Raising the Alarm: Underdiagnosis of Cardiac Sarcoidosis in Young Patients With Unexplained Heart Block

Ghazaleh Goldar; Aaron A Sifuentes; Kaushik Gokul; Usamah M ElBakkush; Mohammed Mhanna; Peter Farjo; Paari Dominic

doi:10.1016/j.jacadv.2025.101890

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Raising the Alarm: Underdiagnosis of Cardiac Sarcoidosis in Young Patients With Unexplained Heart Block

Journal article

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Raising the Alarm: Underdiagnosis of Cardiac Sarcoidosis in Young Patients With Unexplained Heart Block

Ghazaleh Goldar, Aaron A Sifuentes, Kaushik Gokul, Usamah M ElBakkush, Mohammed Mhanna, Peter Farjo and Paari Dominic

JACC. Advances (Online), Vol.4(7), 101890

06/20/2025

DOI: 10.1016/j.jacadv.2025.101890

PMCID: PMC12221766

PMID: 40543461

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Abstract

Background Cardiac abnormalities are often the first or only sign of sarcoidosis. Current guidelines recommend evaluating for cardiac sarcoidosis (CS) in patients below 60 years with unexplained complete heart block (CHB). Objectives The aim of the study was to assess the proportion of patients with unexplained CHB who receive guideline-recommended testing for CS and to compare subsequent diagnosis rates with expected prevalence. Methods We conducted a retrospective cohort study using TriNetX data, identifying patients aged 18 to 60 years with unexplained CHB requiring device placement over the past 5 years. We assessed the use of cardiac diagnostic tests—cardiac magnetic resonance imaging, positron emission tomography, chest computed tomography, and myocardial biopsy—and tracked CS diagnoses over 5 years. Results Among 1,279 patients meeting criteria across 55 health care organizations, 75% were treated at academic centers. The mean age was 48 ± 11 years; 53% were male, and 73% were White. Over a median follow-up of 724 days (Q1-Q3: 0-1,117), advanced cardiac testing was performed in 256 patients (20.0%; 95% CI: 17.8%-22.2%). Specific test utilization included cardiac magnetic resonance imaging in 131 patients (10.2%; 95% CI: 8.6%-11.9%), chest computed tomography in 141 (11.0%; 95% CI: 9.3%-12.7%), cardiac positron emission tomography in ≤10 (0.7%; 95% CI: 0.3%-1.3%), and myocardial biopsy in ≤10 (0.7%; 95% CI: 0.3%-1.3%). Fewer than 10 patients (<1%; 95% CI: 0.3%-1.3%) were diagnosed with CS, far below the expected prevalence of 19% to 34%. Conclusions Despite guideline recommendations, diagnostic testing for CS in younger patients with unexplained CHB remains low. This gap likely contributes to significant underdiagnosis and highlights the need for improved adherence to evaluation protocols.

biopsy

cardiac MRI

cardiac sarcoidosis

complete heart block

FDG-PET

Details

Title: Subtitle: Raising the Alarm: Underdiagnosis of Cardiac Sarcoidosis in Young Patients With Unexplained Heart Block
Creators: Ghazaleh Goldar - University of Iowa
Aaron A Sifuentes - University of Iowa
Kaushik Gokul - Saint Louis University
Usamah M ElBakkush - University of Iowa Hospitals and Clinics
Mohammed Mhanna - University of Iowa
Peter Farjo - University of Iowa
Paari Dominic - University of Iowa
Resource Type: Journal article
Publication Details: JACC. Advances (Online), Vol.4(7), 101890
DOI: 10.1016/j.jacadv.2025.101890
PMID: 40543461
PMCID: PMC12221766
NLM abbreviation: JACC Adv
ISSN: 2772-963X
eISSN: 2772-963X
Publisher: Elsevier
Language: English
Date published: 06/20/2025
Academic Unit: Cardiovascular Medicine; Internal Medicine
Record Identifier: 9984832190902771

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