Effect of Corticosteroids on Left Ventricular Function in Patients With Cardiac Sarcoidosis

Wand, Alison L.; Pavlovic, Noelle; Duvall, Chloe; Rosen, Nachum; Chasler, Jessica; Griffin, Jan M.; Okada, David R.; Jefferson, Artrish; Chrispin, Jonathan; Tandri, Harikrishna; Mathai, Stephen C.; Sharp, Michelle; Chen, Edward S.; Kasper, Edward K.; Hays, Allison G.; Gilotra, Nisha A.

doi:10.1016/j.amjcard.2022.04.051

Cited by 6 publications

(4 citation statements)

References 27 publications

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“…1 Corticosteroids can improve conduction in cases of AVB, but their benefit specific to other arrhythmias, LV dysfunction, and mortality remains unclear. 12,[68][69][70] Corticosteroids are initiated at doses of 30 to 40 mg/d of prednisone equivalent because there is no demonstrated benefit with higher starting doses. [71][72][73] For those with life-threatening manifestations such as cardiogenic shock, higher initial corticosteroid doses, including intravenous doses of methylprednisolone of up to 1000 mg/d, can be prescribed until other causes of acute myocarditis (such as giant-cell myocarditis) are excluded.…”

Section: Immunomodulating Agentsmentioning

confidence: 99%

Diagnosis and Management of Cardiac Sarcoidosis: A Scientific Statement From the American Heart Association

Cheng,

Kittleson,

Beavers

et al. 2024

Circulation

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Cardiac sarcoidosis is an infiltrative cardiomyopathy that results from granulomatous inflammation of the myocardium and may present with high-grade conduction disease, ventricular arrhythmias, and right or left ventricular dysfunction. Over the past several decades, the prevalence of cardiac sarcoidosis has increased. Definitive histological confirmation is often not possible, so clinicians frequently face uncertainty about the accuracy of diagnosis. Hence, the likelihood of cardiac sarcoidosis should be thought of as a continuum (definite, highly probable, probable, possible, low probability, unlikely) rather than in a binary fashion. Treatment should be initiated in individuals with clinical manifestations and active inflammation in a tiered approach, with corticosteroids as first-line treatment. The lack of randomized clinical trials in cardiac sarcoidosis has led to treatment decisions based on cohort studies and consensus opinions, with substantial variation observed across centers. This scientific statement is intended to guide clinical practice and to facilitate management conformity by providing a framework for the diagnosis and management of cardiac sarcoidosis.

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Section: Immunomodulating Agentsmentioning

confidence: 99%

Diagnosis and Management of Cardiac Sarcoidosis: A Scientific Statement From the American Heart Association

Cheng,

Kittleson,

Beavers

et al. 2024

Circulation

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“…One of the strengths of our study is the large sample size, which was achieved using the NIS database and resulted in substantial statistical power. 42 , 43 , 44 Larger samples of patients enable us to construct stronger ML algorithms. We found RF to be a good model, with high AUC scores for HF hospitalization prediction.…”

Section: Discussionmentioning

confidence: 99%

Machine learning predicting mortality in sarcoidosis patients admitted for acute heart failure

Dai

Sherif

Jin

et al. 2022

Cardiovascular Digital Health Journal

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“…A review of 34 clinical reports involving 1297 patients concluded that corticosteroids improve AV conduction in 40% of patients and may prevent the deterioration of LV function, whereas their effect on ventricular arrhythmias and mortality remains ambiguous due to poor data quality [ 20 , 95 ]. There are contradictory results whether corticosteroid therapy is beneficial in patients with severe LV dysfunction (LVEF

30%), some studies reported that patients with severe LV dysfunction did not improve with treatment, other authors reported improvement of severe LV dysfunction [ 96 , 97 , 98 ]. The efficacy of immunosuppressive therapy probably depends on whether the cardiac manifestation of sarcoidosis is due to active inflammation or fibrosis, and the extent and proportion of inflammation and fibrosis.…”

Section: Treatmentmentioning

confidence: 99%

Cardiac Sarcoidosis: A Comprehensive Clinical Review

Vereckei,

Besenyi,

Nagy

et al. 2024

Rev. Cardiovasc. Med.

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Sarcoidosis is an inflammatory multisystemic disease of unknown etiology characterized by the formation of non-caseating granulomas. Sarcoidosis can affect any organ, predominantly the lungs, lymphatic system, skin and eyes. While 90% of patients with sarcoidosis have lung involvement, an estimated 5% of patients with sarcoidosis have clinically manifest cardiac sarcoidosis (CS), whereas approximately 25% have asymptomatic, clinically silent cardiac involvement verified by autopsy or imaging studies. CS can present with conduction disturbances, ventricular arrhythmias, heart failure or sudden cardiac death. Approximately 30% of 60-year-old patients presenting with unexplained high degree atrioventricular (AV) block or ventricular tachycardia are diagnosed with CS, therefore CS should be strongly considered in such patients. CS is the second leading cause of death among patients affected by sarcoidosis after pulmonary sarcoidosis, therefore its early recognition is important, because early treatment may prevent death from cardiovascular involvement. The establishment of isolated CS diagnosis sometimes can be quite difficult, when extracardiac disease cannot be verified. The other reason for the difficulty to diagnose CS is that CS is a chameleon of cardiology and it can mimic (completely or almost completely) different cardiac diseases, such as arrhythmogenic cardiomyopathy, giant cell myocarditis, dilated, restrictive and hypertrophic cardiomyopathies. In this review article we will discuss the current diagnosis and management of CS and delineate the potential difficulties and pitfalls of establishing the diagnosis in atypical cases of isolated CS.

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Effect of Corticosteroids on Left Ventricular Function in Patients With Cardiac Sarcoidosis

Cited by 6 publications

References 27 publications

Diagnosis and Management of Cardiac Sarcoidosis: A Scientific Statement From the American Heart Association

Diagnosis and Management of Cardiac Sarcoidosis: A Scientific Statement From the American Heart Association

Machine learning predicting mortality in sarcoidosis patients admitted for acute heart failure

Cardiac Sarcoidosis: A Comprehensive Clinical Review

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