Abstract Background/Introduction Myocardial involvement in sarcoidosis is a serious complication with an established prevalence and studied group characteristics. However, the prevalence of heart failure might be higher in sarcoidosis patients compared to the general population, independently from myocardial involvement. We hypothesize that systemic inflammation, pulmonary involvement, and a year-long course with multiple pulses of glucocorticosteroids may predispose this group to heart failure (HF). Purpose This study's purpose was to establish the prevalence of HF in patients with sarcoidosis with any biopsy-proven organ involvement and characterize this group. Methods Using the database of a Tertiary Centre, we retrospectively identified patients with sarcoidosis referred for cardiac magnetic resonance from the hospital department or outpatient clinic in the years 2014-2024. The presence of HF was established by the coexistence of symptoms described in the documentation, elevated N-terminal prohormone of brain natriuretic peptide, and either reduced ejection fraction or sign of elevated left ventricular filling pressures assessed by cardiac magnetic resonance (elevated left atrial size, left ventricular hypertrophy). No echocardiography parameters were assessed due to the impossibility of calculating them according to a homogenous standard. Additional clinical and imaging data were collected based on the documentation. Disease activity was defined as sarcoidosis of any organ being in a relapse or chronically active. Results The prevalence of HF in the studied group (n=73) was 15%, of which 12.3% had preserved fraction and 2.7% had reduced ejection fraction. 30% of patients with HF had diagnosed cardiac sarcoidosis. The patients with HF did not differ significantly from the patients without HF in the frequency of myocardial involvement (30% vs 14.3%), disease activity (90% vs 77.8%), present (20% vs 31.7%) or past (40% vs 27.0%) immunosuppressive treatment. Conclusions To date, the only studies assessing HF prevalence in sarcoidosis patients rely solely on diagnoses according to the International Classification of Diseases (ICD) and bear the results of 10.9 to 30% compared to 2.4 – 4.3% in Poland’s general population. This data needs validation, as many cases of HF may not be detected or registered with the ICD code. We decided to identify the patients who met the criteria for HF, even in the absence of an ICD code for HF. The results suggest that the group of sarcoidosis patients has higher rates of HF compared to the general population independently from myocardial involvement. This group, being prevalently under the care of other specialists, remains an undervalued target for HF therapies. There is still a need for further research, preferably prospective studies providing a guidelines-directed diagnostic process for HF, with echocardiography performed with standardised protocols to reduce heterogeneity of the results.
Skwarek et al. (Sat,) studied this question.