October 17, 2024ESC Heart FailureOpen Access

Outcomes of Cardiac Resynchronization Therapy (CRT) in Cardiac Sarcoidosis Patients with a Range of Ejection Fractions

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Why the study?

In cardiac sarcoidosis patients, the benefit of cardiac resynchronization therapy remains unclear across a range of left ventricular ejection fractions.

Does cardiac resynchronization therapy response improve outcomes in cardiac sarcoidosis patients with HFrEF?

Structured PICO

Does cardiac resynchronization therapy response improve outcomes in cardiac sarcoidosis patients with HFrEF?

Population

100 consecutive cardiac sarcoidosis (CS) patients treated with CRT at a tertiary UK centre between 2008 and 2023, mean age 58 ± 10 years, 71% male. Included 63 with HFrEF (LVEF ≤ 40%), 17 with HFmrEF (LVEF 41%-49%), and 20 with HFpEF (LVEF ≥ 50).

Intervention

Cardiac resynchronization therapy (CRT)

Comparator

Compared by CRT response (>5% improvement in serial LVEF) and baseline LVEF categories (HFrEF vs HFmrEF/HFpEF)

Outcome

Composite of all-cause mortality, cardiac transplantation or unplanned hospitalization for decompensated heart failurecomposite

In cardiac sarcoidosis patients with HFrEF, CRT response is associated with better long-term prognosis than non-response, though outcomes remain worse than in those with HFmrEF or HFpEF.

Implication

CRT may improve short-term remodeling in CS with systolic dysfunction; leaves open long-term outcome benefits and routine use.

Abstract

AIMS: In cardiac sarcoidosis (CS) patients, the benefit of cardiac resynchronization therapy (CRT) remains unclear. We sought to assess the short-term and long-term effects of CRT in CS patients with a range of left ventricular (LV) ejection fractions (LVEFs). METHODS: Consecutive CS patients with heart failure with reduced ejection fraction (HFrEF; LVEF ≤ 40%), mildly reduced ejection fraction (HFmrEF; LVEF 41%-49%) and preserved ejection fraction (HFpEF; LVEF ≥ 50) treated with CRT under the care of a tertiary UK centre between 2008 and 2023 were reviewed. CRT response was defined by >5% improvement in serial LVEF. The primary endpoint was a composite of all-cause mortality, cardiac transplantation or unplanned hospitalization for decompensated heart failure. The secondary endpoint included ventricular arrhythmic events. RESULTS: Of the 100 patients enrolled (age 58 ± 10 years; 71% male), 63 had HFrEF, 17 had HFmrEF and 20 had HFpEF. After short-term follow-up (9.8 ± 5.4 months), HFrEF patients demonstrated significant LVEF response (P < 0.01). On Kaplan-Meier analysis (follow-up 38 ± 32 months), HFrEF non-responders had significantly worse event-free survival compared with HFrEF responders for the primary (P < 0.001) and secondary (P = 0.001) endpoints. Despite short-term LV function improvement, CRT responders still had worse event-free survival compared with HFmrEF/HFpEF patients for the primary endpoint (P < 0.001). On multivariable Cox analysis, age [hazard ratio (HR) 1.05, 95% confidence interval (CI) 1.01-1.10, P = 0.008] and HFrEF CRT non-response (HR 12.33, 95% CI 2.45-61.87, P = 0.002) were associated with the primary endpoint. CONCLUSIONS: In CS patients with HFrEF, CRT response is associated with a better long-term prognosis than non-response. However, HFrEF CRT responders still have worse long-term prognosis than HFmrEF/HFpEF patients.