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Diagnostik und Therapie der kardialen Sarkoidose

Konsensuspapier der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin (DGP) und Deutschen Gesellschaft für Kardiologie – Herz und Kreislaufforschung (DGK)

Diagnostics and treatment of cardiac sarcoidosis

Consensus paper of the German Respiratory Society (DGP) and the German Cardiac Society (DGK)

  • Konsensuspapiere
  • Published:
Der Kardiologe Aims and scope

Zusammenfassung

Während 90 % aller Sarkoidosepatienten 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 Granulombildung betroffen sein. Meist jedoch sind 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 ventrikulären Tachykardien. Das Spektrum reicht von der benignen, subklinischen Manifestation als Zufallsbefund bis zur lebensbedrohlichen Komplikation, wie aktuelle Kohortenstudien zeigen. Diagnostische Schritte und therapeutische Empfehlungen zur kardialen Sarkoidose sollten daher einem einheitlichen Standard unterliegen. Die vorliegende Arbeit ist die 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. Symptomatic cardiac manifestations are found in less than 10% of the affected cohorts and show a large heterogeneity based on the ethnic background. Cardiac sarcoidosis is not only found in patients with arrhythmogenic heart disease, such as atrial and ventricular fibrillation but also in all phenotypes of cardiomyopathy. The overall morbidity and mortality caused by cardiac sarcoidosis in Germany remains unclear and large prospective international observational studies underline the importance of this disease entity. This consensus paper on diagnostic and therapeutic algorithms for cardiac sarcoidosis is based on a current literature search and forms an expert opinion statement under the auspices of the German Respiratory Society (DGP) and the German Cardiac Society (DGK). The rationale of this statement is to provide algorithms to facilitate clinical decision-making based on the individual case situation.

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Author information

Authors and Affiliations

  1. Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Bonn, Deutschland

    D. Skowasch

  2. Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Bonn, Bonn, Deutschland

    F. Gaertner

  3. Klinik für Kardiologie, Angiologie und Internistische Intensivmedizin (Med. Klinik I), Universitätsklinikum Aachen, Aachen, Deutschland

    N. Marx

  4. Institut für Cardiomyopathien Heidelberg, Abteilung für Kardiologie, Angiologie und Pulmologie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    B. Meder

  5. Abteilung Pneumologie, Universitätsklinikum Freiburg, Freiburg, Deutschland

    J. Müller-Quernheim

  6. Psychosomatische Medizin und Psychotherapie, Zentrum für Pneumologie, Klinik Donaustauf, Donaustauf, Deutschland

    M. Pfeifer

  7. Medizinische Klinik und Poliklinik II, Sektion Elektrophysiologie, Universitätsklinikum Bonn, Bonn, Deutschland

    J. W. Schrickel

  8. Klinik für Kardiologie I, Sektion für Herzbildgebung, Universitätsklinikum Münster, Münster, Deutschland

    A. Yilmaz

  9. Klinik für Pneumologie, Ev. Lungenklinik Berlin, Lindenberger Weg 27, 13125, Berlin, Deutschland

    C. Grohé

Authors
  1. D. Skowasch
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  2. F. Gaertner
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  3. N. Marx
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  4. B. Meder
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  5. J. Müller-Quernheim
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  6. M. Pfeifer
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  7. J. W. Schrickel
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  8. A. Yilmaz
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  9. C. Grohé
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Corresponding author

Correspondence to C. Grohé.

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Interessenkonflikt

D. Skowasch, F. Gaertner, N. Marx, B. Meder, J. Müller-Quernheim, M. Pfeifer, J.W. Schrickel, A. Yilmaz und C. Grohé geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Additional information

N. Marx hat an diesem Beitrag für die Kommission für Klinische Kardiovaskuläre Medizin der DGK mitgewirkt.

Aus Gründen der Lesbarkeit wird darauf verzichtet, geschlechterspezifische Formulierungen zu verwenden. Soweit personenbezogene Bezeichnungen nur in männlicher Form angeführt sind, beziehen sie sich auf alle Geschlechter in gleicher Weise.

Dieser Beitrag wurde in den Zeitschriften Der Kardiologe 01/2020 und Pneumologie 01/2020 publiziert.

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Skowasch, D., Gaertner, F., Marx, N. et al. Diagnostik und Therapie der kardialen Sarkoidose. Kardiologe 14, 14–25 (2020). https://doi.org/10.1007/s12181-019-00359-y

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