Impact of Corticosteroid Use on the Clinical Response and Prognosis in Patients with Cardiac Sarcoidosis Who Underwent an Upgrade to Cardiac Resynchronization Therapy

Overview

Journal J Arrhythm

Publisher Wiley

Date 2022 Jul 5

PMID 35785370

Authors

Yuya Suzuki

Mitsuru Takami

Koji Fukuzawa

Kunihiko Kiuchi

Akira Shimane

Jun Sakai

Toshihiro Nakamura

Atsusuke Yatomi

Yusuke Sonoda

Hiroyuki Takahara

Kazutaka Nakasone

Kyoko Yamamoto

Ken-Ichi Tani

Hidehiro Iwai

Yusuke Nakanishi

Ken-Ichi Hirata

Affiliations

Soon will be listed here.

Abstract

Background: Corticosteroids are widely used in patients with cardiac sarcoidosis (CS). In addition, upgrading to cardiac resynchronization therapy (CRT) is sometimes needed. This study aimed to investigate the impact of corticosteroid use on the clinical outcomes following CRT upgrades.

Methods: A total of 48 consecutive patients with non-ischemic cardiomyopathies who underwent CRT upgrades were retrospectively reviewed and divided into three groups: group 1 included CS patients taking corticosteroids before the CRT upgrade ( = 7), group 2, CS patients not taking corticosteroids before the CRT upgrade ( = 10), and group 3, non-CS patients ( = 31). The echocardiographic response, heart failure hospitalizations, and cardiovascular deaths were evaluated.

Results: The baseline characteristics during CRT upgrades exhibited no significant differences in the echocardiographic data between the three groups. After the CRT upgrade, responses regarding the ejection fraction (EF) and end-systolic volume (ESV) were significantly lower in CS patients than non-CS patients (ΔEF: group 1, 6.7% vs. group 2, 7.7% vs. group 3, 13.6%; = .039, ΔESV: 3.0 ml vs. -12.7 ml vs. -37.2 ml; = .008). The rate of an echocardiographic response was lowest in group 1 (29%). There were, however, no significant differences in the cumulative freedom from a composite outcome among the three groups ( = .19). No cardiovascular deaths occurred in group 1.

Conclusion: The echocardiographic response to an upgrade to CRT and the long-term prognosis in patients with CS should be carefully evaluated because of the complex etiologies and impact of immunosuppressive therapy.

Citing Articles

Impact of corticosteroid use on the clinical response and prognosis in patients with cardiac sarcoidosis who underwent an upgrade to cardiac resynchronization therapy.

Suzuki Y, Takami M, Fukuzawa K, Kiuchi K, Shimane A, Sakai J J Arrhythm. 2022; 38(3):400-407.

PMID: 35785370 PMC: 9237305. DOI: 10.1002/joa3.12697.

References

van der Heijden A, Hoke U, Thijssen J, Borleffs C, Wolterbeek R, Schalij M . Long-Term Echocardiographic Outcome in Super-Responders to Cardiac Resynchronization Therapy and the Association With Mortality and Defibrillator Therapy. Am J Cardiol. 2016; 118(8):1217-1224. DOI: 10.1016/j.amjcard.2016.07.041. View

Chiu C, Nakatani S, Zhang G, Tachibana T, Ohmori F, Yamagishi M . Prevention of left ventricular remodeling by long-term corticosteroid therapy in patients with cardiac sarcoidosis. Am J Cardiol. 2004; 95(1):143-6. DOI: 10.1016/j.amjcard.2004.08.083. View

Patel D, Trulock K, Toro S, Grimaldi A, Gonzalez M, Moennich L . Effect of Cardiac Resynchronization Therapy on Left Ventricular Remodeling in Patients With Cardiac Sarcoidosis. Am J Cardiol. 2018; 123(2):329-333. DOI: 10.1016/j.amjcard.2018.09.044. View

Ungprasert P, Crowson C, Matteson E . Risk of cardiovascular disease among patients with sarcoidosis: a population-based retrospective cohort study, 1976-2013. Eur Respir J. 2017; 49(2). PMC: 5564441. DOI: 10.1183/13993003.01290-2016. View

Sekhri V, Sanal S, Delorenzo L, Aronow W, Maguire G . Cardiac sarcoidosis: a comprehensive review. Arch Med Sci. 2012; 7(4):546-54. PMC: 3258766. DOI: 10.5114/aoms.2011.24118. View

FLEMING H, Bailey S . The prognosis of sarcoid heart disease in the United Kingdom. Ann N Y Acad Sci. 1986; 465:543-50. DOI: 10.1111/j.1749-6632.1986.tb18531.x. View

Soejima K, Yada H . The work-up and management of patients with apparent or subclinical cardiac sarcoidosis: with emphasis on the associated heart rhythm abnormalities. J Cardiovasc Electrophysiol. 2009; 20(5):578-83. DOI: 10.1111/j.1540-8167.2008.01417.x. View

Varma N, Mittal S, Prillinger J, Snell J, Dalal N, Piccini J . Survival in Women Versus Men Following Implantation of Pacemakers, Defibrillators, and Cardiac Resynchronization Therapy Devices in a Large, Nationwide Cohort. J Am Heart Assoc. 2017; 6(5). PMC: 5524072. DOI: 10.1161/JAHA.116.005031. View

Schwertner W, Behon A, Merkel E, Tokodi M, Kovacs A, Zima E . Long-term survival following upgrade compared with de novo cardiac resynchronization therapy implantation: a single-centre, high-volume experience. Europace. 2021; 23(8):1310-1318. PMC: 8350864. DOI: 10.1093/europace/euab059. View

10.

Silverman K, Hutchins G, Bulkley B . Cardiac sarcoid: a clinicopathologic study of 84 unselected patients with systemic sarcoidosis. Circulation. 1978; 58(6):1204-11. DOI: 10.1161/01.cir.58.6.1204. View

11.

Roberts W, McAllister Jr H, Ferrans V . Sarcoidosis of the heart. A clinicopathologic study of 35 necropsy patients (group 1) and review of 78 previously described necropsy patients (group 11). Am J Med. 1977; 63(1):86-108. DOI: 10.1016/0002-9343(77)90121-8. View

12.

Valeyre D, Prasse A, Nunes H, Uzunhan Y, Brillet P, Muller-Quernheim J . Sarcoidosis. Lancet. 2013; 383(9923):1155-67. DOI: 10.1016/S0140-6736(13)60680-7. View

13.

Kato Y, Morimoto S, Uemura A, Hiramitsu S, Ito T, Hishida H . Efficacy of corticosteroids in sarcoidosis presenting with atrioventricular block. Sarcoidosis Vasc Diffuse Lung Dis. 2003; 20(2):133-7. View

14.

Yufu K, Kondo H, Shinohara T, Kawano K, Ishii Y, Miyoshi M . Outcome of Patients With Cardiac Sarcoidosis Who Received Cardiac Resynchronization Therapy: Comparison With Dilated Cardiomyopathy Patients. J Cardiovasc Electrophysiol. 2016; 28(2):177-181. DOI: 10.1111/jce.13119. View

15.

Ypenburg C, van Bommel R, Borleffs C, Bleeker G, Boersma E, Schalij M . Long-term prognosis after cardiac resynchronization therapy is related to the extent of left ventricular reverse remodeling at midterm follow-up. J Am Coll Cardiol. 2009; 53(6):483-90. DOI: 10.1016/j.jacc.2008.10.032. View

16.

Terasaki F, Azuma A, Anzai T, Ishizaka N, Ishida Y, Isobe M . JCS 2016 Guideline on Diagnosis and Treatment of Cardiac Sarcoidosis　- Digest Version. Circ J. 2019; 83(11):2329-2388. DOI: 10.1253/circj.CJ-19-0508. View

17.

Sairaku A, Yoshida Y, Nakano Y, Hirayama H, Maeda M, Hashimoto H . Cardiac resynchronization therapy for patients with cardiac sarcoidosis. Europace. 2017; 19(5):824-830. DOI: 10.1093/europace/euw223. View

18.

Suzuki Y, Takami M, Fukuzawa K, Kiuchi K, Shimane A, Sakai J . Impact of corticosteroid use on the clinical response and prognosis in patients with cardiac sarcoidosis who underwent an upgrade to cardiac resynchronization therapy. J Arrhythm. 2022; 38(3):400-407. PMC: 9237305. DOI: 10.1002/joa3.12697. View

19.

Nakai T, Ikeya Y, Kogawa R, Okumura Y . Cardiac resynchronization therapy: Current status and near-future prospects. J Cardiol. 2021; 79(3):352-357. DOI: 10.1016/j.jjcc.2021.10.021. View

20.

Matsui Y, Iwai K, Tachibana T, Fruie T, Shigematsu N, Izumi T . Clinicopathological study of fatal myocardial sarcoidosis. Ann N Y Acad Sci. 1976; 278:455-69. DOI: 10.1111/j.1749-6632.1976.tb47058.x. View