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Cardiovascular outcomes among giant cell myocarditis compared with cardiac sarcoidosis: A propensity score-matched
Vikash Jaiswal1, Muhammad Hanif2, Yusra Mashkoor3
1Department of Cardiovascular Research, Larkin Community Hospital, South Miami, FL, USA.
Insights
Giant cell myocarditis (GCM) patients face higher mortality risks compared to cardiac sarcoidosis (CS) patients. However, GCM is associated with lower risks of heart failure, ventricular tachycardia, and atrial fibrillation.
Area of Science:
- Cardiology
- Immunology
- Rare Diseases
Background:
- Giant cell myocarditis (GCM) and cardiac sarcoidosis (CS) are rare, severe inflammatory heart muscle diseases.
- Limited research exists on the comparative cardiovascular outcomes of GCM and CS.
Purpose of the Study:
- To investigate and compare the cardiovascular outcomes between patients diagnosed with GCM and CS.
- To provide insights into the prognosis and risk stratification for these rare cardiac conditions.
Main Methods:
- A retrospective analysis of adult patients diagnosed with GCM or CS was conducted using the TriNeTX Global Collaborative Network database (January 2000 - May 2023).
- Propensity score matching (PSM) was employed to create comparable groups for GCM and CS.
- Patients were followed for 6-month and 12-month cardiovascular outcomes.
Main Results:
- Propensity score matched analysis of 4804 patients revealed significantly higher all-cause mortality in the GCM group at both 6 months and 1 year compared to the CS group.
- Conversely, the GCM group exhibited significantly lower incidences of heart failure, ventricular tachycardia, atrioventricular node block, and atrial flutter/fibrillation at both follow-up points.
- Heart transplant incidence was similar between the GCM and CS groups.
Conclusions:
- Giant cell myocarditis is associated with a substantially higher risk of mortality compared to cardiac sarcoidosis.
- Patients with GCM demonstrate a lower risk profile for key secondary cardiovascular outcomes, including heart failure and arrhythmias, when contrasted with CS.
Background:
Giant cell myocarditis (GCM) and cardiac sarcoidosis (CS) are rare inflammatory diseases of the myocardium with poor prognosis. Cardiovascular disease outcomes among both diseases have not been well studied with limited literature.
Objective:
This study aims to investigate the cardiovascular outcomes among patients with GCM and CS.
Method:
We queried the TriNeTX Global Collaborative Network for adult patients with giant cell myocarditis and cardiac sarcoidosis between January 2000 to May 2023 and created two groups: one with giant cell myocarditis and second with cardiac sarcoidosis. Both the groups were followed for 6 months and 12 months.
Result:
After propensity score matched analysis (PSM), among the 4804 patients (2402 patients in each group), the mean age of patients was 57.1 and 57.6 years in GCM and CS groups, respectively. PSM analysis showed that primary outcome i.e., all-cause mortality was significantly higher in GCM group both after 6 months [relative risk (RR) 2.33, 95 % confidence interval (CI): 1.64-3.30, p < 0.01] and 1 year follow up [RR, 1.54 (95 % CI: 1.20-1.98), p < 0.01] as compared with CS group. However, secondary outcomes i.e., heart failure (HF) at 6 month (RR 0.66, 95 % CI: 0.52-0.85, p < 0.01), and at 1 year (RR 0.60, 95 % CI: 0.49-0.73, p < 0.01), ventricular tachycardia (VT) at 6 months (RR 0.34, 95 % CI: 0.25-0.46, p < 0.01), and at 1 year (RR 0.32, 95 % CI: 0.25-0.41, p < 0.01), atrioventricular (AV) node block at 6 month (RR 0.45, 95 % CI: 0.33-0.61, p < 0.01), and at 1 year (RR 0.43, 95 % CI: 0.34-0.55, p < 0.01), and atrial flutter and fibrillation (AF) at 6 months (RR 0.67, 95 % CI: 0.48-0.94, p = 0.02), and at 1 year (RR 0.59, 95 % CI: 0.45-0.76, p < 0.01) were found significantly lower in GCM group as compared to CS group. On the other hand, heart transplant incidence was comparable between both the groups.
Conclusion:
These findings suggest that GCM patients have high risk of mortality and lower risk of HF, VT, AV node block, and AF when compared with CS.
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