Natural History of Patients Diagnosed with Cardiac Sarcoidosis at Left Ventricular Assist Device Implantation or Cardiac Transplantation

Area of Science:

• Cardiology
• Pathology
• Immunology

Background:

• Cardiac sarcoidosis (CS) diagnosis often occurs late, particularly when identified incidentally during advanced heart failure therapy evaluations.
• The natural history of CS diagnosed pathologically at left ventricular assist device (LVAD) implantation or cardiac transplantation is not well-documented.

Purpose of the Study:

• To describe the clinical characteristics and outcomes of patients with CS incidentally diagnosed via pathological examination of the apical core or explanted heart.
• To compare these outcomes with patients diagnosed with CS prior to advanced heart failure therapies.

Main Methods:

• Retrospective review of 232 patients meeting CS criteria.
• Pathological confirmation of CS in 54 patients, with 10 diagnosed incidentally during LVAD implantation or heart transplantation.
• Comparison of clinical data and outcomes between the 10 incidentally diagnosed patients and 10 patients with pre-existing CS.

Main Results:

• The 10 incidentally diagnosed patients often presented with severe dilated cardiomyopathy (mean ejection fraction 23%).
• Half of the incidentally diagnosed patients had no prior diagnosis of sarcoidosis.
• No significant survival difference was observed between incidentally diagnosed CS patients and those with known CS or general advanced heart failure cohorts.

Conclusions:

• Incidental pathological diagnosis of CS during LVAD or transplant evaluation can reveal severe cardiomyopathy as the initial presentation.
• Patients with CS diagnosed during advanced heart failure therapies may have outcomes similar to non-CS patients, suggesting effective management strategies.