Why the study?
The prognosis and risk of later fatal arrhythmia in cardiac sarcoidosis with relatively preserved cardiac function were unclear.
What are the predictors of ventricular arrhythmic events in patients with cardiac sarcoidosis and mildly impaired cardiac function (LVEF >35%)?
What are the predictors of ventricular arrhythmic events in patients with cardiac sarcoidosis and mildly impaired cardiac function (LVEF >35%)?
In patients with cardiac sarcoidosis and LVEF >35%, primary prevention ICD should be considered if they have concomitant NSVT with AVB or abnormal Ga/PET due to a significant risk of fatal arrhythmias.
Answers are grounded in this paper and cite their sources.
May refine arrhythmic risk stratification in cardiac sarcoidosis; leaves open whether predictors warrant primary prevention ICDs in LVEF >35%.
The prognosis and later fatal arrhythmia in cardiac sarcoidosis (CS) with relatively preserved cardiac function were unclear. This study aimed to evaluate the prognosis and arrhythmic events in patients with CS and mildly impaired cardiac function. Data were collected from a nationwide Japanese cohort survey conducted in 57 hospitals (n = 420); 322 patients with CS with left ventricular ejection fraction (LVEF) >35% were investigated. Ventricular tachycardia (VT) manifestation was present in 50 patients (16%) and absent in 272 (84%), of whom 36 (72%) and 46 (17%), respectively, had an implantable cardioverter-defibrillator (ICD). Over a median of 5 years, 23 all-cause deaths and 31 appropriate ICD discharges were observed. In Kaplan-Meier analysis, all-cause death did not differ between patients with and without VT manifestation (P = 0.660), although appropriate ICD therapy was significantly less used in patients without VT manifestation than in those with VT manifestation (P < 0.001). Of the 272 patients without VT manifestation, 18 had ventricular arrhythmic events (VAEs), including 3 sudden cardiac deaths and 15 appropriate ICD discharges. In multivariate analysis, concomitant nonsustained ventricular tachycardia (NSVT) with atrioventricular block (AVB), lower LVEF, abnormal gallium-67 scintigraphy or 18F-fluorodeoxyglucose positron emission tomography of the heart (Ga/PET), and concomitant NSVT with abnormal Ga/PET at CS diagnosis were independent predictors of VAEs (P = 0.008, P = 0.021, P = 0.049, and P = 0.024, respectively). If concomitant NSVT with AVB, concomitant NSVT with abnormal Ga/PET, or abnormal Ga/PET is observed in patients with CS and mildly impaired cardiac function (LVEF >35%), ICD should be considered as primary prevention.
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Kamada et al. (2023) studied this question.
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