Cardiac Sarcoidosis

Clinical and subclinical cardiac sarcoidosis (CS) remains diagnostically challenging as the sensitivity and specificity of the diagnostic modalities are limited. The Japanese Ministry of Health and Welfare criteria and the Heart Rhythm Society expert consensus statement on CS are the most common guidelines used to diagnose CS. However, they are mostly based on expert opinions and lack clinical trial validation. The emergence and increase use of newer imaging modalities such as cardiac magnetic resonance and positron emission tomography may give valuable information for accurate diagnosis and assessment of treatment response in CS patient. Although immunosuppressive therapies, particularly corticosteroids, have been proposed as the mainstay of treatment in CS, there is paucity of data on the optimal initiation, duration, and dosage of immunosuppressive therapies. Recommendations are mostly based on small observational studies. Further studies are warranted to better characterize the use of immunosuppressive therapies in this patient population. Device therapies such as implantable cardioverter-defibrillators are usually recommended for patient with clinical CS. In conclusion, this article synthesizes the current best evidence of utilizing various imaging modalities to diagnose CS and summarizing the main therapeutic approaches to manage and treat CS.