Sex differences in cardiac sarcoidosis

Cardiac sarcoidosis (CS) is an inflammatory cardiomyopathy for which sex differences outcomes are not well described.

This study aimed to understand differences in CS presentation, complications, and outcomes between females and males.

Patients meeting Japanese Circulation Society or Heart Rhythm Society criteria for CS were evaluated at a single institution from January 1, 1999, to December 31, 2023 (n = 455). Presenting characteristics including demographics, symptoms, conduction abnormalities, arrhythmias and left ventricular ejection fraction (LVEF) between females and males were compared. Sex-based differences in hospitalizations, LVAD implantation, transplantation and death were analyzed.

The cohort was mostly male (60.7 %). Females presented at an older age (58.5, IQR 51-65 in females, vs 54, IQR 45-61 in males, p = 0.001), and more females experienced palpitations (46.4 %, p = 0.04), chest pain (34.6 % p = 0.02), and fatigue (53.6 % p = 0.01) at presentation. Females had higher New York Heart Association (NYHA) class (III or IV) (31.5 % vs 21.8 %; p = 0.05), and higher NT-proBNP (467 in females vs 257.5 in males, p = 0.03) at presentation. Cardiovascular hospitalization-free survival, LVAD/transplant-free survival, and overall survival were not significantly different.

Females presented at an older age and were more symptomatic with higher NYHA class symptoms than males, suggesting that females are presenting or being diagnosed with CS later than males. LVEF, rates of heart block, and ventricular arrhythmias were similar between sexes, suggesting greater heart failure severity in females with CS may be related to greater left ventricular stiffening or worse valvular disease. Differences in survival outcomes were not significant.