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Risk of Adverse Outcomes Associated With Cardiac Sarcoidosis Diagnostic Schemes
Rahul Myadam1, Thomas C Crawford2, Frank M Bogun2
1Virginia Commonwealth University, Pauley Heart Center, Division of Cardiology, Department of Internal Medicine, Richmond, Virginia, USA.
Insights
Older diagnostic criteria for cardiac sarcoidosis (CS) are linked to worse patient outcomes. The 1993 and 2006 Japanese criteria predicted adverse events, unlike newer schemes, highlighting the need for updated diagnostic approaches.
Area of Science:
- Cardiology
- Immunology
- Internal Medicine
Background:
- Multiple diagnostic schemes for cardiac sarcoidosis (CS) exist.
- Evaluating these schemes' association with clinical outcomes is crucial for patient management.
Purpose of the Study:
- To assess the correlation between different CS diagnostic criteria and adverse clinical outcomes.
- Compare the predictive value of 1993, 2006, and 2017 Japanese criteria and the 2014 Heart Rhythm Society criteria.
Main Methods:
- Utilized data from the international Cardiac Sarcoidosis Consortium registry.
- Defined adverse outcomes as all-cause mortality, LVAD, heart transplant, or appropriate ICD therapy.
- Employed logistic regression to analyze the association between diagnostic schemes and outcomes.
Main Results:
- Patients meeting the 1993 (35.2%) and 2006 (37.2%) Japanese criteria showed significantly higher odds of adverse events compared to those who did not.
- No statistically significant association was found between adverse events and meeting the 2014 Heart Rhythm Society or 2017 Japanese criteria.
- The 1993 criteria (OR 2.00) and 2006 criteria (OR 2.54) were independently associated with increased adverse outcomes.
Conclusions:
- The 1993 and 2006 Japanese criteria for CS are associated with a higher likelihood of adverse clinical outcomes.
- Further prospective research and development of novel risk models are necessary for managing CS.
Background:
Multiple cardiac sarcoidosis (CS) diagnostic schemes have been published.
Objectives:
This study aims to evaluate the association of different CS diagnostic schemes with adverse outcomes. The diagnostic schemes evaluated were 1993, 2006, and 2017 Japanese criteria and the 2014 Heart Rhythm Society criteria.
Methods:
Data were collected from the Cardiac Sarcoidosis Consortium, an international registry of CS patients. Outcome events were any of the following: all-cause mortality, left ventricular assist device placement, heart transplantation, and appropriate implantable cardioverter-defibrillator therapy. Logistic regression analysis evaluated the association of outcomes with each CS diagnostic scheme.
Results:
A total of 587 subjects met the following criteria: 1993 Japanese (n = 310, 52.8%), 2006 Japanese (n = 312, 53.2%), 2014 Heart Rhythm Society (n = 480, 81.8%), and 2017 Japanese (n = 112, 19.1%). Patients who met the 1993 criteria were more likely to experience an event than patients who did not (n = 109 of 310, 35.2% vs n = 59 of 277, 21.3%; OR: 2.00; 95% CI: 1.38-2.90; P < 0.001). Similarly, patients who met the 2006 criteria were more likely to have an event than patients who did not (n = 116 of 312, 37.2% vs n = 52 of 275, 18.9%; OR: 2.54; 95% CI: 1.74-3.71; P < 0.001). There was no statistically significant association between the occurrence of an event and whether a patient met the 2014 or the 2017 criteria (OR: 1.39; 95% CI: 0.85-2.27; P = 0.18 or OR: 1.51; 95% CI: 0.97-2.33; P = 0.067, respectively).
Conclusions:
CS patients who met the 1993 and the 2006 criteria had higher odds of adverse clinical outcomes. Future research is needed to prospectively evaluate existing diagnostic schemes and develop new risk models for this complex disease.
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