What is the clinical evidence from this study?

Study design: Cohort. Population: Cardiac sarcoidosis (n=512). Intervention: Male sex vs. Female sex. Primary outcome: Potentially fatal ventricular arrhythmia events (pFVAEs) (HR 1.80, 95% CI 1.08-3.01, p=0.025).

April 25, 2023Open Access

Sex differences in clinical characteristics and prognosis of patients with cardiac sarcoidosis

Key Result

Male patients with cardiac sarcoidosis had a significantly higher risk of potentially fatal ventricular arrhythmia events compared to female patients (adjusted HR 1.80).

Study Design

Type

Cohort (n=512)

Multicenter

Yes

Structured PICO

Population

512 Japanese patients with cardiac sarcoidosis (mean age 61.6±11.4 years, 64.2% female) enrolled in a multicentre retrospective registry between 2001 and 2017.

Outcome

Potentially fatal ventricular arrhythmia events (pFVAEs)—a composite of sudden cardiac death, sustained ventricular tachycardia lasting >30 s, ventricular fibrillation or the requirement for implantable cardioverter defibrillator therapycomposite

Male patients with cardiac sarcoidosis have a significantly higher risk of potentially fatal ventricular arrhythmia events compared to female patients, suggesting a need for sex-specific risk stratification.

Main Result

Effect estimate: HR 1.80 (95% CI 1.08-3.01)

Absolute Event Rate: 25.1% vs 16.1%

p-value: p=0.025

Limitations

Cohort comprised only Japanese patients, limiting generalizability to other populations
Did not consider smoking, alcohol consumption, social/cultural behaviours, education or socioeconomic status
Ventricular arrhythmic events might be underestimated due to low prevalence of patients with cardiovascular implantable electronic devices
Did not obtain data on maximum standardised uptake values on FDG-PET
Myocardial inflammation was not assessed in all patients, leaving the possibility of misdiagnosis in some cases
Classified patients according to self-identified binary gender

Abstract

OBJECTIVE: Owing to the paucity of data, this study aimed to investigate sex differences in clinical features and prognosis of patients with cardiac sarcoidosis (CS). METHODS: This study was a secondary analysis of the ILLUstration of the Management and prognosIs of JapaNese PATiEnts with Cardiac Sarcoidosis registry-a retrospective multicentre registry that enrolled patients with CS between 2001 and 2017. The primary outcome was potentially fatal ventricular arrhythmia events (pFVAEs)-a composite of sudden cardiac death, sustained ventricular tachycardia lasting >30 s, ventricular fibrillation or the requirement for implantable cardioverter defibrillator therapy. RESULTS: Of the 512 participants (mean age±SD 61.6±11.4 years), 329 (64.2%) were females. Both sexes had peak ages of 60-64 years at diagnosis. Male patients were younger and had a higher prevalence of coronary artery disease and lower left ventricular ejection fraction than female patients. During a median follow-up of 3 years (IQR 1.6-5.6), pFVAEs were observed in 99 patients, with males having a significantly higher risk than females (p=0.002). This association was retained even after adjustment for other risk factors for pFVAEs, including left ventricular ejection fraction (adjusted HR 1.80; 95% CI 1.08 to 3.01, p=0.025). CONCLUSION: Approximately two-thirds of patients with CS were females, with a peak age of approximately 60 years at clinical diagnosis in both sexes; male patients were younger than female patients. Male patients had a significantly higher risk of pFVAEs than female patients. TRIAL REGISTRATION NUMBER: UMIN000034974.

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