Sarcoidosis is a disease of unknown cause which affects adults of all ethnic backgrounds. Clumps of tissue called granulomas develop primarily in the lungs, but can damage other organs, especially the heart. Anecdotal evidence from autopsy studies suggests the heart is affected in up to 68% of patients, but there is much uncertainty about this figure.

If undetected and untreated, it can lead to serious complications or even sudden death. The current recommendation is to perform heart tracings (ECG s) on all patients, but this detects fewer than half of those with heart involvement.

Blood markers traditionally used to diagnose heart disease are unreliable, meaning there is no simple blood test in use.

The investigators propose a study with three aims. Firstly, identify the true prevalence of heart disease by performing Magnetic Resonance Imaging (MRI) scans on a group of patients with newly diagnosed lung sarcoidosis. Those found to have heart disease will have specialist (but routine) electrical heart tests. Secondly, (and perhaps the most immediate and clinically relevant) to identify the best method of diagnosing heart involvement using a combination of three simple tests: advanced ECG, 24-hour continuous ECG and a new type of computerised ultrasound scan. Thirdly, to identify proteins in the blood that could be used to develop a simple blood test for heart involvement in patients with lung sarcoidosis.

Inclusion Criteria:

• Newly referred adult patients with pulmonary sarcoidosis and diagnosis made at multidisciplinary meeting as per current joint BTS/ATS guidance
• Patient may be on ≤10mg prednisolone at time of recruitment (if already started at another site prior to referral).
• Able to give informed consent and able to comply with protocol
• ≥>18 yrs

Exclusion Criteria:

• History of other cardiac disease (e.g. coronary artery disease)cardiac surgery or previous myocardial infarction (MI)
• Inability to give informed consent
• <18 yrs
• Patient may be on >10mg prednisolone at time of recruitment (if already started at another site prior to referral).
• On non-steroidal medication including methotrexate
• Pregnancy
• Alcoholism
• Illicit drug abuse

Exclusion criteria for MRI:

• Cardiac pacemakers
• Surgical clips in the head (particularly aneurysm clips)
• Electronic inner ear implants (bionic ears)
• Ocular metal fragments • Electronic stimulators • Implanted pumps
• Severe claustrophobia

Patients with diagnosis of pulmonary sarcoidosis