Sex differences in cardiac sarcoidosis.

Area of Science:

• Cardiology
• Immunology
• Genetics

Background:

• Cardiac sarcoidosis (CS) is an inflammatory cardiomyopathy with poorly understood sex-based outcome differences.
• Understanding these disparities is crucial for effective patient management and treatment strategies.

Purpose of the Study:

• To investigate sex-based differences in the clinical presentation, complications, and outcomes of cardiac sarcoidosis.
• To identify potential factors contributing to disparities in CS between females and males.

Main Methods:

• A retrospective analysis of 455 patients diagnosed with CS between 1999 and 2023.
• Comparison of demographic, symptomatic, electrocardiographic, and echocardiographic characteristics between female and male patients.
• Analysis of sex-based differences in hospitalization rates, left ventricular assist device (LVAD) implantation, heart transplantation, and mortality.

Main Results:

• Females presented at an older age (58.5 vs. 54 years) and reported more symptoms like palpitations, chest pain, and fatigue.
• Females exhibited higher New York Heart Association (NYHA) class (31.5% vs. 21.8% for NYHA class III/IV) and elevated NT-proBNP levels.
• No significant differences were observed in cardiovascular hospitalization-free survival, LVAD/transplant-free survival, or overall survival between sexes.

Conclusions:

• Females with CS present later and with more severe symptoms than males, suggesting delayed diagnosis or presentation.
• Similar left ventricular ejection fraction (LVEF), heart block, and ventricular arrhythmia rates between sexes may indicate greater heart failure severity in females due to factors like left ventricular stiffening or valvular disease.
• Despite presentation differences, survival outcomes for CS were comparable between females and males.