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Purpose Identification of subclinical dysfunction of the right ventricular (RV) using modern exercise stress echo. Methods The main group consists of 66 patients with I-II stage of histologically verified pulmonary sarcoidosis: 42 men (63.6%) and 24 women (36.4%); mean age 31.9±5.59 years. The control group included 33 healthy, non-smokers: 24 men (72.7%) and 9 women (27.3%); average age 30.18±5.3 years. Stress-echo was performed on US system Vivid E9 (GE, USA), on a GE “e-Bike” horizontal bicycle ergometer, according to the “50x25” protocol with an increase in load every 2 min. In addition to the standard protocols, the global longitudinal RV strain (GLS RV) and systolic pressure in the pulmonary artery (SPAP, mm Hg) were assessed at rest and at the peak of exercise. Results RV GLS values in patients with sarcoidosis at the peak of exercise didn't increase, but rather decreased from −22.8±3.4% to 21.2±4.7% (p=0.004), unlike increased in healthy volunteers: from −24.1±2.7% to −25.1±3% (p=0.002), the whole values were within the normal range. An important fact is the decrease in the level of GLS RV in patients with pulmonary sarcoidosis (7%, p=0.00001). The estimated rest SPAP in patients with sarcoidosis was slightly higher than in healthy people (28.5±8.3 and 24.8±5.21 mm Hg.; p=0.03), but these values also didn't accede norms. At the peak of exercise, it increased greater than in the control group (32.9±10.1 and 48.36±14.4 mm Hg; p=0.000001). It was additionally revealed that in patients with sarcoidosis, GLS RV decrease by −0.8% was accompanied by an increase in SPAP by 8 mm Hg. In the control group the lower quartile of SPAP was 29 mm Hg, at the peak of exercise – 38 mm Hg. In the main group the value of SPAP exceeded the upper quartile of the control group (38 mm Hg) in 79% of cases. So we confirmed the presence of subclinical pulmonary hypertension in asymptomatic patients at the early stages of pulmonary sarcoidosis. To cut he limits of pathology in the main group, threshold GLS RV values were obtained at the peak of exercise by the method of classification trees. Values less than −21.6% were correlated with the presence of subclinical RV dysfunction with 90% rang; in combination with increase in SPAP more than 39.5 mm Hg – 100% rang. 50 patients (75% of the main group) showed an increase in SPAP at the peak of exercise more than 39.5 mm Hg. 37 patients (56%) showed GLS RV decrease less than −21.6%. Combination of these two parameters was detected in 42% of cases. Conclusions Thus, in 42% of young patients with sarcoidosis, latent right ventricular dysfunction was revealed at the absence of symtoms and pathological changes in resting echocardiography. Therefore, GLS RV decrease at the peak of exercise less than −21.6% with an increase in SPAP more than 39.5 mm Hg may be a predictor of subclinical cardiac dysfunction in patients with pulmonary sarcoidosis. Funding Acknowledgement Type of funding source: None

Purpose To assess CPET data in young patients with pulmonary sarcoidosis (grade I-II) respectively corresponding parameters in healthy individuals. Methods 99 people aged 25–44 years were examined: 66 people with pulmonary sarcoidosis (PS) I-II grade formed the main group. The control group included 33 healthy, non-smoking people. In both groups the CPET was performed for assessment functional status of cardiorespiratory system. Results Vital capacity and FEV1 didn't differ in both groups (p=0.6 and 0.19). However, Tiffno's index was significantly higher in the control group (p=0.0002). There were no differences in RVOT1, RVOT2, RA volume index in both groups. A comparative analysis of the RV wall thickness revealed that the values in both groups did not exceed the normal limits, but in the main group it was significantly larger (p=0.01). The basal RV diameter at rest were also larger in patients with sarcoidosis (p=0.007). LV contractility at rest was within normal values in both groups, however, in patients with sarcoidosis EF were statistically less than in the control group. At the peak of exercise EF increased more significantly in the control group (p Thus, at the early stages of pulmonary sarcoidosis in young people there are no significant contractility abnormalities both at rest and at the peak of exercise, whereas the EF increase was lower than in healthy individuals. It is necessary to determine GLS RV, which may indicate RV dysfunction preceding the development of LV dysfunction. In patients with sarcoidosis, it's necessary to determine PAP at the peak of exercise, which increased in 79% of cases more than in healthy individuals. This may be due to secondary heart lesion at presence of pulmonary hypertension. The maximum oxygen consumption at the peak of exercise is higher in healthy individuals than in patients with sarcoidosis. So functional reserve was higher in the control group. Thus, the CPET today is an informative diagnostic tool which should be included in the diagnostic algorithms for patients with sarcoidosis.