Guideline for Diagnosis of Cardiac Sarcoidosis from The Japanese Ministry of Health and Welfare (15)

Histologic diagnosis group
 Cardiac sarcoidosis is diagnosed when histologic analysis of operative or endomyocardial biopsy specimens demonstrates epithelioid granuloma without caseating granuloma
Clinical diagnosis group
 In patients with histologic diagnosis of extracardiac sarcoidosis, cardiac sarcoidosis is diagnosed when item (a) and 1 or more of items (b–e) are present:
  • (a) Complete right bundle branch block, left-axis deviation, atrioventricular block, ventricular tachycardia, premature ventricular contraction (>grade 2 in Lown's classification), or abnormal Q or ST–T change on electrocardiogram or Holter electrocardiogram

  • (b) Abnormal wall motion, regional wall thinning or thickening, or dilatation of left ventricle on echocardiogram

  • (c) Perfusion defect on 201Tl myocardial scintigram or abnormal accumulation on 67Ga-citrate or 99mTc-pyrophosphate myocardial scintigram

  • (d) Abnormal intracardiac pressure, low cardiac output, or abnormal wall motion or depressed ejection fraction of left ventricle

  • (e) Interstitial fibrosis or cellular infiltration over moderate grade in endomyocardial biopsy even if findings are nonspecific