Kardiale Sarkoidose

Zusammenfassung

Die Sarkoidose ist eine Systemerkrankung, bei der die frühzeitigen entzündlichen und unter Therapie rückbildungsfähigen Organveränderungen häufig subklinisch verlaufen. Bei narbigen Residuen ist oft keine Besserung mehr zu erreichen. Ein fortschreitender Funktionsverlust bis zum Organversagen kann auftreten. Der Beteiligung des Herzens kommt dabei eine wesentliche prognostische Bedeutung zu. Ein frühzeitiger Therapiebeginn mit Kortikosteroiden vor Auftreten irreversibler Funktionsstörungen des Herzens geht mit einer exzellenten Prognose einher. Die technischen Entwicklungen in den bildgebenden Verfahren haben zwar die grafische Darstellung von Struktur und Funktion des Herzens deutlich verbessert, dennoch ist bislang kein einzelnes Verfahren in der Früherkennung zuverlässig. Die Kombination verschiedener Verfahren und der klinischen Beschwerden erlaubt jedoch häufig eine frühe Diagnosestellung. Entscheidend ist das „daran denken” und die rechtzeitige Einleitung einer weiterführenden Diagnostik bei entsprechenden Beschwerden. In der spezifischen Therapie fehlen weiterhin Alternativen zur Kortisontherapie. Die symptomatische kardiale Behandlung orientiert sich wesentlich an der Behandlung dilatativer Kardiomyopathien, da in vielen Frage wie z. B. der anti-arrhythmischen Therapie oder der Indikation zur Implantation antitachykarder Schrittmachersysteme keine, eigenständigen verlässlichen Studien zur Herzsarkoidose vorliegen.

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