ATS GUIDELINES Bundle

4 Diagnosis Diagnostic Evaluation of Suspected Extrapulmonary Disease ➤ For patients with extracardiac sarcoidosis and suspected cardiac involvement, the ATS suggests cardiac magnetic resonance imaging (MRI), rather than positron emission tomography (PET) or TTE, to obtain both diagnostic and prognostic information (conditional recommendation, very low-quality evidence). ➤ For patients with extracardiac sarcoidosis and suspected cardiac involvement who are being managed in a setting in which cardiac MRI is not available, the ATS suggests dedicated PET, rather than TTE, to obtain diagnostic and prognostic information (conditional recommendation, very low-quality evidence). ➤ For patients with sarcoidosis in whom pulmonary hypertension (PH) is suspected, the ATS suggests initial testing with TTE (conditional recommendation, very low-quality evidence). Remarks: "PH is suspected" refers to clinical manifestations, including exertional chest pain and/or syncope, exam findings of a prominent P2 or S4, reduced 6-minute walk distance, desaturation with exercise, reduced DLCO, increased pulmonary artery diameter relative to ascending aorta diameter (e.g., by compute tomography [CT] scan), elevated brain natriuretic factor, and/or fibrotic lung disease. ➤ For patients with sarcoidosis in whom PH is suspected and a transthoracic echocardiogram is suggestive of PH, the ATS suggests right heart catheterization to definitively confirm or exclude PH (conditional recommendation, very low-quality evidence). ➤ For patients with sarcoidosis in whom PH is suspected and a transthoracic echocardiogram is NOT suggestive of PH, the need for right heart catheterization should be determined on a case-by-case basis (best practice statement).

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