Subclinical Cardiac Dysfunction in Sarcoidosis (14)
The group with fast HR responses and normal resting ejection fraction could be explained in two ways: the normal ejection fraction at rest may fail to increase appropriately or may even decrease during exercise, or these patients may have chronotropic abnormalities secondary to sarcoidotic involvement in and around the sinus node. In favor of the latter possibility is the finding that six of the eight patients in this group (high SHR and normal LVEF) had resting tachycardia suggesting an impairment, both at rest and during exercise, of their intrinsic pacemakers. In contrast, none of the patients with high SHR and low resting LVEF had resting tachycardia, suggesting a different cause for their poor performance. buy flovent inhaler
Other interpretations for the low LVEF in these patients should be considered, since they might explain some of our findings. Specifically, increases in ventricular afterload can reduce LVEF independent of the state of contractility. If wall tension is increased by abnormal ventricular compliance, ejection fraction could be reduced. The presence of myocardial granulomata could conceivably have decreased ventricular compliance sufficiently to reduce LVEF, as has been described in other myocardial infiltrative processes such as amyloidosis. In fact, studies looking at patients with sarcoidosis similar to ours at autopsy have reported diffuse granulomata in the myocardium in 20 to 30 percent of the cases,” and it is possible that this infiltration alters ventricular function.