Key result
Pre-CRT corticosteroids in cardiac sarcoidosis associate with lower echocardiographic response but similar clinical outcomes.
Why the study?
Corticosteroids are widely used in cardiac sarcoidosis, and CRT upgrades are sometimes needed, but the impact of corticosteroid use on clinical outcomes following CRT upgrades was unclear.
Does corticosteroid use before CRT upgrade affect echocardiographic response and clinical outcomes in patients with cardiac sarcoidosis?
Cohort (n=48)
Does corticosteroid use before CRT upgrade affect echocardiographic response and clinical outcomes in patients with cardiac sarcoidosis?
Absolute Event Rate: 6.7% vs 7.7%
p-value: p=0.039
In patients with cardiac sarcoidosis undergoing CRT upgrade, prior corticosteroid use is associated with a blunted echocardiographic response but does not significantly worsen composite clinical outcomes.
Corticosteroid use before CRT upgrade may blunt echocardiographic response in cardiac sarcoidosis without worsening outcomes; hypothesis-generating and requires confirmation.
Aims Corticosteroids are widely used in patients with cardiac sarcoidosis (CS). In addition, upgrading to cardiac resynchronization therapy (CRT) is sometimes needed. This study aimed to investigate the impact of corticosteroid use on the clinical outcomes following CRT upgrades. Methods A total of 48 consecutive patients with non-ischemic cardiomyopathies who underwent CRT upgrades were retrospectively reviewed and divided into three groups: group 1 included CS patients taking corticosteroids before the CRT upgrade (n = 7), group 2, CS patients not taking corticosteroids before the CRT upgrade (n = 10), and group 3, non-CS patients (n = 31). The echocardiographic response, heart failure hospitalizations, and cardiovascular deaths were evaluated. Results The baseline characteristics during CRT upgrades exhibited no significant differences in the echocardiographic data between the three groups. After the CRT upgrade, responses regarding the ejection fraction (EF) and end-systolic volume (ESV) were significantly lower in CS patients than non-CS patients (ΔEF: group 1, 6.7% vs. group 2, 7.7% vs. group 3, 13.6%; p=0.039, ΔESV: 3.0 mL vs. -12.7 mL vs. -37.2 mL; p = 0.008). The rate of an echocardiographic response was lowest in group 1 (29%). There were, however, no significant differences in the cumulative freedom from a composite outcome among the three groups (p = 0.19). No cardiovascular deaths occurred in group 1. Conclusion CS patients taking corticosteroids before the CRT upgrade had lower echocardiographic responses but higher freedom rates from a composite endpoint. The timing of corticosteroid use would affect the clinical course following a CRT upgrade.
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Suzuki et al. (2024) conducted a cohort in Cardiac sarcoidosis and non-ischemic cardiomyopathies (n=48). Corticosteroids before CRT upgrade vs. No corticosteroids before CRT upgrade (CS patients) and non-CS patients was evaluated on Echocardiographic response (change in ejection fraction and end-systolic volume), heart failure hospitalizations, and cardiovascular deaths (p=0.039). Corticosteroid use before CRT upgrade in cardiac sarcoidosis yielded lower echocardiographic responses (ΔEF 6.7% vs 7.7% vs 13.6%; p=0.039) but similar composite clinical outcomes (p=0.19).
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