Sarcoidosis confers increased risk for HF, arrhythmia, mortality
Click Here to Manage Email Alerts
Patients diagnosed with sarcoidosis experienced greater risk for HF and other adverse CV outcomes compared with the general population, according to a study published in the Journal of the American College of Cardiology.
For this study, researchers used four national registries to identify residents of Denmark who received a first-time diagnosis of sarcoidosis from 1996 to 2016. Patients were matched 1:4 by age, sex and comorbidities with individuals in the general population who did not have sarcoidosis (median age, 43 years; 54% men).
“Although most commonly affecting the lungs, skin and intrathoracic lymph nodes, the disease may involve any organ system, including the heart. Clinical manifestations of cardiac sarcoidosis include HF, ventricular arrhythmias, atrioventricular conduction disturbances and sudden cardiac death,” Adelina Yafasova, MB, of the department of cardiology at Rigshospitalet, Copenhagen University Hospital, Denmark, and colleagues wrote. “It is estimated that 5% of patients with systemic sarcoidosis have clinically manifest cardiac involvement, although autopsy and cardiac imaging studies suggest a significantly higher prevalence of cardiac involvement in sarcoidosis with substantial ethnic variations.”
Cardiac outcomes in sarcoidosis
After adjustment for malignancy and liver disease, investigators found that compared with the general population, individuals with sarcoidosis experienced greater risk for:
- HF (HR = 1.65; 95% CI, 1.43-1.91);
- composite outcome of implantable cardioverter defibrillator implantation, ventricular arrhythmias and cardiac arrest (HR = 2.19; 95% CI, 1.69-2.84);
- composite outcome of pacemaker implantation, atrioventricular block and sinoatrial dysfunction (HR = 2.29; 95% CI, 1.78-2.94);
- atrial fibrillation or flutter (HR = 1.36; 95% CI, 1.2-1.54); and
- all-cause mortality (HR = 1.45; 95% CI, 1.34-1.56).
“It is possible that the development of HF in patients with sarcoidosis may be attributed to underlying atherosclerotic coronary artery disease or the treatment of sarcoidosis (eg, steroid-induced hypertension or diabetes, which, in turn, increases the likelihood of HF) rather than the disease itself,” the researchers wrote. “Although data on HF etiology were not available in this study, an interesting observation was the relatively low prevalence of hypertension and prior acute myocardial infarction, coronary artery bypass grafting and percutaneous coronary intervention — the most common causes of HF in the developed world — in patients with sarcoidosis diagnosed with HF compared with HF patients in other studies.
“Although speculative, these data suggest a different etiology of HF in at least some patients with sarcoidosis,” the researchers wrote.
Cardiac manifestations in sarcoidosis
“The HF patients in this study did not have imaging or biopsy confirmation of cardiac sarcoidosis, limiting the ability to compare data between the present and previous smaller studies with different selection criteria,” Melissa A. Lyle, MD, heart failure cardiologist, and Leslie T. Cooper Jr., MD, chair of cardiovascular medicine at Mayo Clinic in Jacksonville, Florida, wrote in a related editorial. “Although information regarding the number or patients who redeemed prescriptions for specific immunosuppressive agents is included, the specific treatment regimens are missing and could impact prognosis, although a recent report suggested that the clinical presentation of cardiac sarcoidosis had a greater impact on outcomes compared with the treatment regimen.
“Despite study design limitations, there are important takeaways from this study, including the increased risk of HF and adverse cardiac events in patients with sarcoidosis,” Lyle and Cooper wrote. “These findings support the need for monitoring for cardiac manifestations in patients with systemic sarcoidosis. Future management guidelines for cardiac sarcoidosis should include these data for developing recommendations regarding the role of advanced imaging modalities and biopsy for diagnosis, prognosis, and treatment.”
Reference:
Collapse
Click Here to Manage Email Alerts