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Original Research |

Cardiac sarcoidosis: the impact of age and implanted devices on survival

Ying Zhou; Elyse E. Lower; Hui-ping Li; Alexandru Costea; Mehran Attari; Robert P. Baughman
Author and Funding Information

Conflict of interest: Drs. Baughman and Lower have had research grants from Genentech, Mallinckrodt, Jansenn, and Celgene regarding treatment for sarcoidosis. Dr. Baughman has spoken on behalf of Mallinckrodt. None of the other authors have any conflict of interest.

1Department of Internal Medicine, University of Cincinnati Medical Center, 1001 Holmes, Eden Ave, Cincinnati, OH 45267, USA

2Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji university School of Medicine, Shanghai 200433, China


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.08.1457
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Abstract

Objective  To assess the clinical characteristics, diagnosis, and outcome of cardiac sarcoidosis in a single institution sarcoidosis clinic.

Methods  Patients with cardiac sarcoidosis were identified using refined WASOG criteria of highly probable and probable. Patient demographics, local and systemic treatments and clinical outcome were collected.

Results  Of the 1815 patients evaluated over a six year period, 73 patients met the WASOG criteria for cardiac sarcoidosis. The median age at diagnosis was 46 years with a median follow up of 8.8 years. Reduced left ventricular ejection fraction (LVEF) was the most common manifestation (54.8%). Patients with arrhythmias experienced ventricular tachycardia (VT) or severe heart block, (35.6% and 19.2%, respectively) with or without reduced LVEF. A total of 45 (61.6%) patients underwent cardiac PET and/or MRI, with 41 (91.1%) having a positive study. During follow up, 10 patients (13.7%) either underwent transplant (3 patients) or died (7 patients) from sarcoidosis. Kaplan-Meier survival curves revealed five and ten year survival rates of 95.5% and 93.4%, respectively. Univariate factors of age at diagnosis < 46, implantation of pacemaker or defibrillator, mycophenolate treatment, or LVEF>40% were associated with improved survival. Cox regression analysis demonstrated that age ≥ 46 years and lack of an implanted pacemaker or defibrillator were the only independent predictors of mortality.

Conclusion  The new WASOG criteria were able to characterize cardiac involvement in our sarcoidosis clinic. Age and lack of pacemaker or defibrillator were the significant predictors of mortality for cardiac sarcoidosis, and reduced LVEF <40% was associated with worse prognosis.


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