Risk of Adverse Cardiovascular Events in Cardiac Sarcoidosis Independent of Left Ventricular Function

Area of Science:

• Cardiology
• Electrophysiology
• Sarcoidosis Research

Background:

• Cardiac sarcoidosis (CS) is a complex inflammatory condition affecting the heart.
• Left ventricular ejection fraction (LVEF) is a key indicator of cardiac function, but its prognostic value in CS requires further clarification.
• Ventricular arrhythmias (VA) and sudden cardiac death (SCD) are significant concerns in CS patients.

Purpose of the Study:

• To investigate the association between baseline LVEF and the risk of VA/SCD, heart transplantation, and death in patients with CS.
• To determine if LVEF <35% is a significant predictor of adverse outcomes in CS.
• To identify optimal LVEF thresholds for risk stratification in CS.

Main Methods:

• Retrospective analysis of 110 CS patients meeting 2014 Heart Rhythm Society (HRS) criteria.
• Patients were categorized by baseline LVEF: <35% (n=32) and ≥35% (n=78).
• Logistic and Cox proportional hazards regression models were used to assess risk factors and outcomes, including VA/SCD, heart transplantation, and death.

Main Results:

• Overall, 44.5% of CS patients experienced VA/SCD during a median follow-up of 2.6 years.
• Patients with LVEF <35% had a higher incidence of VA/SCD (59.4%) compared to those with LVEF ≥35% (38.5%).
• Adjusted analysis did not show a significant association between LVEF <35% and increased VA/SCD risk, but a trend towards higher risk of heart transplantation and death was observed in the lower LVEF group.

Conclusions:

• CS patients exhibit high rates of VA, SCD, and heart transplantation, irrespective of LVEF.
• While LVEF <35% suggests an elevated risk for VA/SCD, this association was not statistically significant after adjustment in this cohort.
• All CS patients warrant thorough arrhythmia risk assessment, even those with preserved LVEF.