Key result
Probable cardiac sarcoidosis is linked to adverse cardiac events or death in ~41% of patients.
Why the study?
Cardiac sarcoidosis may remain asymptomatic or cause conduction disturbances, ventricular arrhythmias, HF, or sudden death, prompting evaluation of long-term clinical outcomes in a Southern European population.
Cohort (n=314)
In a Southern European cohort of patients with extracardiac sarcoidosis, probable cardiac involvement was identified in 8.6% of patients—most of whom were asymptomatic—yet 40.7% experienced major adverse clinical events over a median follow-up of 3.6 years, underscoring the necessity of vigilant cardiac monitoring.
Supports cardiac monitoring in extracardiac sarcoidosis; leaves open whether screening improves outcomes.
Background Sarcoidosis is a granulomatous disease of unknown cause, and cardiac involvement occurs in a minority of patients. Cardiac sarcoidosis (CS) may lead to conduction disturbances, ventricular arrhythmias, heart failure (HF), or even sudden death, though many cases remain asymptomatic. Purpose To evaluate the long-term clinical outcomes of patients with suspected CS in a Southern European population over a 16-year follow-up period. Methods We reviewed all [18F]FDG-Positron Emission Tomography (PET) reports of patients assessed for suspected sarcoidosis from 2009-2025. Patients with biopsy-confirmed sarcoidosis were evaluated using Hearth Rhythm Society (HRS) criteria to identify probable cardiac involvement. The primary outcome was a composite of HF hospitalization, arrhythmias requiring intervention, pacemaker implantation for complete heart block, and all-cause mortality. Results Out of 960 [18F]FDG-PET scans, 314 patients had histologically confirmed extracardiac sarcoidosis. Of these, 27 (8.6%; 41% female; mean age 58.8 ± 13.2 years) were classified as probable cardiac sarcoidosis per HRS criteria, based on [18F]FDG-PET (n = 15), cardiovascular magnetic resonance (CMR) (n = 11), or unexplained LVEF <40% (n = 1). Most patients had no cardiac symptoms (59.3%) during follow-up, and atrial fibrillation occurred in 29.6%, while coronary artery disease and significant valvular disease each occurred in 7.4%. After a median follow-up of 43 [17-104] months, the composite outcome occurred in eleven patients (40.7%): 22.2% had HF hospitalizations; 22.2% had uncontrolled arrythmia requiring intervention (three titration of betablockers due to high burden of premature ventricular complex / non-sustained ventricular tachycardia (VT), two atrial flutter ablation, and one implanted cardiac resynchronization therapy with a defibrillator (CRT-D) due to non-sustained VT and left ventricle systolic disfunction); 14.8% implanted a pacemaker due to complete heart block at a median age of 66 [58-72] years. Additionally, five-patients (18.5%) died during follow-up, two of cardiovascular causes (HF and intestinal ischemia). Conclusions Probable cardiac involvement was identified in 8.3% of this Southern European extracardiac sarcoidosis cohort, mostly occurring in asymptomatic patients. Over a median follow-up of 3.6 years, nearly half of the patients experienced major adverse events highlighting the need for vigilant cardiac monitoring in this population.
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Salvador et al. (2026) conducted a cohort in Cardiac sarcoidosis (n=314). Probable cardiac sarcoidosis per HRS criteria was evaluated on Composite of HF hospitalization, arrhythmias requiring intervention, pacemaker implantation for complete heart block, and all-cause mortality. Probable cardiac sarcoidosis occurred in 8.6% of extracardiac sarcoidosis patients and led to composite adverse cardiac outcomes or death in 40.7% over a median 43-month follow-up.
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