Heart Failure, Atrioventricular Block, and Ventricular Tachycardia in Sarcoidosis

Abstract

Background Sarcoidosis is a granulomatous disease usually affecting the lungs, although cardiac morbidity may be common. The risk of these outcomes and the characteristics that predict them remain largely unknown. This study investigates the epidemiology of heart failure, atrioventricular block, and ventricular tachycardia among patients with and without sarcoidosis. Methods and Results We identified California residents aged ≥21 years using the Office of Statewide Health Planning and Development ambulatory surgery, emergency, or inpatient databases from 2005 to 2015. The risk of sarcoidosis on incident heart failure, atrioventricular block, and ventricular tachycardia were each determined. Linkage to the Social Security Death Index was used to ascertain overall mortality. Among 22 527 964 California residents, 19 762 patients with sarcoidosis (0.09%) were identified. Sarcoidosis was the strongest predictor of heart failure (hazard ratio [HR], 11.2; 95% CI, 10.7–11.7), atrioventricular block (HR, 117.7; 95% CI, 103.3–134.0), and ventricular tachycardia (HR, 26.1; 95% CI, 24.2–28.1) identified among all risk factors. The presence of any cardiac involvement best predicted each outcome. Approximately 22% (95% CI, 18%–26%) of the relationship between sarcoidosis and increased mortality was explained by the presence of at least 1 of these cardiovascular outcomes. Conclusions The magnitude of risk associated with sarcoidosis as a predictor of heart failure, atrioventricular block, and ventricular tachycardia, exceeds all established risk factors. Surveillance for and anticipation of these outcomes among patients with sarcoidosis is indicated, and consideration of a sarcoidosis diagnosis may be prudent among patients with heart failure, atrioventricular block, or ventricular tachycardia.

RETRACTED: Association between sarcoidosis and cardiovascular Outcomes: A systematic review and Meta-analysis

“…A total of 6 studies [22] , [23] , [24] , [25] , [26] , [27] were included in our analysis which comprised 42,763 patients in the cardiac sarcoidosis group and 22,496,333 patients in the non-sarcoidosis group. The pooled prevalence of sarcoidosis in our cohort is 13.1% (95% CI 1% to 70%).…”

“…3 studies [22] , [23] , [27] reported data relevant to our primary outcomes that is all-cause mortality. The pooled analysis of primary endpoints showed that all-cause mortality was significantly higher in patients with CS compared to those without [RR, 2.08 (95% CI: 1.17 to 3.08), p = 0.01, I 2 = 98.3%] ( Fig.…”

“…Among the secondary outcomes, 3 studies [23] , [24] , [27] reported data relevant to the ventricular tachycardia, and 5 studies [22] , [23] , [24] , [25] , [26] reported on heart failure. The pooled analysis of secondary endpoints showed that incidence of ventricular tachycardia was significantly higher with CS groups compared to those without (RR = 15.3 (95% CI = 5.39 to 43.42, p < 0.001) with moderate heterogeneity (I 2 = 60%).…”

“…In our study, heart failure was found to be significantly higher in patients with sarcoidosis as compared to non-sarcoidosis patients. Rosenthal and colleagues conducted a study to evaluate the incidence of HF in sarcoidosis and found that HF was significantly higher in those with sarcoidosis (240/1000) than in those without sarcoidosis (12/1000) (P < 0.001) [23] . Similarly, Yafasova and colleagues found a high incidence of HF among patients with sarcoidosis as compared to the non-sarcoidosis control groups [22] .…”

Cardiac Sarcoidosis—Diagnostic and Therapeutic Challenges

“…Supraventricular tachyarrhythmias including atrial fibrillation is rarely observed initially but can present at later stages of the disease [ 37 , 38 , 39 ]. Signs of heart failure usually indicate left-ventricular infiltration and systolic dysfunction but can also result from diastolic dysfunction and/or restrictive physiology [ 40 , 41 ]. In rare cases, CS can also infiltrate or compress the coronary macro- or microvasculature leading to angina, a diagnosis of myocardial infarction with non-occlusive coronary arteries (MINOCA) or even occlusive myocardial infarction [ 41 , 42 , 43 , 44 ].…”