Semin Respir Crit Care Med 2010; 31(4): 494-500
DOI: 10.1055/s-0030-1262217
© Thieme Medical Publishers

Sarcoidosis-Associated Pulmonary Hypertension: Assessment and Management

Veronica Palmero1 , 2 , Roxana Sulica1 , 2
  • 1Division of Pulmonary and Critical Care Medicine, Beth Israel Medical Center, New York, New York
  • 2Department of Medicine, Albert Einstein College of Medicine, New York, New York
Further Information

Publication History

Publication Date:
27 July 2010 (online)

ABSTRACT

Pulmonary hypertension (PH) is a recognized complication of sarcoidosis, with increased morbidity and poor prognosis. Sarcoidosis-associated pulmonary hypertension (SAPH) is typically seen in advanced cases, with pulmonary fibrosis, destruction and obliteration of the pulmonary vasculature, and chronic hypoxemia. PH can, however, occur in the absence of pulmonary fibrosis, suggesting alternative pathophysiological mechanisms. Diverse processes may coexist in the pathogenesis of SAPH, and there is an overlap with mechanisms of pulmonary arterial hypertension (PAH). This has encouraged the study of PAH-specific therapeutic agents in the treatment of SAPH. In small series, prostacyclin analogues, endothelin receptor antagonists, and phosphodiesterase-5 inhibitors have been shown to improve hemodynamics, functional status, and outcomes. This article reviews the most recent data available in the epidemiology, pathophysiology, diagnosis, and treatment of SAPH.

REFERENCES

  • 1 Shigemitsu H, Nagai S, Sharma O P. Pulmonary hypertension and granulomatous vasculitis in sarcoidosis.  Curr Opin Pulm Med. 2007;  13 434-438
  • 2 Badesch D B, Champion H C, Sanchez M A et al.. Diagnosis and assessment of pulmonary arterial hypertension.  J Am Coll Cardiol. 2009;  54(1, Suppl) S55-S66
  • 3 Simonneau G, Robbins I M, Beghetti M et al.. Updated clinical classification of pulmonary hypertension.  J Am Coll Cardiol. 2009;  54(1, Suppl) S43-S54
  • 4 Baughman R P, Engel P J, Meyer C A, Barrett A B, Lower E E. Pulmonary hypertension in sarcoidosis.  Sarcoidosis Vasc Diffuse Lung Dis. 2006;  23 108-116
  • 5 Handa T, Nagai S, Miki S et al.. Incidence of pulmonary hypertension and its clinical relevance in patients with sarcoidosis.  Chest. 2006;  129 1246-1252
  • 6 Shorr A F, Helman D L, Davies D B, Nathan S D. Pulmonary hypertension in advanced sarcoidosis: epidemiology and clinical characteristics.  Eur Respir J. 2005;  25 783-788
  • 7 Sulica R, Teirstein A S, Kakarla S, Nemani N, Behnegar A, Padilla M L. Distinctive clinical, radiographic, and functional characteristics of patients with sarcoidosis-related pulmonary hypertension.  Chest. 2005;  128 1483-1489
  • 8 Nunes H, Humbert M, Capron F et al.. Pulmonary hypertension associated with sarcoidosis: mechanisms, haemodynamics and prognosis.  Thorax. 2006;  61 68-74
  • 9 Takemura T, Matsui Y, Oritsu M et al.. Pulmonary vascular involvement in sarcoidosis: granulomatous angiitis and microangiopathy in transbronchial lung biopsies.  Virchows Arch A Pathol Anat Histopathol. 1991;  418 361
  • 10 Rosen Y, Moon S, Huang C T, Gourin A, Lyons H A. Granulomatous pulmonary angiitis in sarcoidosis.  Arch Pathol Lab Med. 1977;  101 170-174
  • 11 Takemura T, Matsui Y, Saiki S, Mikami R. Pulmonary vascular involvement in sarcoidosis: a report of 40 autopsy cases.  Hum Pathol. 1992;  23 1216-1223
  • 12 Westcott J L, DeGraff Jr A C. Sarcoidosis, hilar adenopathy, and pulmonary artery narrowing.  Radiology. 1973;  108 585-586
  • 13 Damuth T E, Bower J S, Cho K, Dantzker D R. Major pulmonary artery stenosis causing pulmonary hypertension in sarcoidosis.  Chest. 1980;  78 888-891
  • 14 Sperling R T, Creager M A. Nitric oxide and pulmonary hypertension.  Coron Artery Dis. 1999;  10 287-294
  • 15 Preston I R, Klinger J R, Landzberg M J, Houtchens J, Nelson D, Hill N S. Vasoresponsiveness of sarcoidosis-associated pulmonary hypertension.  Chest. 2001;  120 866-872
  • 16 Giaid A, Yanagisawa M, Langleben D et al.. Expression of endothelin-1 in the lungs of patients with pulmonary hypertension.  N Engl J Med. 1993;  328 1732-1739
  • 17 Sofia M, Mormile M, Faraone S, Alifano M, Carratù P, Carratù L. Endothelin-1 excretion in urine in active pulmonary sarcoidosis and in other interstitial lung diseases.  Sarcoidosis. 1995;  12 118-123
  • 18 Letizia C, Danese A, Reale M G et al.. Plasma levels of endothelin-1 increase in patients with sarcoidosis and fall after disease remission.  Panminerva Med. 2001;  43 257-261
  • 19 Reichenberger F, Schauer J, Kellner K, Sack U, Stiehl P, Winkler J. Different expression of endothelin in the bronchoalveolar lavage in patients with pulmonary diseases.  Lung. 2001;  179 163-174
  • 20 Baughman R P, Sparkman B K, Lower E E. Six-minute walk test and health status assessment in sarcoidosis.  Chest. 2007;  132 207-213
  • 21 Arcasoy S M, Christie J D, Ferrari V A et al.. Echocardiographic assessment of pulmonary hypertension in patients with advanced lung disease.  Am J Respir Crit Care Med. 2003;  167 735-740
  • 22 Gluskowski J, Hawrylkiewicz I, Zych D, Zieliński J. Effects of corticosteroid treatment on pulmonary haemodynamics in patients with sarcoidosis.  Eur Respir J. 1990;  3 403-407
  • 23 Fisher K A, Serlin D M, Wilson K C, Walter R E, Berman J S, Farber H W. Sarcoidosis-associated pulmonary hypertension: outcome with long-term epoprostenol treatment.  Chest. 2006;  130 1481-1488
  • 24 Baughman R P, Judson M A, Lower E E et al.. Inhaled iloprost for sarcoidosis associated pulmonary hypertension.  Sarcoidosis Vasc Diffuse Lung Dis. 2009;  26 110
  • 25 Milman N, Burton C M, Iversen M, Videbaek R, Jensen C V, Carlsen J. Pulmonary hypertension in end-stage pulmonary sarcoidosis: therapeutic effect of sildenafil?.  J Heart Lung Transplant. 2008;  27 329-334
  • 26 Foley R J, Metersky M L. Successful treatment of sarcoidosis-associated pulmonary hypertension with bosentan.  Respiration. 2008;  75 211-214
  • 27 Barnett C F, Bonura E J, Nathan S D et al.. Treatment of sarcoidosis-associated pulmonary hypertension: a two-center experience.  Chest. 2009;  135 1455-1461
  • 28 Macfarlane J T. Prognosis in sarcoidosis.  Br Med J (Clin Res Ed). 1984;  288 1557-1558
  • 29 Lynch III J P, Kazerooni E A, Gay S E. Pulmonary sarcoidosis.  Clin Chest Med. 1997;  18 755-785
  • 30 Arcasoy S M, Christie J D, Pochettino A et al.. Characteristics and outcomes of patients with sarcoidosis listed for lung transplantation.  Chest. 2001;  120 873-880
  • 31 Shorr A F, Davies D B, Nathan S D. Outcomes for patients with sarcoidosis awaiting lung transplantation.  Chest. 2002;  122 233-238
  • 32 Shorr A F, Davies D B, Nathan S D. Predicting mortality in patients with sarcoidosis awaiting lung transplantation.  Chest. 2003;  124 922-928

Roxana SulicaM.D. 

Division of Pulmonary and Critical Care Medicine, Beth Israel Medical Center

10 Union Square East, Ste. 2A, New York, NY 10003

Email: RSulica@chpnet.org

    >