Among patients with cardiac sarcoidosis, those with a primary diagnosis of ventricular arrhythmia and global left ventricular systolic dysfunction were associated with a poorer prognosis. The study findings were presented at the American Heart Association Scientific Sessions 2021, held virtually from November 13 to 15, 2021.
Diagnoses of cardiac sarcoidosis have increased in recent years due to uptake of cardiac positron emission tomography (PET) scan and magnetic resonance imaging (MRI). Patients with cardiac sarcoidosis can vary greatly in presentation from advanced heart block to heart failure (HF) and ventricular arrhythmias. It remains unclear which presenting symptoms associate with poorer or more favorable outcomes.
To better assess cardiac sarcoidosis trajectories, researchers from Allegheny General Hospital conducted a retrospective review of patient records. Patients (N=223) who were evaluated for suspected cardiac sarcoidosis by PET/MRI between 2016 and 2019 were assessed for clinical outcomes on the basis of primary presentation. A total of 62 patients were found to have cardiac sarcoidosis.
The patients were 65% men, had a mean age of 60±10 years, and 79% were White. Patients were referred for cardiac sarcoidosis assessment due to HF (59%), high grade atrioventricular block/ventricular arrhythmia (25%), and for screening (16%).
During PET/MRI, no differences in late gadolinium enhancement during cardiovascular magnetic resonance or inflammation were observed, but patient groups differed for resting anteroseptal perfusion and summed rest scores (P <.05).
Patients received steroids (39%), immunosuppressant (25%), or combinatorial therapy (10%).
At 3.5 years, there were 6 deaths, 10 HF admissions, and 10 ICD shocks. Event-free survival was 80% among the screening group, 76% among the heart failure group, and 53% for the patients with arrhythmia.
In a multivariate analysis, risk for major adverse cardiovascular events was predicted by ventricular tachycardia presentation (odds ratio [OR], 11; P <.05) and global hypokinesis (OR, 10; P <.05) with an 86% sensitivity and 63% specificity.
This study found that patients with cardiac sarcoidosis who presented with ventricular arrhythmia and global left ventricular systolic dysfunction were associated with poorer clinical outcomes.
These data were sourced from a single center, so findings may not be generalizable.
Bosah A, Doyle M, Poornima IG. Clinical Presentation rather than imaging findings determine outcomes in cardiac sarcoidosis. Presented at: AHA Scientific Sessions 2021. Abstract 13823.