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Crea F. Heart failure and ischaemic heart disease: new challenges and opportunities. Eur Heart J 2024; 45:2681-2685. [PMID: 39121015 DOI: 10.1093/eurheartj/ehae497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2024] Open
Affiliation(s)
- Filippo Crea
- Center of Excellence of Cardiovascular Sciences, Ospedale Isola Tiberina - Gemelli Isola, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
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Pöyhönen P, Lehtonen J, Velikanova D, Simonen P, Uusitalo V, Mälkönen H, Nordenswan HK, Vihinen T, Kaikkonen K, Haataja P, Kerola T, Rissanen TT, Vepsäläinen V, Alatalo A, Pietilä-Effati P, Kupari M. 30-Year Trends in the Incidence, Characteristics, and Outcome of Cardiac Sarcoidosis in a Nationwide Cohort. JACC. ADVANCES 2024; 3:101102. [PMID: 39105120 PMCID: PMC11298841 DOI: 10.1016/j.jacadv.2024.101102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/17/2024] [Accepted: 06/05/2024] [Indexed: 08/07/2024]
Abstract
Background Cardiac sarcoidosis (CS) is a rare but potentially fatal inflammatory cardiomyopathy. Objectives The authors studied temporal changes in the incidence, characteristics, and outcome of CS. Methods A retrospective analysis was made of a 30-year nationwide cohort of CS. Results The cohort comprised 511 patients with a median age of 52 years and female preponderance (69%). Altogether 77, 166, and 268 cases of CS were diagnosed in years 1988 to 2009, 2010 to 2014, and 2015 to 2019, respectively; the 5-year count of 2015 to 2019 was 134-fold the count of 1990 to 1994 (268/2) and 18-fold the count of 2000 to 2004 (268/15). Prior to 2010, compared with the later periods, CS presented more often with ventricular tachycardia/fibrillation (prevalence 36% vs 19% in 2010-2014 and 11% in 2015-2019, P < 0.001), left ventricular ejection fraction <50% (49%, 35%, and 31%; P = 0.010), and elevation of natriuretic peptides (87%, 57%, and 49%; P < 0.001). On magnetic resonance imaging, late gadolinium enhancement involved a median of 15% (IQR: 11%-22%) of left ventricular mass in studies of 1988 to 2009 (n = 16), 15% (IQR: 9%-22%) in studies of 2010 to 2014 (n = 87), and 11% (IQR: 5%-19%) in studies of 2015 to 2019 (n = 150) (P = 0.031). The respective 5-year incidences of the composite of death, heart transplantation, left ventricular-assisted device implantation, or ventricular tachyarrhythmia were 40% (95% CI: 29%-51%), 32% (95% CI: 25%-39%), and 23% (95% CI: 16%-30%) (P = 0.002). The prognostic trend disappeared after adjustment for differences in the presenting phenotype. Conclusions Diagnoses of incident CS have increased exponentially in Finland. Concurrently, the phenotype has turned milder and prognosis better, suggesting detection of CS at an earlier stage of its course.
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Affiliation(s)
- Pauli Pöyhönen
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jukka Lehtonen
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Diana Velikanova
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Piia Simonen
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Valtteri Uusitalo
- Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Clinical Physiology and Nuclear Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Henriikka Mälkönen
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Hanna-Kaisa Nordenswan
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | | | - Kari Kaikkonen
- Medical Research Center Oulu, University and University Hospital of Oulu, Oulu, Finland
| | - Petri Haataja
- Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Tuomas Kerola
- Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland
| | | | | | | | | | - Markku Kupari
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Suwa K, Naruse Y, Nabeta T, Kitai T, Taniguchi T, Yoshioka K, Tanaka H, Okumura T, Baba Y, Matsue Y, Maekawa Y. Cardiac sarcoidosis treated with nonsteroidal immunosuppressive therapy. IJC HEART & VASCULATURE 2024; 53:101473. [PMID: 39139610 PMCID: PMC11320430 DOI: 10.1016/j.ijcha.2024.101473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 07/01/2024] [Accepted: 07/17/2024] [Indexed: 08/15/2024]
Abstract
Background Nonsteroidal immunosuppressive therapy is a potential therapeutic strategy for cardiac sarcoidosis. However, it is not recommended as an established treatment option. This study aimed to demonstrate the clinical outcomes of patients with cardiac sarcoidosis using nonsteroidal immunosuppressants through the ILLUstration of the Management and PrognosIs of JapaNese PATiEnts with Cardiac Sarcoidosis multicenter retrospective registry. Methods From a cohort of 512 patients, 426 who received corticosteroid therapy and 26 who received other immunosuppressive therapy were included for analysis. Clinical outcomes included all-cause death, fatal ventricular arrhythmic events (FVAE), and worsening heart failure with hospitalization. Results Nonsteroidal immunosuppressants were used for retained fluorodeoxyglucose uptake in the heart (n = 14), corticosteroid side effects (n = 7), ventricular arrhythmia (n = 4), complete atrioventricular block (n = 2), worsened extracardiac sarcoidosis (n = 2), and other reasons (n = 2). They comprised of methotrexate (n = 20), cyclosporine (n = 2), cyclophosphamide (n = 2), and azathioprine (n = 3). After the addition of a nonsteroidal immunosuppressant, corticosteroids were reduced in 14 of 26 patients (5 [5-17] mg), although no patient discontinued corticosteroids. Of the 14 patients, decreased fluorodeoxyglucose uptake was observed in seven at follow-up. Clinical outcomes were observed in 11 patients (42.3 %). Detected events included all-cause death in five patients (19.2 %), FVAE in four (15.4 %), and worsening heart failure with hospitalization in five (19.2 %), with some overlap. Conclusions Nonsteroidal immunosuppressive therapy may be a possible treatment option for patients who are not stabilized with corticosteroids alone or develop corticosteroid side effects.
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Affiliation(s)
- Kenichiro Suwa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yoshihisa Naruse
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takeru Nabeta
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tatsunori Taniguchi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kenji Yoshioka
- Department of Cardiology, Kameda Medical Center, Chiba, Japan
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuichi Baba
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuichiro Maekawa
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Yamada Y, Sato K, Yamamoto M, Nabeta T, Naruse Y, Taniguchi T, Kitai T, Yoshioka K, Tanaka H, Okumura T, Baba Y, Fujimoto Y, Matsue Y, Komatsu Y, Nogami A, Ishizu T. Association Between Right Bundle Branch Block and Ventricular Arrhythmia in Patients With Cardiac Sarcoidosis. JACC. ADVANCES 2024; 3:101105. [PMID: 39105116 PMCID: PMC11299579 DOI: 10.1016/j.jacadv.2024.101105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 05/17/2024] [Accepted: 06/05/2024] [Indexed: 08/07/2024]
Abstract
Background Ventricular arrhythmia (VA) is a life-threatening condition associated with cardiac sarcoidosis (CS). Right bundle branch block (RBBB) is a common conduction disorder in CS; however, its association with VA remains unknown. Objectives This study aimed to investigate the relationship between RBBB and VA in patients with CS. Methods This was a post hoc analysis of ILLUMINATE-CS (Illustration of the Management and Prognosis of Japanese Patients with Cardiac Sarcoidosis), a multicenter, retrospective, and observational study that evaluated the clinical characteristics and prognosis of CS. Eligible patients were divided into two groups based on the presence or absence of RBBB at the time of diagnosis. The primary outcome was serious ventricular arrhythmia events (SVAEs), defined as a combination of sudden cardiac death and documented ventricular fibrillation, sustained ventricular tachycardia, or appropriate implantable cardioverter-defibrillator therapy. Results Overall, 312 patients were studied, with 155 (49.7%) patients presenting with RBBB (RBBB group). Patients in the RBBB group had a higher prevalence of basal interventricular septum (IVS) thinning and prominent late gadolinium enhancement in the basal IVS on cardiac magnetic resonance imaging than those in the non-RBBB group. During a median follow-up of 3.0 years (IQR: 1.6-6.0 years), 66 patients experienced SVAE. In multivariable Cox regression analysis, the RBBB group was independently associated with a higher incidence of SVAEs (HR: 1.93 [95% CI: 1.14-3.28]; P = 0.015). Conclusions In patients with CS, RBBB was an independent predictor of SVAEs, which might reflect the specific scar distribution that is predominant in the IVS.
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Affiliation(s)
- Yu Yamada
- Department of Cardiology, Institute of Medicine; University of Tsukuba, Tsukuba, Japan
| | - Kimi Sato
- Department of Cardiology, Institute of Medicine; University of Tsukuba, Tsukuba, Japan
| | - Masayoshi Yamamoto
- Department of Cardiology, Institute of Medicine; University of Tsukuba, Tsukuba, Japan
| | - Takeru Nabeta
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yoshihisa Naruse
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tatsunori Taniguchi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kenji Yoshioka
- Department of Cardiology, Kameda Medical Center, Kamogawa, Japan
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuichi Baba
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Yudai Fujimoto
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Hongo, Japan
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Hongo, Japan
| | - Yuki Komatsu
- Department of Cardiology, Institute of Medicine; University of Tsukuba, Tsukuba, Japan
| | - Akihiko Nogami
- Department of Cardiology, Institute of Medicine; University of Tsukuba, Tsukuba, Japan
| | - Tomoko Ishizu
- Department of Cardiology, Institute of Medicine; University of Tsukuba, Tsukuba, Japan
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Ahmed R, Sawatari H, Amanullah K, Okafor J, Wafa SEI, Deshpande S, Ramphul K, Ali I, Khanji M, Mactaggart S, Abou-Ezzeddine O, Kouranos V, Sharma R, Somers VK, Mohammed SF, Chahal CAA. Characteristics and Outcomes of Hospitalized Patients With Heart Failure and Sarcoidosis: A Propensity-Matched Analysis of the Nationwide Readmissions Database 2010-2019. Am J Med 2024; 137:751-760.e8. [PMID: 38588938 DOI: 10.1016/j.amjmed.2024.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Sarcoidosis is associated with a poor prognosis. There is a lack of data examining the outcomes and readmission rates of sarcoidosis patients with heart failure (SwHF) and without heart failure (SwoHF). We aimed to compare the impact of non-ischemic heart failure on outcomes and readmissions in these two groups. METHODS The US Nationwide Readmission Database was queried from 2010 to 2019 for SwHF and SwoHF patients identified using the International Classification of Diseases, 9th and 10th Editions. Those with ischemic heart disease were excluded, and both cohorts were propensity matched for age, gender, and Charlson Comorbidity Index (CCI). Clinical characteristics, length of stay, adjusted healthcare-associated costs, 90-day readmission and mortality were analyzed. RESULTS We identified 97,961 hospitalized patients (median age 63 years, 37.9% male) with a diagnosis of sarcoidosis (35.9% SwHF vs 64.1% SwoHF). On index admission, heart failure patients had higher prevalences of atrioventricular block (3.3% vs 1.4%, P < .0001), ventricular tachycardia (6.5% vs 1.3%, P < .0001), ventricular fibrillation (0.4% vs 0.1%, P < .0001) and atrial fibrillation (22.1% vs 7.5%, P < .0001). SwHF patients were more likely to be readmitted (hazard ratio 1.28, P < .0001), had higher length of hospital stay (5 vs 4 days, P < .0001), adjusted healthcare-associated costs ($9,667.0 vs $9,087.1, P < .0001) and mortality rates on readmission (5.1% vs 3.8%, P < .0001). Predictors of mortality included heart failure, increasing age, male sex, higher CCI, and liver disease. CONCLUSION SwHF is associated with higher rates of arrhythmia at index admission, as well as greater hospital cost, readmission and mortality rates compared to those without heart failure.
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Affiliation(s)
- Raheel Ahmed
- Cardiac Sarcoidosis Services, Royal Brompton Hospital, London, part of Guys and St Thomas's NHS Trust, London, UK
| | - Hiroyuki Sawatari
- Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | | | - Joseph Okafor
- Cardiac Sarcoidosis Services, Royal Brompton Hospital, London, part of Guys and St Thomas's NHS Trust, London, UK
| | | | - Saurabh Deshpande
- Department of Electrophysiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India
| | | | - Isma Ali
- The Online Clinic, Harley St Service, London, UK
| | | | | | | | - Vasilis Kouranos
- Cardiac Sarcoidosis Services, Royal Brompton Hospital, London, part of Guys and St Thomas's NHS Trust, London, UK
| | - Rakesh Sharma
- Cardiac Sarcoidosis Services, Royal Brompton Hospital, London, part of Guys and St Thomas's NHS Trust, London, UK
| | - Virend K Somers
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn
| | | | - C Anwar A Chahal
- Department of Cardiology, Barts Heart Centre, London, UK; Northumbria Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK; William Harvey Research Institute, Queen Mary University of London, London, UK; Center for Inherited Cardiovascular Diseases, Department of Cardiology, WellSpan Health, York, Penn.
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6
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Takaya Y, Nakagawa K, Miyoshi T, Nishii N, Morita H, Nakamura K, Yuasa S. Impact of extracardiac sarcoidosis on clinical outcomes in patients with cardiac sarcoidosis: Importance of continued screening for cardiac involvement. Int J Cardiol 2024; 413:132368. [PMID: 39025136 DOI: 10.1016/j.ijcard.2024.132368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 06/18/2024] [Accepted: 07/15/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND The prognostic impact of extracardiac sarcoidosis remains unknown in cardiac sarcoidosis (CS). We aimed to evaluate the influence of extracardiac sarcoidosis on clinical outcomes and the effect of continued outpatient visits for screening of cardiac involvement. METHODS Ninety-nine patients with CS were divided into two groups: patients with systemic CS who had prior extracardiac sarcoidosis, patients with isolated CS who had no prior extracardiac sarcoidosis. Patients with systemic CS were divided according to the continuation of outpatient visits. The endpoint was cardiac death, fatal ventricular arrhythmia, or hospitalization for heart failure. RESULTS At the time of diagnosing CS, patients with isolated CS had a higher prevalence of high-grade atrioventricular block or fatal ventricular arrhythmia, and left ventricular contractile dysfunction than those with systemic CS. Over a median follow-up of 42 months, cardiac events occurred in 19 (37%) of 52 patients with systemic CS and in 27 (57%) of 47 patients with isolated CS. The event-free survival rate was worse in patients with isolated CS than in those with systemic CS. Cox proportional hazard analysis showed that the absence of prior extracardiac sarcoidosis was an independent predictor of adverse outcomes. Patients with systemic CS who ceased outpatient visits had a lower left ventricular ejection fraction with severe heart failure symptoms and a worse event-free survival rate than those who continued outpatient visits. CONCLUSIONS The presence of extracardiac sarcoidosis is associated with clinical outcomes. The cessation of screening for cardiac involvement after diagnosing extracardiac sarcoidosis is associated with adverse outcomes.
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Affiliation(s)
- Yoichi Takaya
- Department of Cardiovascular Medicine, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
| | - Koji Nakagawa
- Department of Cardiovascular Medicine, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Toru Miyoshi
- Department of Cardiovascular Medicine, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Nobuhiro Nishii
- Department of Cardiovascular Medicine, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroshi Morita
- Department of Cardiovascular Medicine, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shinsuke Yuasa
- Department of Cardiovascular Medicine, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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7
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Arunachalam Karikalan S, Yusuf A, El Masry H. Arrhythmias in Cardiac Sarcoidosis: Management and Prognostic Implications. J Clin Med 2024; 13:3165. [PMID: 38892878 PMCID: PMC11172558 DOI: 10.3390/jcm13113165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/14/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Cardiac sarcoidosis (CS) is characterized by various arrhythmic manifestations ranging from catastrophic sudden cardiac death secondary to ventricular arrhythmia, severe conduction disease, sinus node dysfunction, and atrial fibrillation. The management of CS is complex and includes not only addressing the arrhythmia but also controlling the myocardial inflammation resultant from the autoimmune reaction. Arrhythmic manifestations of CS carry significant prognostic implications and invariably affect long-term survival in these patients. In this review, we focus on management of arrhythmic manifestation of cardiac sarcoidosis as well as risk stratification for sudden cardiac death in these patients.
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Affiliation(s)
| | - Ali Yusuf
- Department of Internal Medicine, Texas Tech University Health Sciences, Amarillo, TX 79430, USA;
| | - Hicham El Masry
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ 85054, USA;
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8
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Sykora D, Rosenbaum AN, Churchill RA, Kim BM, Elwazir MY, Bois JP, Giudicessi JR, Bratcher M, Young KA, Ryan SM, Sugrue AM, Killu AM, Chareonthaitawee P, Kapa S, Deshmukh AJ, Abou Ezzeddine OF, Cooper LT, Siontis KC. Arrhythmic manifestations and outcomes of definite and probable cardiac sarcoidosis. Heart Rhythm 2024:S1547-5271(24)02326-9. [PMID: 38588996 DOI: 10.1016/j.hrthm.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/01/2024] [Accepted: 04/03/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND The 2014 Heart Rhythm Society consensus statement defines histological (definite) and clinical (probable) diagnostic categories of cardiac sarcoidosis (CS), but few studies have compared their arrhythmic phenotypes and outcomes. OBJECTIVE The purpose of this study was to evaluate the electrophysiological/arrhythmic phenotype and outcomes of patients with definite and probable CS. METHODS We analyzed the arrhythmic/electrophysiological phenotype in a single-center North American cohort of 388 patients (median age 56 years; 39% female, n = 151) diagnosed with definite (n = 58) or probable (n = 330) CS (2000-2022). The primary composite outcome was survival to first ventricular tachycardia/fibrillation (VT/VF) event or sudden cardiac death. Key secondary outcomes were also assessed. RESULTS At index evaluation, in situ cardiac implantable electronic devices and antiarrhythmic drug use were more common in definite CS. At a median follow-up of 3.1 years, the primary outcome occurred in 22 patients with definite CS (38%) and 127 patients with probable CS (38%) (log-rank, P = .55). In multivariable analysis, only a higher ratio of the 18F-fluorodeoxyglucose maximum standardized uptake value of the myocardium to the maximum standardized uptake value of the blood pool (hazard ratio 1.09; 95% confidence interval 1.03-1.15; P = .003, per 1 unit increase) was associated with the primary outcome. During follow-up, patients with definite CS had a higher burden of device-treated VT/VF events (mean 2.86 events per patient-year vs 1.56 events per patient-year) and a higher rate of progression to heart transplant/left ventricular assist device implantation but no difference in all-cause mortality compared with patients with probable CS. CONCLUSION Patients with definite and probable CS had similarly high risks of first sustained VT/VF/sudden cardiac death and all-cause mortality, though patients with definite CS had a higher overall arrhythmia burden. Both CS diagnostic groups as defined by the 2014 Heart Rhythm Society criteria require an aggressive approach to prevent arrhythmic complications.
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Affiliation(s)
- Daniel Sykora
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Andrew N Rosenbaum
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - B Michelle Kim
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mohamed Y Elwazir
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - John P Bois
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - John R Giudicessi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Melanie Bratcher
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Kathleen A Young
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sami M Ryan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Alan M Sugrue
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ammar M Killu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Suraj Kapa
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | | | - Leslie T Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida
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9
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De Bortoli A, Dawson KA, Hashem D, Spence SD, Pena E, Inacio JR, Nery P, Juneau D, Dwivedi G, Beanlands R, Paterson I, Birnie DH. Screening tools for the detection of clinically silent cardiac sarcoidosis. Respir Med 2024; 224:107538. [PMID: 38340906 DOI: 10.1016/j.rmed.2024.107538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/29/2023] [Accepted: 01/20/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND clinically silent cardiac sarcoidosis (CS) may be associated with adverse outcomes, hence the rationale for screening patients with extracardiac sarcoidosis. The optimal screening strategy has not been clearly defined. METHODS patients with extra-cardiac sarcoidosis were prospectively included and underwent screening consisting of symptom history, electrocardiography (ECG), transthoracic echocardiogram, Holter, and signal-averaged ECG (SAECG). Cardiac magnetic resonance (CMR) was performed in all patients. Clinically silent CS was defined as CMR demonstrating late gadolinium enhancement (LGE) in a pattern compatible with CS according to a majority of independent and blinded CMR experts. Significant cardiac involvement was defined as the presence of LGE ≥6% and/or a positive fluorodeoxyglucose-positron emission tomography. RESULTS among the 129 patients included, clinically silent CS was diagnosed in 29/129 (22.5%), and 19/129 patients (14.7%) were classified as CS with significant cardiac involvement. There was a strong association between hypertension and CS (p < 0.05). Individual screening tools provided low diagnostic yield; however, combination of tests performed better, for example, a normal Holter and a normal SAECG had negative predictive values of 91.7%. We found consistently better diagnostic accuracy for the detection of CS with significant cardiac involvement. CONCLUSION clinically silent CS and CS with significant cardiac involvement were found in 22.5% and 14.7% of patients with extra-cardiac sarcoidosis. The association with hypertension raises the possibility that some cases of hypertensive cardiomyopathy may be mistaken for CS. Screening with readily available tools, for example Holter and SAECG, may help identifying patients without CS where additional CMR is not needed.
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Affiliation(s)
- Alessandro De Bortoli
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada; Department of Cardiology, Vestfold Hospital Trust, Tønsberg, Norway.
| | - Kristin A Dawson
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Dalia Hashem
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada; King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Stewart David Spence
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada; Faculty of Medicine, University of Calgary, AB, Canada
| | - Elena Pena
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - João R Inacio
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada; Centro Hospital Universitário Lisboa Norte, Universidade de Lisboa, Lisbon, Portugal
| | - Pablo Nery
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Daniel Juneau
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada; Nuclear Medicine, Centre Hospitalier de L'Université de Montréal, Montréal, QC, Canada
| | - Girish Dwivedi
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada; School of Medicine, The University of Western Australia, Australia; Australian National Phenome Centre, Murdoch University, Western Australia, Australia; Department of Cardiology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Robert Beanlands
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Ian Paterson
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - David H Birnie
- Department of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
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Akama Y, Fujimoto Y, Matsue Y, Maeda D, Yoshioka K, Dotare T, Sunayama T, Nabeta T, Naruse Y, Kitai T, Taniguchi T, Sato S, Tanaka H, Okumura T, Baba Y, Minamino T. Relationship of Mild to Moderate Impairment of Left Ventricular Ejection Fraction With Fatal Ventricular Arrhythmic Events in Cardiac Sarcoidosis. J Am Heart Assoc 2024; 13:e032047. [PMID: 38456399 PMCID: PMC11010031 DOI: 10.1161/jaha.123.032047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 01/26/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Current guidelines recommend placing an implantable cardiac defibrillator for patients with cardiac sarcoidosis and a severely impaired left ventricular ejection fraction (LVEF) of ≤35%. In this study, we determined the association between mild or moderate LVEF impairment and fatal ventricular arrhythmic event (FVAE). METHODS AND RESULTS We retrospectively analyzed 401 patients with cardiac sarcoidosis without sustained ventricular arrhythmia at diagnosis. The primary end point was an FVAE, defined as the combined endpoint of documented ventricular tachycardia or ventricular fibrillation and sudden cardiac death. Two cutoff points for LVEF were used: a sex-specific lower threshold of normal range of LVEF (52% for men and 54% for women) and an LVEF of 35%, which is used in the current guidelines. During a median follow-up of 3.2 years, 58 FVAEs were observed, and the 5- and 10-year estimated incidences of FVAEs were 16.8% and 23.0%, respectively. All patients were classified into 3 groups according to LVEF: impaired LVEF group, mild to moderate impairment of LVEF group, and maintained LVEF group. Multivariable competing risk analysis showed that both the impaired LVEF group (hazard ratio [HR], 3.24 [95% CI, 1.49-7.04]) and the mild to moderate impairment of LVEF group (HR, 2.16 [95% CI, 1.04-4.46]) were associated with a higher incidence of FVAEs than the maintained LVEF group after adjustment for covariates. CONCLUSIONS Patients with cardiac sarcoidosis are at a high risk of FVAEs, regardless of documented ventricular arrhythmia at the time of diagnosis. In patients with cardiac sarcoidosis, mild to moderate impairment of LVEF is associated with FVAEs.
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Affiliation(s)
- Yuka Akama
- Department of Cardiovascular Biology and MedicineJuntendo University Graduate School of MedicineTokyoJapan
| | - Yudai Fujimoto
- Department of Cardiovascular Biology and MedicineJuntendo University Graduate School of MedicineTokyoJapan
| | - Yuya Matsue
- Department of Cardiovascular Biology and MedicineJuntendo University Graduate School of MedicineTokyoJapan
| | - Daichi Maeda
- Department of Cardiovascular Biology and MedicineJuntendo University Graduate School of MedicineTokyoJapan
| | | | - Taishi Dotare
- Department of Cardiovascular Biology and MedicineJuntendo University Graduate School of MedicineTokyoJapan
| | - Tsutomu Sunayama
- Department of Cardiovascular Biology and MedicineJuntendo University Graduate School of MedicineTokyoJapan
| | - Takeru Nabeta
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaJapan
| | - Yoshihisa Naruse
- Division of Cardiology, Internal Medicine IIIHamamatsu University School of MedicineHamamatsuJapan
| | - Takeshi Kitai
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterOsakaJapan
| | - Tatsunori Taniguchi
- Department of Cardiovascular MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Shuntaro Sato
- Clinical Research CanterNagasaki University HospitalNagasakiJapan
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Takahiro Okumura
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Yuichi Baba
- Department of Cardiology and Geriatrics, Kochi Medical SchoolKochi UniversityNankokuJapan
| | - Tohru Minamino
- Department of Cardiovascular Biology and MedicineJuntendo University Graduate School of MedicineTokyoJapan
- Japan Agency for Medical Research and Development‐Core Research for Evolutionary Medical Science and Technology (AMED‐CREST), Japan Agency for Medical Research and DevelopmentTokyoJapan
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11
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Nabeta T, Matsumoto S, Ishii S, Eda Y, Yazaki M, Fujita T, Iida Y, Ikeda Y, Kitai T, Naruse Y, Taniguchi T, Yoshioka K, Tanaka H, Okumura T, Baba Y, Matsue Y, Ako J. Characteristics and incidence of cardiac events across spectrum of age in cardiac sarcoidosis. IJC HEART & VASCULATURE 2024; 50:101321. [PMID: 38161782 PMCID: PMC10755711 DOI: 10.1016/j.ijcha.2023.101321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/29/2023] [Accepted: 12/03/2023] [Indexed: 01/03/2024]
Abstract
Background Clinical characteristics and the risk of cardiovascular events in patients with cardiac sarcoidosis (CS) according to the age of initial diagnosis are unclear. Methods This study is a sub-analysis of the ILLUMINATE-CS registry, which is a retrospective, multicenter registry that enrolled patients with CS between 2001 and 2017. Patients were divided into three groups according to the tertile of age at the time of initial diagnosis of CS. The study compared the clinical background at the time of CS diagnosis and the incidence rate of cardiac events across age categories. Results A total of 511 patients were analyzed in this study. In baseline, older patients were more likely to be female. History of hypertension, heart failure admission, and atrioventricular block were more common in patients with older age. There was no significant difference in the history of ventricular arrhythmias and left ventricular ejection fraction among all age groups. During a median follow-up period of 3.2 [IQR: 1.7-4.2] years, 35 deaths, 56 heart failure hospitalization, and 98 fatal ventricular arrhythmias was observed. The incidence rate of all-cause death and heart failure hospitalization was significantly higher in patients with older age (p < 0.001), while there was no significant difference in the incidence rate of ventricular arrhythmia among age groups (p = 0.74). Conclusions In patients with CS, the risk of all-cause death and heart failure hospitalization was higher in older patients compared with other age groups; however, the risk of ventricular arrhythmia was comparable across all age groups.
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Affiliation(s)
- Takeru Nabeta
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Shingo Matsumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Faculty of Medicine, Toho University, Tokyo, Japan
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Shunsuke Ishii
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yuko Eda
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Mayu Yazaki
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Teppei Fujita
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yuichiro Iida
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yuki Ikeda
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yoshihisa Naruse
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tatsunori Taniguchi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kenji Yoshioka
- Department of Cardiology, Kameda Medical Center, Chiba, Japan
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuichi Baba
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
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12
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Maeda D, Matsue Y, Dotare T, Sunayama T, Iso T, Yoshioka K, Nabeta T, Naruse Y, Kitai T, Taniguchi T, Tanaka H, Okumura T, Baba Y, Minamino T. Clinical characteristics and prognosis of patients with isolated cardiac sarcoidosis: Insights from the ILLUMINATE-CS study. Eur J Heart Fail 2024; 26:77-86. [PMID: 37823255 DOI: 10.1002/ejhf.3056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 10/07/2023] [Accepted: 10/10/2023] [Indexed: 10/13/2023] Open
Abstract
AIM Data on the clinical features and prognosis of patients with isolated cardiac sarcoidosis (iCS) are limited. This study evaluated the clinical characteristics and prognostic impact of iCS. METHODS AND RESULTS This was a secondary analysis of the ILLUMINATE-CS study, a multicentre, retrospective registry investigating the clinical characteristics and prognosis of cardiac sarcoidosis. iCS was diagnosed according to the 2016 Japanese Circulation Society (JCS) guidelines. Clinical characteristics and prognosis were compared between patients with iCS and systemic cardiac sarcoidosis (sCS). The primary outcome was a combined endpoint of all-cause death, hospitalization for heart failure, or fatal ventricular arrhythmia events. Among 475 patients with CS (mean age, 62.0 ± 10.9 years; female ratio, 59%) diagnosed by the JCS guidelines, 119 (25.1%) were diagnosed with iCS. Patients with iCS had a higher prevalence of a history of atrial fibrillation or hospitalization for heart failure, or lower left ventricular ejection fraction than those with sCS. During a median follow-up of 42.3 (interquartile range, 22.8-72.5) months, 141 primary outcomes (29.7%) occurred. Cox proportional hazard analysis revealed that iCS was a significant risk factor for the primary outcome in the unadjusted model (hazard ratio [HR] 1.62; 95% confidence interval [CI] 1.12-2.34; p = 0.011). However, this association was not retained after adjustment for other covariates (adjusted HR 1.27; 95% CI 0.86-1.88; p = 0.226). CONCLUSIONS Patients with iCS had more impaired cardiovascular function at the time of diagnosis than those with sCS. However, iCS was not independently associated with poor prognosis after adjustment for prognostic factors.
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Affiliation(s)
- Daichi Maeda
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Taishi Dotare
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tsutomu Sunayama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takashi Iso
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kenji Yoshioka
- Department of Cardiology, Kameda Medical Center, Chiba, Japan
| | - Takeru Nabeta
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Yoshihisa Naruse
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tatsunori Taniguchi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuichi Baba
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Japan Agency for Medical Research and Development-Core Research for Evolutionary Medical Science and Technology (AMED-CREST), Japan Agency for Medical Research and Development, Tokyo, Japan
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13
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Kouranos V, Khattar RS, Okafor J, Ahmed R, Azzu A, Baksi JA, Wechalekar K, Cowie MR, Wells AU, Lüscher TF, Sharma R. Predictors of outcome in a contemporary cardiac sarcoidosis population: Role of brain natriuretic peptide, left ventricular function and myocardial inflammation. Eur J Heart Fail 2023; 25:2287-2298. [PMID: 37877328 DOI: 10.1002/ejhf.3057] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 10/26/2023] Open
Abstract
AIMS Cardiac sarcoidosis (CS) is a potentially fatal condition that varies in its clinical presentation. Here, we describe baseline characteristics at presentation along with prognosis and predictors of outcome in a sizable and deeply phenotyped contemporary cohort of CS patients. METHODS AND RESULTS Consecutive CS patients seen at one institution were retrospectively enrolled after undergoing laboratory testing, electrocardiogram, echocardiography, cardiac magnetic resonance (CMR) imaging and 18 F-flourodeoxyglucose positron emission tomography (FDG-PET) at baseline. The composite endpoint consisted of all-cause mortality, aborted sudden cardiac death, major ventricular arrhythmic events, heart failure hospitalization and heart transplantation. A total of 319 CS patients were studied (67% male, 55.4 ± 12 years). During a median follow-up of 2.2 years (range: 1 month-11 years), 8% of patients died, while 33% reached the composite endpoint. The annualized mortality rate was 2.7% and the 5- and 10-year mortality rates were 6.2% and 7.5%, respectively. Multivariate analysis showed serum brain natriuretic peptide (BNP) levels (hazard ratio [HR] 2.41, 95% confidence interval [CI] 1.34-4.31, p = 0.003), CMR left ventricular ejection fraction (LVEF) (HR 0.96, 95% CI 0.94-0.98, p < 0.0001) and maximum standardized uptake value of FDG-PET (HR 1.11, 95% CI 1.04-1.19, p = 0.001) to be independent predictors of outcome. These findings remained robust for different patient subgroups. CONCLUSION Cardiac sarcoidosis is associated with significant morbidity and mortality, particularly in those with cardiac involvement as the first manifestation. Higher BNP levels, lower LVEF and more active myocardial inflammation were independent predictors of outcomes.
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Affiliation(s)
- Vasileios Kouranos
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Rajdeep S Khattar
- National Heart & Lung Institute, Imperial College London, London, UK
- Department of Echocardiography, Royal Brompton Hospital, London, UK
| | - Joseph Okafor
- National Heart & Lung Institute, Imperial College London, London, UK
- Department of Echocardiography, Royal Brompton Hospital, London, UK
| | - Raheel Ahmed
- National Heart & Lung Institute, Imperial College London, London, UK
- Department of Cardiology, Royal Brompton Hospital, London, UK
| | - Alessia Azzu
- National Heart & Lung Institute, Imperial College London, London, UK
- Cardiac Magnetic Resonance Imaging Department, Royal Brompton Hospital, London, UK
| | - John Arun Baksi
- National Heart & Lung Institute, Imperial College London, London, UK
- Cardiac Magnetic Resonance Imaging Department, Royal Brompton Hospital, London, UK
| | - Kshama Wechalekar
- National Heart & Lung Institute, Imperial College London, London, UK
- Nuclear Medicine Department, Royal Brompton Hospital, London, UK
| | | | - Athol Umfrey Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Thomas F Lüscher
- National Heart & Lung Institute, Imperial College London, London, UK
- Department of Cardiology, Royal Brompton Hospital, London, UK
- King's College London, London, UK
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Zürich, Switzerland
| | - Rakesh Sharma
- National Heart & Lung Institute, Imperial College London, London, UK
- Department of Cardiology, Royal Brompton Hospital, London, UK
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14
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Sama C, Fongwen NT, Chobufo MD, Hamirani YS, Mills JD, Roberts M, Greathouse M, Zeb I, Kazienko B, Balla S. A systematic review and meta-analysis of the prevalence, incidence, and predictors of atrial fibrillation in cardiac sarcoidosis. Int J Cardiol 2023; 391:131285. [PMID: 37619882 DOI: 10.1016/j.ijcard.2023.131285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/06/2023] [Accepted: 08/20/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND The occurrence of atrial arrhythmias, in particular, atrial fibrillation (AF) in patients with cardiac sarcoidosis (CS) are of growing interest in the field of infiltrative cardiomyopathies. Via a systematic review with meta-analysis, we sought to synthesize data on the prevalence, incidence, and predictors of atrial arrhythmias as well as outcomes in patients with CS. METHODS PubMed/Medline, Web of Science, and Scopus were systematically queried from inception until April 26th, 2023. Using the random-effects model, separate plots were generated for each effect size assessed. RESULTS From a total of 8 studies comprising 978 patients with CS, the pooled summary estimates for the prevalence of AF was 23% (95% CI: 13%-34%). Paroxysmal AF was the most common subtype of AF (83%; 95% CI: 77%-90%), followed by persistent AF (17%; 95% CI: 10%-23%). In 9 studies involving 545 patients with CS, the pooled incidence of AF was estimated at 5%, 13.1%, and 8.9% at <2 years, 2-4 years, and > 4 years of follow-up respectively, with an overall cumulative incidence of 10.6% (95% CI: 4.9%-17.8%) over a 6-year follow-up period. Increased left atrial size and atrial 18F-fluorodeoxyglucose uptake were identified as strong independent predictors for the development of atrial arrhythmias on qualitative synthesis. CONCLUSION The burden of AF and related arrhythmias in CS patients is considerable. This necessitates close follow-up and predictive risk-stratification tools to guide the initiation of appropriate strategies, including therapeutic interventions for prevention of AF-related embolic phenomenon, especially in those with known clinical predictors.
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Affiliation(s)
- Carlson Sama
- Department of Medicine, Section of Internal Medicine, West Virginia University School of Medicine, WV, USA.
| | - Noah T Fongwen
- London School of Hygiene and Tropical Medicine, London, United Kingdom; Africa Centres for Disease Control and Prevention (Africa CDC), Addis Ababa, Ethiopia
| | - Muchi Ditah Chobufo
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - Yasmin S Hamirani
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - James D Mills
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - Melissa Roberts
- Department of Medicine, Section of Internal Medicine, West Virginia University School of Medicine, WV, USA
| | - Mark Greathouse
- Department of Cardiology, Allegheny Health Network, Pittsburgh, PA, USA
| | - Irfan Zeb
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - Brian Kazienko
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - Sudarshan Balla
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
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15
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Baba Y, Kubo T, Ochi Y, Hirota T, Yamasaki N, Ohnishi H, Kubota T, Yokoyama A, Kitaoka H. High-sensitivity Cardiac Troponin T Is a Useful Biomarker for Predicting the Prognosis of Patients with Systemic Sarcoidosis Regardless of Cardiac Involvement. Intern Med 2023; 62:3097-3105. [PMID: 36927971 PMCID: PMC10686728 DOI: 10.2169/internalmedicine.1331-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/30/2023] [Indexed: 03/18/2023] Open
Abstract
Objective Cardiac involvement defines the prognosis for patients with systemic sarcoidosis. Despite advancements in techniques for diagnosing cardiac lesions, there remains significant room for improvement in cardiac screening and prognostic prediction. The present study therefore assessed the prognostic factors associated with cardiovascular events in patients with sarcoidosis. Methods We retrospectively studied 132 patients with systemic sarcoidosis and evaluated the clinical data obtained between 2009 and 2022. A Kaplan-Meier survival analysis and Cox proportional hazards models were used to evaluate the associations between cardiovascular events and prognostic factors. Results The median age of the patients at the diagnosis was 64.0 (55.0-71.0) years old. During a mean follow-up period of 6.3±3.2 years, 28 patients suffered from cardiovascular events. Patients in the event group had more severe heart failure symptoms, more frequent ventricular tachycardia, higher serum high-sensitivity cardiac troponin T (hs-cTnT) values [0.025 (0.017-0.044) vs. 0.011 (0.007-0.019) ng/mL, p<0.001], and lower left ventricular ejection fraction values than those in the non-event group. These trends were observed even if the patients were not diagnosed with cardiac involvement at the time of enrollment. A multivariate analysis revealed that hs-cTnT was an independent biomarker for the prediction of cardiac events (hs-cTnT >0.014 ng/mL: HR: 7.31, 95% confidence interval: 2.20 to 24.28, p<0.001). Conclusion Hs-cTnT is a useful biomarker for predicting cardiovascular events in patients with sarcoidosis, even if cardiac involvement is not detected at the initial evaluation.
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Affiliation(s)
- Yuichi Baba
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Japan
| | - Toru Kubo
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Japan
| | - Yuri Ochi
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Japan
| | - Takayoshi Hirota
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Japan
| | - Naohito Yamasaki
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Japan
| | - Hiroshi Ohnishi
- Department of Respiratory Medicine and Allergology, Kochi Medical School, Kochi University, Japan
| | - Tetsuya Kubota
- Department of Respiratory Medicine and Allergology, Kochi Medical School, Kochi University, Japan
| | - Akihito Yokoyama
- Department of Respiratory Medicine and Allergology, Kochi Medical School, Kochi University, Japan
| | - Hiroaki Kitaoka
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Japan
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16
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Kazui S, Takenaka S, Nagai T, Kato Y, Komoriyama H, Kobayashi Y, Takahashi A, Kamiya K, Sato T, Tada A, Yasui Y, Nakai M, Sato T, Tsujino I, Konno S, Anzai T. Association of longitudinal cardiac troponin trajectory with adverse events in patients with cardiac sarcoidosis. Int J Cardiol 2023; 389:131268. [PMID: 37591415 DOI: 10.1016/j.ijcard.2023.131268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 08/11/2023] [Accepted: 08/13/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Although high-sensitivity cardiac troponins may be sensitive and easily repeatable markers of disease activity in patients with cardiac sarcoidosis (CS), the association between longitudinal cardiac troponin trajectory and adverse events remains unclear. This study aimed to clarify whether longitudinal cardiac troponin levels were associated with adverse events in patients with CS. METHODS We examined 63 consecutive CS-initiated prednisolone (PSL) patients with available longitudinal high-sensitivity cardiac troponin T (cTnT) data between December 2013 and March 2023. The area under the cTnT trajectory, which reflected cumulative cTnT release, was calculated to assess the association between longitudinal cTnT levels and adverse events. Patients were divided into two groups according to the median area under the cTnT trajectory per month. The primary outcome was a composite of sustained ventricular tachycardia or fibrillation, worsening heart failure, and sudden cardiac death (SCD). RESULTS In total, 463 cTnT measurements were collected over a median follow-up period of 30.4 (interquartile range [IQR] 15.6-34.2) months. The primary outcome was observed in 12 (19%) patients. A higher area under the cTnT trajectory was significantly associated with an increased incidence of the primary outcome (P = 0.027), while cTnT levels before and one month after initiation of PSL, and these changes were not related to adverse events (P = 0.179, 0.096, and 0.95, respectively). CONCLUSIONS Longitudinal cTnT trajectory following PSL initiation was associated with adverse cardiac events in patients with CS, suggesting that longitudinal measurement of cTnT would be useful for the early identification of high-risk patients.
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Affiliation(s)
- Sho Kazui
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Sakae Takenaka
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
| | - Yoshiya Kato
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan; Department of Cardiovascular Medicine, Kushiro City General Hospital, Hokkaido, Japan
| | - Hirokazu Komoriyama
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan; Department of Cardiovascular Medicine, Kushiro City General Hospital, Hokkaido, Japan
| | - Yuta Kobayashi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Akinori Takahashi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan; Department of Cardiovascular Medicine, Kushiro City General Hospital, Hokkaido, Japan
| | - Kiwamu Kamiya
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takuma Sato
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Atsushi Tada
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yutaro Yasui
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Michikazu Nakai
- Clinical Research Support Center, University of Miyazaki Hospital, Miyazaki, Japan
| | - Takahiro Sato
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Ichizo Tsujino
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Satoshi Konno
- Department of Respiratory Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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17
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Fujimoto Y, Matsue Y, Maeda D, Dotare T, Sunayama T, Iso T, Nakamura Y, Singh YS, Akama Y, Yoshioka K, Kitai T, Naruse Y, Taniguchi T, Tanaka H, Okumura T, Baba Y, Nabeta T, Minamino T. Prevalence and prognostic value of atrial fibrillation in patients with cardiac sarcoidosis. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead100. [PMID: 37849788 PMCID: PMC10578462 DOI: 10.1093/ehjopen/oead100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 09/09/2023] [Accepted: 09/26/2023] [Indexed: 10/19/2023]
Abstract
Aims The prognostic value of the presence of atrial fibrillation (AF) in patients at the time of cardiac sarcoidosis (CS) diagnosis is unknown. This study aimed to investigate the association between AF at the time of CS diagnosis and patient prognosis. Methods and results This study is a post-hoc analysis of Illustration of the Management and Prognosis of Japanese Patients with CS, a multicentre, retrospective observational study that evaluated the clinical characteristics and prognosis of patients with CS. The primary endpoint was the combined endpoint of all-cause death and hospitalization due to heart failure. After excluding patients with missing data about AF status, 445 patients (62 ± 11 years, 36% males) diagnosed with CS according to the Japanese current diagnostic guideline were analysed. Compared to patients without AF, patients with AF (n = 46, 10%) had higher levels of brain natriuretic peptide and a higher prevalence of heart failure hospitalizations. During a median follow-up period of 3.2 years (interquartile range, 1.7-5.8 years), 80 primary endpoints were observed. Kaplan-Meier curve analysis indicated that concomitant AF at the time of diagnosis was significantly associated with a high incidence of primary endpoints (log-rank P = 0.002). This association was retained after adjusting for known risk factors including log-transformed brain natriuretic peptide levels and left ventricular ejection fractions [hazard ratio, 1.96 (95% confidence interval, 1.05-3.65); P = 0.035]. Conclusion The presence of AF at the time of CS diagnosis is associated with higher incidence of all-cause death and heart failure hospitalization.
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Affiliation(s)
- Yudai Fujimoto
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Daichi Maeda
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Taishi Dotare
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Tsutomu Sunayama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Takashi Iso
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yutaka Nakamura
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yu Suresvar Singh
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yuka Akama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Kenji Yoshioka
- Department of Cardiology, Kameda Medical Center, Kamogawa City, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshihisa Naruse
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tatsunori Taniguchi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuichi Baba
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Kochi, Japan
| | - Takeru Nabeta
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
- Japan Agency for Medical Research and Development-Core Research for Evolutionary Medical Science and Technology (AMED-CREST), Japan Agency for Medical Research and Development, Tokyo, Japan
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18
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Janssen MTHF, Landewé RBM, Post MC, Erckens RJ, Mostard RLM. Organ involvement and assessment in sarcoidosis. Curr Opin Pulm Med 2023; 29:485-492. [PMID: 37461850 DOI: 10.1097/mcp.0000000000000997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
PURPOSE OF REVIEW In recent years new recommendations have been published about organ assessment in the diagnosis of sarcoidosis. RECENT FINDINGS Screening for pulmonary, cardiac, ocular, neurologic and renal involvement and hypercalcemia is recommended in the work-up for sarcoidosis, additionally, screening for hypercalciuria at the time of the diagnosis might be beneficial. SUMMARY One of the goals in the work-up of sarcoidosis is to assess the extent and severity of organ involvement. Timely and accurate assessment leads to determination of treatment indication. Screening for pulmonary involvement should include pulmonary imaging and pulmonary function tests. Screening for cardiac involvement should include a clear history including palpitations and collapse and a baseline electrocardiogram or 24-h Holter monitoring. At diagnosis, ophthalmological assessment is recommended. Furthermore, serum calcium level and serum creatinine level should be obtained. Although routine 24-h urinary calcium excretion is not included in the guidelines, performing this test routinely can be considered. On indication, neurologic, rheumatologic or dermatologic assessment can be performed.
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Affiliation(s)
| | - Robert B M Landewé
- Department of Rheumatology, Zuyderland Medical Centre, Heerlen, Limburg
- Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology Centre, Amsterdam
| | - Marco C Post
- Department of Cardiology, St. Antonius Hospital Nieuwegein and Utrecht
- Department of Cardiology, University Medical Centre Utrecht, Utrecht
| | | | - Rémy L M Mostard
- Department of Pulmonology
- Department of Pulmonology, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands
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19
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Iso T, Maeda D, Matsue Y, Dotare T, Sunayama T, Yoshioka K, Nabeta T, Naruse Y, Kitai T, Taniguchi T, Tanaka H, Okumura T, Baba Y, Minamino T. Sex differences in clinical characteristics and prognosis of patients with cardiac sarcoidosis. Heart 2023; 109:1387-1393. [PMID: 37185298 DOI: 10.1136/heartjnl-2022-322243] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 04/05/2023] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVE Owing to the paucity of data, this study aimed to investigate sex differences in clinical features and prognosis of patients with cardiac sarcoidosis (CS). METHODS This study was a secondary analysis of the ILLUstration of the Management and prognosIs of JapaNese PATiEnts with Cardiac Sarcoidosis registry-a retrospective multicentre registry that enrolled patients with CS between 2001 and 2017. The primary outcome was potentially fatal ventricular arrhythmia events (pFVAEs)-a composite of sudden cardiac death, sustained ventricular tachycardia lasting >30 s, ventricular fibrillation or the requirement for implantable cardioverter defibrillator therapy. RESULTS Of the 512 participants (mean age±SD 61.6±11.4 years), 329 (64.2%) were females. Both sexes had peak ages of 60-64 years at diagnosis. Male patients were younger and had a higher prevalence of coronary artery disease and lower left ventricular ejection fraction than female patients. During a median follow-up of 3 years (IQR 1.6-5.6), pFVAEs were observed in 99 patients, with males having a significantly higher risk than females (p=0.002). This association was retained even after adjustment for other risk factors for pFVAEs, including left ventricular ejection fraction (adjusted HR 1.80; 95% CI 1.08 to 3.01, p=0.025). CONCLUSION Approximately two-thirds of patients with CS were females, with a peak age of approximately 60 years at clinical diagnosis in both sexes; male patients were younger than female patients. Male patients had a significantly higher risk of pFVAEs than female patients. TRIAL REGISTRATION NUMBER UMIN000034974.
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MESH Headings
- Humans
- Male
- Female
- Middle Aged
- Stroke Volume
- Cardiomyopathies/diagnosis
- Cardiomyopathies/epidemiology
- Cardiomyopathies/therapy
- Sex Characteristics
- Electric Countershock/adverse effects
- Ventricular Function, Left
- Sarcoidosis/complications
- Sarcoidosis/diagnosis
- Sarcoidosis/epidemiology
- Prognosis
- Defibrillators, Implantable/adverse effects
- Tachycardia, Ventricular/diagnosis
- Tachycardia, Ventricular/epidemiology
- Tachycardia, Ventricular/etiology
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Arrhythmias, Cardiac/complications
- Myocarditis
- Retrospective Studies
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Affiliation(s)
- Takashi Iso
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Daichi Maeda
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Taishi Dotare
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tsutomu Sunayama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kenji Yoshioka
- Department of Cardiology, Kameda Medical Center, Chiba, Japan
| | - Takeru Nabeta
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Yoshihisa Naruse
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tatsunori Taniguchi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuichi Baba
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Japan Agency for Medical Research and Development-Core Research for Evolutionary Medical Science and Technology (AMED-CREST), Japan Agency for Medical Research and Development, Tokyo, Japan
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20
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Hutt E, Brizneda MV, Goldar G, Aguilera J, Wang TKM, Taimeh Z, Culver D, Callahan T, Tang WHW, Cremer PC, Jaber WA, Ribeiro Neto ML, Jellis CL. Optimal left ventricular ejection fraction in risk stratification of patients with cardiac sarcoidosis. Europace 2023; 25:euad273. [PMID: 37721485 PMCID: PMC10516712 DOI: 10.1093/europace/euad273] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 07/24/2023] [Accepted: 08/24/2023] [Indexed: 09/19/2023] Open
Abstract
AIMS Identifying patients with cardiac sarcoidosis (CS) who are at an increased risk of sudden cardiac death (SCD) poses a clinical challenge. We sought to identify the optimal cutoff for left ventricular ejection fraction (LVEF) in predicting ventricular arrhythmia (VA) and all-cause mortality and to identify clinical and imaging risk factors in patients with known CS. METHODS AND RESULTS This retrospective cohort included 273 patients with well-established CS. The primary endpoint was a composite of VA and all-cause mortality. A modified receiver operating curve analysis was utilized to identify the optimal cutoff for LVEF in predicting the primary composite endpoint. Cox proportional hazard regression analysis was used to identify independent risk factors of the outcomes. At median follow-up of 7.9 years, the rate of the primary endpoint was 38% (83 VAs and 32 all-cause deaths). The 5-year overall survival rate was 97%. The optimal cutoff LVEF for the primary composite endpoint was 42% in the entire cohort and in subjects without a history of VA. Younger age, history of VA, lower LVEF, and any presence of scar by cardiac magnetic resonance (CMR) imaging and/or positron emission tomography (PET) were found to be independent risk factors for the primary endpoint and for VA, whereas lower LVEF, baseline NT-proBNP, and any presence of scar were independent risk factor of all-cause mortality. CONCLUSION Among patients with CS, a mild reduction in LVEF of 42% was identified as the optimal cutoff for predicting VA and all-cause mortality. Prior VA and scar by CMR or PET are strong risk factors for future VA and all-cause mortality.
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Affiliation(s)
- Erika Hutt
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, OH 44195, USA
| | - Maria Vega Brizneda
- Department of Internal Medicine, Medicine Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Ghazaleh Goldar
- Department of Internal Medicine, Medicine Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Jose Aguilera
- Section of Cardiac Electrophysiology and Pacing, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Tom Kai Ming Wang
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, OH 44195, USA
| | - Ziad Taimeh
- Section of Heart Failure and Transplantation Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Daniel Culver
- Sarcoidosis Center, Respiratory Institute Cleveland Clinic, Cleveland, OH 44195, USA
| | - Thomas Callahan
- Section of Cardiac Electrophysiology and Pacing, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - W H Wilson Tang
- Section of Heart Failure and Transplantation Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Paul C Cremer
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, OH 44195, USA
| | - Wael A Jaber
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, OH 44195, USA
| | - Manuel L Ribeiro Neto
- Sarcoidosis Center, Respiratory Institute Cleveland Clinic, Cleveland, OH 44195, USA
| | - Christine L Jellis
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, OH 44195, USA
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21
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Okabe T, Nabeta T, Naruse Y, Taniguchi T, Kitai T, Yoshioka K, Tanaka H, Okumura T, Baba Y, Matsue Y. Prognostic Implication of the Resolution of Myocardial FDG Uptake in Patients With Cardiac Sarcoidosis. JACC. ASIA 2023; 3:683-685. [PMID: 37614539 PMCID: PMC10442873 DOI: 10.1016/j.jacasi.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Affiliation(s)
- Toshitaka Okabe
- Showa University Northern Yokohama Hospital, Division of Cardiology and Cardiac Catheterization Laboratories, 35-1, Chigasaki-Chuo, Tsuzuki, Yokohama 224-8503, Japan @_T_OKABE
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22
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Okafor J, Khattar R, Sharma R, Kouranos V. The Role of Echocardiography in the Contemporary Diagnosis and Prognosis of Cardiac Sarcoidosis: A Comprehensive Review. Life (Basel) 2023; 13:1653. [PMID: 37629510 PMCID: PMC10455750 DOI: 10.3390/life13081653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 07/23/2023] [Accepted: 07/26/2023] [Indexed: 08/27/2023] Open
Abstract
Cardiac sarcoidosis (CS) is a rare inflammatory disorder characterised by the presence of non-caseating granulomas within the myocardium. Contemporary studies have revealed that 25-30% of patients with systemic sarcoidosis have cardiac involvement, with detection rates increasing in the era of advanced cardiac imaging. The use of late gadolinium enhancement cardiac magnetic resonance and 18fluorodeoxy glucose positron emission tomography (FDG-PET) imaging has superseded endomyocardial biopsy for the diagnosis of CS. Echocardiography has historically been used as a screening tool with abnormalities triggering the need for advanced imaging, and as a tool to assess cardiac function. Regional wall thinning or aneurysm formation in a noncoronary distribution may indicate granuloma infiltration. Thinning of the basal septum in the setting of extracardiac sarcoidosis carries a high specificity for cardiac involvement. Abnormal myocardial echotexture and eccentric hypertrophy may be suggestive of active myocardial inflammation. The presence of right-ventricular involvement as indicated by free-wall aneurysms can mimic arrhythmogenic right-ventricular cardiomyopathy. More recently, the use of myocardial strain has increased the sensitivity of echocardiography in diagnosing cardiac involvement. Echocardiography is limited in prognostication, with impaired left-ventricular (LV) ejection fraction and LV dilatation being the only established independent predictors of mortality. More research is required to explore how advanced echocardiographic technologies can increase both the diagnostic sensitivity and prognostic ability of this modality in CS.
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Affiliation(s)
- Joseph Okafor
- Department of Echocardiography, Royal Brompton Hospital, London SW3 6NP, UK
- Cardiac Sarcoidosis Centre, Royal Brompton Hospital, London SW3 6NP, UK
| | - Rajdeep Khattar
- Department of Echocardiography, Royal Brompton Hospital, London SW3 6NP, UK
- Cardiac Sarcoidosis Centre, Royal Brompton Hospital, London SW3 6NP, UK
| | - Rakesh Sharma
- Cardiac Sarcoidosis Centre, Royal Brompton Hospital, London SW3 6NP, UK
| | - Vasilis Kouranos
- Cardiac Sarcoidosis Centre, Royal Brompton Hospital, London SW3 6NP, UK
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23
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Cherrett C, Lee W, Bart N, Subbiah R. Management of the arrhythmic manifestations of cardiac sarcoidosis. Front Cardiovasc Med 2023; 10:1104947. [PMID: 37304969 PMCID: PMC10248162 DOI: 10.3389/fcvm.2023.1104947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Cardiac sarcoidosis (CS) is characterised by a high burden of arrhythmic manifestations and cardiac electrophysiologists play an important role in both the diagnosis and management of this challenging condition. CS is characterised by the formation of noncaseating granulomas within the myocardium, which can subsequently lead to fibrosis. Clinical presentations of CS are varied and depend on the location and extent of granulomas. Patients may present with atrioventricular block, ventricular arrhythmias, sudden cardiac death or heart failure. CS is being increasing diagnosed through use of advanced cardiac imaging, however endomyocardial biopsy is often still required to confirm the diagnosis. Due to the low sensitivity of fluoroscopy-guided right ventricular biopsies, three-dimensional electro-anatomical mapping and electrogram-guided biopsies are being investigated as a means to improve diagnostic yield. Cardiac implantable electronic devices are often required in the management of CS, either for pacing or for primary or secondary prevention of ventricular arrhythmias. Catheter ablation for ventricular arrythmias may also be required, although this is often associated with high recurrence rates due to the challenging nature of the arrhythmogenic substrate. This review will explore the underlying mechanisms of the arrhythmic manifestations of CS, provide an overview of current clinical practice guidelines, and examine the important role that cardiac electrophysiologists play in managing patients with CS.
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Affiliation(s)
- Callum Cherrett
- Cardiology Department, St Vincent’s Hospital Sydney, Sydney, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - William Lee
- Cardiology Department, St Vincent’s Hospital Sydney, Sydney, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | - Nicole Bart
- Cardiology Department, St Vincent’s Hospital Sydney, Sydney, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | - Rajesh Subbiah
- Cardiology Department, St Vincent’s Hospital Sydney, Sydney, NSW, Australia
- School of Medicine, University of New South Wales, Sydney, NSW, Australia
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
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24
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Ueberham L, Hagendorff A, Klingel K, Paetsch I, Jahnke C, Kluge T, Ebbinghaus H, Hindricks G, Laufs U, Dinov B. Pathophysiological Gaps, Diagnostic Challenges, and Uncertainties in Cardiac Sarcoidosis. J Am Heart Assoc 2023; 12:e027971. [PMID: 36892055 PMCID: PMC10111513 DOI: 10.1161/jaha.122.027971] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
Cardiac sarcoidosis can mimic any cardiomyopathy in different stages. Noncaseating granulomatous inflammation can be missed, because of the nonhomogeneous distribution in the heart. The current diagnostic criteria show discrepancies and are partly nonspecific and insensitive. Besides the diagnostic pitfalls, there are controversies in the understanding of the causes, genetic and environmental background, and the natural evolution of the disease. Here, we review the current pathophysiological aspects and gaps that are relevant for future cardiac sarcoidosis diagnostics and research.
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Affiliation(s)
- Laura Ueberham
- Klinik und Poliklinik für Kardiologie Universitätsklinikum Leipzig Leipzig Germany
| | - Andreas Hagendorff
- Klinik und Poliklinik für Kardiologie Universitätsklinikum Leipzig Leipzig Germany
| | - Karin Klingel
- Cardiopathology Institute for Pathology, Eberhard Karls Universität Tübingen Tübingen Germany
| | - Ingo Paetsch
- Department of Electrophysiology Heart Center Leipzig at University of Leipzig Leipzig Germany
| | - Cosima Jahnke
- Department of Electrophysiology Heart Center Leipzig at University of Leipzig Leipzig Germany
| | - Theresa Kluge
- Klinik und Poliklinik für Nuklearmedizin Universitätsklinikum Leipzig Leipzig Germany
| | - Hans Ebbinghaus
- Department of Electrophysiology Heart Center Leipzig at University of Leipzig Leipzig Germany
| | - Gerhard Hindricks
- Department of Electrophysiology Heart Center Leipzig at University of Leipzig Leipzig Germany
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie Universitätsklinikum Leipzig Leipzig Germany
| | - Borislav Dinov
- Department of Electrophysiology Heart Center Leipzig at University of Leipzig Leipzig Germany
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25
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Shenoy C, Bawaskar PH. Late Gadolinium Enhancement on Cardiac Magnetic Resonance in Suspected Cardiac Sarcoidosis: Is it Diagnostic or Prognostic? Yes. JACC Cardiovasc Imaging 2023; 16:358-360. [PMID: 36752435 DOI: 10.1016/j.jcmg.2022.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 11/18/2022] [Accepted: 11/29/2022] [Indexed: 01/13/2023]
Affiliation(s)
- Chetan Shenoy
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
| | - Parag H Bawaskar
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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26
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Uusitalo V, Niemelä M, Kupari M. Reply: Incidence of Atrial Fibrillation in Cardiac Sarcoidosis. JACC Cardiovasc Imaging 2023; 16:263. [PMID: 36754479 DOI: 10.1016/j.jcmg.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 02/09/2023]
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27
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Hagiwara H, Watanabe M, Kadosaka T, Koizumi T, Kobayashi Y, Koya T, Nakao M, Tsuneta S, Kato Y, Komoriyama H, Kamada R, Nagai T, Kudo K, Anzai T. Fragmented QRS on 12-lead electrocardiogram predicts long-term prognosis in patients with cardiac sarcoidosis. Heart Vessels 2023; 38:803-816. [PMID: 36635468 DOI: 10.1007/s00380-022-02229-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/28/2022] [Indexed: 01/14/2023]
Abstract
Fragmented QRS (fQRS) on a 12-lead electrocardiogram is a known marker of fatal arrhythmias or cardiac adverse events in ischemic and non-ischemic cardiomyopathy patients. Nonetheless, the association between fQRS and clinical outcomes in patients with cardiac sarcoidosis (CS) remains unclear. Herein, we investigated whether fQRS is associated with long-term clinical outcomes in CS patients. A total of 78 patients who received immunosuppressive therapy (IST) for clinically diagnosed CS were retrospectively examined. Patients were classified into two groups according to the presence (n = 19) or absence (n = 59) of fQRS on electrocardiogram before IST. The primary outcome was the composite event of all-cause death, ventricular tachyarrhythmias (VTs), and hospitalization for heart failure. Results of late gadolinium enhancement on cardiac magnetic resonance imaging were also analyzed. During a median follow-up period of 3.7 years (interquartile range: 1.6-6.2 years), the primary outcome occurred more frequently in patients with fQRS than in those without (47% vs. 13%, log-rank p = 0.002). Multivariable Cox regression analyses showed that fQRS was an independent determinant of the primary outcome. The incidence of VTs, within 12 months of IST initiation, was comparable between the two groups; however, late-onset VTs, defined as those occurring ≥ 12 months after IST initiation, occurred more frequently in the fQRS group (21% vs. 2%, log-rank p = 0.002). The scar zone and scar border zone were greater in patients with fQRS than in those without it. In conclusion, our analysis suggests that fQRS is an independent predictor of adverse events, particularly late-onset VTs, in patients with CS.
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Affiliation(s)
- Hikaru Hagiwara
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
- Department of Cardiovascular Medicine, Kushiro City General Hospital, Kushiro, Japan
| | - Masaya Watanabe
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
| | - Takahide Kadosaka
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takuya Koizumi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Yuta Kobayashi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Taro Koya
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Motoki Nakao
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Satonori Tsuneta
- Department of Diagnostic Imaging, Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Yoshiya Kato
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
- Department of Cardiovascular Medicine, Kushiro City General Hospital, Kushiro, Japan
| | - Hirokazu Komoriyama
- Department of Cardiovascular Medicine, Kushiro City General Hospital, Kushiro, Japan
| | - Rui Kamada
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kohsuke Kudo
- Department of Diagnostic Imaging, Graduate School of Medicine, Hokkaido University, Kita-15 Nishi-7, Kita-Ku, Sapporo, 060-8638, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Abstract
About 5% of sarcoidosis patients develop clinically manifest cardiac features. Cardiac sarcoidosis (CS) typically presents with conduction abnormalities, ventricular arrhythmias and heart failure. Its diagnosis is challenging and requires a substantial degree of clinical suspicion as well as expertise in advanced cardiac imaging. Adverse events, particularly malignant arrhythmias and development of heart failure, are common among CS patients. A timely diagnosis is paramount to ameliorating outcomes for these patients. Despite weak evidence, immunosuppression (primarily with corticosteroids) is generally recommended in the presence of active inflammation in the myocardium. The burden of malignant arrhythmias remains important regardless of treatment, thus leading to the recommended use of an implantable cardioverter defibrillator in most patients with clinically manifest CS.
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Affiliation(s)
- Alessandro De Bortoli
- Division of Cardiology, University of Ottawa Heart Institute.,Department of Cardiology, Vestfold Hospital Trust
| | - David H Birnie
- Division of Cardiology, University of Ottawa Heart Institute
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29
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Miyakuni S, Maeda D, Matsue Y, Yoshioka K, Dotare T, Sunayama T, Nabeta T, Naruse Y, Kitai T, Taniguchi T, Tanaka H, Okumura T, Baba Y, Matsumura A, Minamino T. The Prognostic Value of B-Type Natriuretic Peptide in Patients With Cardiac Sarcoidosis Without Heart Failure: Insights From ILLUMINATE-CS. J Am Heart Assoc 2022; 11:e025803. [PMID: 36515231 PMCID: PMC9798822 DOI: 10.1161/jaha.122.025803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background The prognostic role of BNP (B-type natriuretic peptide) in patients with cardiac sarcoidosis without evident heart failure is unknown. Methods and Results This is a post hoc analysis of ILLUMINATE-CS (Illustration of the Management and Prognosis of Japanese Patients With Cardiac Sarcoidosis), a multicenter, retrospective, and observational study that evaluated the clinical characteristics and prognosis of cardiac sarcoidosis. We analyzed patients with cardiac sarcoidosis without evident heart failure at the time of diagnosis. The association between baseline BNP levels and prognosis was investigated. The primary end point was the combined end point of all-cause death, heart failure hospitalization, and fatal ventricular arrhythmia. In total, 238 patients (61.0±11.1 years, 37% men) were analyzed, and 61 primary end points were observed during a median follow-up period of 3.0 (interquartile range, 1.7-5.8) years. Patients with high BNP (BNP above the median value of BNP) were older and had a lower renal function and left ventricular ejection fraction than those with low BNP values. Kaplan-Meier curve analysis indicated that high BNP levels were significantly associated with a high incidence of primary end points (log-rank P=0.004), and this association was retained even in multivariable Cox regression (hazard ratio, 2.06 [95% CI, 1.19-3.55]; P=0.010). Log-transformed BNP as a continuous variable was associated with the primary end point (hazard ratio, 2.12 [95% CI, 1.31-3.43]; P=0.002). Conclusions High baseline BNP level was an independent predictor of future adverse events in patients with cardiac sarcoidosis without heart failure at the time of diagnosis. Registration URL: https://www.umin.ac.jp/english/; Unique Identifier: UMIN-CTR: UMIN000034974.
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Affiliation(s)
- Shota Miyakuni
- Department of Cardiovascular Biology and MedicineJuntendo University Graduate School of MedicineTokyoJapan,Department of CardiologyKameda Medical CenterChibaJapan
| | - Daichi Maeda
- Department of Cardiovascular Biology and MedicineJuntendo University Graduate School of MedicineTokyoJapan
| | - Yuya Matsue
- Department of Cardiovascular Biology and MedicineJuntendo University Graduate School of MedicineTokyoJapan
| | | | - Taishi Dotare
- Department of Cardiovascular Biology and MedicineJuntendo University Graduate School of MedicineTokyoJapan
| | - Tsutomu Sunayama
- Department of Cardiovascular Biology and MedicineJuntendo University Graduate School of MedicineTokyoJapan
| | - Takeru Nabeta
- Department of Cardiovascular MedicineKitasato University School of MedicineSagamiharaJapan
| | - Yoshihisa Naruse
- Division of Cardiology, Internal Medicine IIIHamamatsu University School of MedicineHamamatsuJapan
| | - Takeshi Kitai
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular CenterOsakaJapan
| | - Tatsunori Taniguchi
- Department of Cardiovascular MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Takahiro Okumura
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Yuichi Baba
- Department of Cardiology and Geriatrics, Kochi Medical SchoolKochi UniversityNankokuJapan
| | | | - Tohru Minamino
- Department of Cardiovascular Biology and MedicineJuntendo University Graduate School of MedicineTokyoJapan,Japan Agency for Medical Research and Development‐Core Research for Evolutionary Medical Science and Technology (AMED‐CREST)Japan Agency for Medical Research and DevelopmentTokyoJapan
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30
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Slivnick JA, Wali E, Patel AR. Imaging in Cardiac Sarcoidosis: Complementary Role of Cardiac Magnetic Resonance and Cardiac Positron Emission Tomography. CURRENT CARDIOVASCULAR IMAGING REPORTS 2022. [DOI: 10.1007/s12410-022-09571-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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31
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Crea F. Pulmonary hypertension, sarcoidosis, and inflammatory and dilated cardiomyopathy: new light shed on prevalence, mechanisms, and treatment. Eur Heart J 2022; 43:3371-3375. [PMID: 36130231 DOI: 10.1093/eurheartj/ehac497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
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32
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Dai Q, Sherif AA, Jin C, Chen Y, Cai P, Li P. Machine learning predicting mortality in sarcoidosis patients admitted for acute heart failure. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2022; 3:297-304. [PMID: 36589310 PMCID: PMC9795270 DOI: 10.1016/j.cvdhj.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Sarcoidosis with cardiac involvement, although rare, has a worse prognosis than sarcoidosis involving other organ systems. Objective We used a large dataset to train machine learning models to predict in-hospital mortality among sarcoidosis patients admitted with heart failure (HF). Method Utilizing the National Inpatient Sample, we identified 4659 patients hospitalized with a primary diagnosis of HF. In this cohort, we identified patients with a secondary diagnosis of sarcoidosis using International Statistical Classification of Disease, Tenth Revision (ICD-10) codes. Patients were separated into a training group and a testing group in a 7:3 ratio. Least absolute shrinkage and selection operator regression was used to select variables to prevent model overfitting or underfitting. For machine learning models, logistic regression, random forest, and XGBoosting were applied in the training group. Parameters in each of the models were tuned using the GridSearchCV function. After training, all models were further validated in the testing group. Models were then evaluated using the area under curve (AUC) score, sensitivity, and specificity. Results A total of 2.3% of sarcoidosis patients died in HF admission. Our machine learning model analysis found the RF model to have the highest AUC score and sensitivity. Feature analysis found that comorbid arrhythmias and fluid electrolyte disorders were the strongest factors in predicting in-hospital mortality. Conclusion Machine learning methods can be useful in identifying predictors of in-hospital mortality in a given dataset.
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Affiliation(s)
- Qiying Dai
- Division of Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Akil A. Sherif
- Division of Cardiology, Saint Vincent Hospital, Worcester, Massachusetts
| | - Chengyue Jin
- Division of Cardiology, Mount Sinai Beth Israel Medical Center, New York, New York
| | - Yongbin Chen
- Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota
| | - Peng Cai
- Department of Mathematical Sciences, Worcester Polytechnic Institute, Worcester, Massachusetts
| | - Pengyang Li
- Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia,Address reprint requests and correspondence: Dr Pengyang Li, Division of Cardiology, Pauley Heart Center, Virginia Commonwealth University, Richmond, VA 23219.
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Affiliation(s)
- Benjamin Meder
- Institute for Cardiomyopathies Heidelberg and Department of Internal Medicine III, University of Heidelberg, D-62910 Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Heidelberg, Germany
| | - Jan Koelemen
- Institute for Cardiomyopathies Heidelberg and Department of Internal Medicine III, University of Heidelberg, D-62910 Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Heidelberg, Germany
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