B42-17 Does Lung Involvement Predict Adverse Cardiac Outcomes in Cardiac Sarcoidosis?

Rationale Cardiac sarcoidosis (CS) is a rare manifestation of sarcoidosis associated with the development of heart failure, conduction system abnormalities, atrial and ventricular tachyarrhythmias, and sudden cardiac death. Left ventricular ejection fraction <35%, perfusion defects on cardiac PET, and late gadolinium enhancement on cardiac MRI are recognized risk factors for adverse cardiac outcomes in CS. However, the association between pulmonary abnormalities and outcomes in CS is uncertain. In the current study, we investigated the relationship between pulmonary parenchymal abnormalities on chest CT and lung function parameters with adverse cardiac events in patients with CS. Methods Patients with a diagnosis of CS adjudicated by a multidisciplinary team of cardiologists, pulmonologists, and radiologists specializing in sarcoidosis were included. Chest CT scans and pulmonary function tests obtained within 3 months of diagnosis of CS were analyzed. CT scans were classified as normal lung parenchyma, nonfibrotic lung abnormalities, or fibrotic lung abnormalities (Lancet Respir Med 2024). Pulmonary function parameters analyzed included percent predicted (pp) forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC, total lung capacity (TLC), and diffusing capacity (DLCO). Adverse cardiac outcomes evaluated were heart failure (HF), complete heart block (CHB), atrial fibrillation/flutter (AF), tachycardia/ventricular fibrillation (VT/VF), pacemaker/implantable cardiac defibrillator (PM/ICD) placement, ICD discharge, and sudden cardiac death (SCD). The relation between chest CT patterns and individual pulmonary function parameters with each adverse cardiac outcome was assessed by ANOVA and two-tailed t-test, respectively. Results Data on 42 patients with CS (age 63±11 [mean±SD] years, 79% male), with follow-up of 3.1±3.1 years from CS diagnosis were analyzed. 14 patients (33%) had normal lung parenchyma, 10 (24%) had nonfibrotic lung abnormalities, and 18 (43%) had fibrotic lung abnormalities. There were no significant differences between patients with normal lung parenchyma, nonfibrotic and fibrotic lung abnormalities in the occurrence of HF, CHB, AF, VT/VF, PM/ICD placement, ICD discharge, or SCD during follow up. ppFEV1 and ppFVC were lower in patients who developed AF than those without AF (77.0±18.7% vs 92.4±24.2%, p = 0.027 and 81.0±15.8% vs 93.1±18.8%, p = 0.031), but there were no other significant differences in pulmonary function associated with any adverse cardiac outcome. Conclusions The absence or presence of nonfibrotic and fibrotic pulmonary parenchymal abnormalities was not associated with differences in adverse cardiac outcomes in patients with CS. ppFEV1 and ppFVC were lower in patients who developed AF, but there were no other differences in pulmonary function associated with any adverse cardiac outcome.