 10.1183/1025448x.erm3205.

6. Lebedeva M., Popova E., Ponomarev A. et al. [Extrapulmonary manifestations of sarcoidosis]. Vrach. 2011; (3): 43–45 (in Russian).

7. Shmelev E.I. [Sarcoidosis]. Atmosfera: Pul'monologiya i allergologiya. 2004; (2): 3–10 (in Russian).

8. Segura A.M., Radovancevic R., Demirozu Z.T. et al. Granulomatous myocarditis in severe heart failure patients undergoing implantation of a left ventricular assist device. Cardiovasc. Pathol. 2014; 23 (1): 17–20. DOI: 10.1016/j.carpath.2013.06.005.

9. Chuchalin A.G., Vizel' A.A., Il'kovich M.M. et al. [Diagnosis and treatment of sarcoidosis: summary of Federal Concillative Clinical Recommendations (Part I. Classification, etiopathogenesis, clinic)]. Vestnik sovremennoy klini cheskoy meditsiny. 2014; 7 (4): 62–70 (in Russian).

10. Chuchalin A.G., Vizel' A.A., Il'kovich M.M. et al. [Diagnosis and treatment of sarcoidosis: summary of federal concillative clinical recommendations. (Part II. Diagnosis, treatment, prognosis)]. Vestnik sovremennoy klinicheskoy meditsiny. 2014; 7 (5): 73–81 (in Russian).

11. Ministry of Health of Russia. Russian Respiratory Society. [Federal clinical guidelines for the diagnosis and treatment of sarokidosis]. 2016 Available at: spulmo.ru›download/ Саркоидоз проект.pdf (in Russian).

12. Vorselaars A.D., Verwoerd A., van Moorsel C.H. et al. Predic tion of relapse after discontinuation of infliximab therapy in severe sarcoidosis. Eur. Respir. J. 2014; 43 (2): 602–609. DOI: 10.1183/09031936.00055213.

13. Vizel A.A., ed. [Sarcoidosis]. Moscow: Atmosfera; 2010 (in Russian).

14. Agrawal V., Crisi G.M., D'Agati V.D., Freda B.J. Renal sarcoidosis presenting as acute kidney injury with granulomatous interstitial nephritis and vasculitis. Am. J. Kidney Dis. 2012; 59 (2): 303–308. DOI: 10.1053/j.ajkd.2011.09.025.

15. Stepanyan I.E. [Sarcoidosis in therapeutic practice] Doctor. ru 2014; 2 (90): 17–22 (in Russian).

16. Vizel' A.A., Vizel' I.Yu. [Sarcoidosis: What general practitioner should know]. Effektivnaya farmakoterapiya. 2015; (29): 32–37 (in Russian).