Different Impact of Immunosuppressive Therapy on Cardiac Outcomes in Systemic Versus Isolated Cardiac Sarcoidosis

IF 1.2 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Tomoka Masunaga, Toru Hashimoto, Takeo Fujino, Kisho Ohtani, Yusuke Ishikawa, Tomoaki Yoshitake, Keisuke Shinohara, Shouji Matsushima, Tomomi Ide, Yuzo Yamasaki, Takuro Isoda, Shingo Baba, Kousei Ishigami, Hiroyuki Tsutsui, Shintaro Kinugawa
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引用次数: 0

Abstract

Isolated cardiac sarcoidosis (iCS) is increasingly recognized; however, its prognosis and the efficacy of immunosuppressive therapy remain undetermined. We aimed to compare the prognosis of iCS and systemic sarcoidosis including cardiac involvement (sCS) under immunosuppressive therapy.

We retrospectively reviewed the clinical data of 42 patients with sCS and 30 patients with iCS diagnosed at Kyushu University Hospital from 2004 through 2022. We compared the characteristics and the rate of adverse cardiac events including cardiac death, fatal ventricular tachyarrhythmia, and heart failure hospitalization between the 2 groups. The median follow-up time was 1535 [interquartile range, 630-2555] days, without a significant difference between the groups. There were no significant differences in gender, NYHA class, or left ventricular ejection fraction. Immunosuppressive agents were administered in 86% of sCS and in 73% of iCS patients (P = 0.191). When analyzed only with patients receiving immunosuppressive therapy (sCS, n = 36; iCS, n = 21), the cardiac event-free survival was significantly lower in iCS than sCS (37% versus 79%, P = 0.002). Myocardial LGE content at the initial diagnosis was comparable in both groups. The disease activity was serially evaluated in 26 sCS and 16 iCS patients by quantitative measures of FDG-PET including cardiac metabolic volume and total lesion glycolysis, representing 3-dimensional distribution and intensity of inflammation in the entire heart. Although iCS patients had lower baseline disease activity than sCS patients, immunosuppressive therapy did not attenuate disease activity in iCS in contrast to sCS.

iCS showed a poorer response to immunosuppressive therapy and a worse cardiac prognosis compared to sCS despite lower baseline disease activity.

免疫抑制疗法对全身性肉样瘤病和孤立性肉样瘤病心脏预后的不同影响
孤立性心脏肉样瘤病(iCS)已被越来越多的人所认识,但其预后和免疫抑制疗法的疗效仍未确定。我们回顾性研究了九州大学医院自 2004 年至 2022 年诊断的 42 例心脏受累肉样瘤病患者和 30 例心脏受累肉样瘤病患者的临床数据,旨在比较心脏受累肉样瘤病和接受免疫抑制治疗的包括心脏受累在内的全身性肉样瘤病(sCS)的预后。我们比较了两组患者的特征和不良心脏事件的发生率,包括心源性死亡、致命性室性心动过速和心力衰竭住院治疗。中位随访时间为 1535 天[四分位间范围为 630-2555 天],两组间无显著差异。两组患者的性别、NYHA分级或左室射血分数无明显差异。86%的 sCS 患者和 73% 的 iCS 患者使用了免疫抑制剂(P = 0.191)。如果仅对接受免疫抑制剂治疗的患者进行分析(sCS,n = 36;iCS,n = 21),iCS 的无心脏事件生存率明显低于 sCS(37% 对 79%,P = 0.002)。两组患者初诊时的心肌 LGE 含量相当。对 26 名 sCS 和 16 名 iCS 患者的疾病活动性进行了连续评估,采用 FDG-PET 定量测量,包括心脏代谢容积和总病变糖酵解,代表整个心脏炎症的三维分布和强度。尽管iCS患者的基线疾病活动度低于sCS患者,但与sCS相比,免疫抑制疗法并没有减轻iCS的疾病活动度。尽管iCS的基线疾病活动度较低,但与sCS相比,iCS对免疫抑制疗法的反应较差,心脏预后也较差。
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来源期刊
International heart journal
International heart journal 医学-心血管系统
CiteScore
2.50
自引率
6.70%
发文量
148
审稿时长
6-12 weeks
期刊介绍: Authors of research articles should disclose at the time of submission any financial arrangement they may have with a company whose product figures prominently in the submitted manuscript or with a company making a competing product. Such information will be held in confidence while the paper is under review and will not influence the editorial decision, but if the article is accepted for publication, the editors will usually discuss with the authors the manner in which such information is to be communicated to the reader.
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