Heart transplantation outcomes in cardiac sarcoidosis

Jackson, Kamari; Youmans, Quentin R.; Wu, Tingqing; Harap, Rebecca; Anderson, Allen S.; Chicos, Alexandru B.; Ezema, Ashley; Mandieka, Edwin; Ohiomoba, Ramael; Pawale, Amit; Pham, Duc Thinh; Russell, Stuart; Sporn, Peter H. S.; Yancy, Clyde W.; Okwuosa, Ike S.

doi:10.1016/j.healun.2021.08.012

Cited by 17 publications

(7 citation statements)

References 27 publications

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“…88 Compared with other cardiomyopathies, individuals undergoing heart transplantation for CS have similar or better outcomes according to United Network for Organ Sharing registry analyses. 86,89 Limited data exist on the long-term outcomes of mechanical circulatory support in individuals with CS. 86,90 It should be noted that despite increasing awareness and diagnosis of CS, the diagnosis of sarcoidosis frequently is unrecognized until examination of native heart tissue at the time of LVAD or transplantation, 91,92 with clinical misclassification in up to 66% of individuals (most often as dilated cardiomyopathy).…”

Section: Advanced Hf Therapiesmentioning

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: Advanced Hf Therapiesmentioning

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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“…Mechanical assist devices and heart transplantation should be considered for patients with a fulminant course of disease and/or CS-relative terminal heart failure. Data indicate a good post-transplant survival and a comparable outcome in relation to non-CS transplant recipients [ 114 , 115 , 116 ].…”

Section: Managementmentioning

confidence: 99%

Cardiac Sarcoidosis—Diagnostic and Therapeutic Challenges

Korthals,

Bietenbeck,

Könemann

et al. 2024

JCM

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Sarcoidosis is a multisystem disorder of unknown etiology. The leading hypothesis involves an antigen-triggered dysregulated T-cell-driven immunologic response leading to non-necrotic granulomas. In cardiac sarcoidosis (CS), the inflammatory response can lead to fibrosis, culminating in clinical manifestations such as atrioventricular block and ventricular arrhythmias. Cardiac manifestations frequently present as first and isolated signs or may appear in conjunction with extracardiac manifestations. The incidence of sudden cardiac death (SCD) is high. Diagnosis remains a challenge. For a definite diagnosis, endomyocardial biopsy (EMB) is suggested. In clinical practice, compatible findings in advanced imaging using cardiovascular magnetic resonance (CMR) and/or positron emission tomography (PET) in combination with extracardiac histological proof is considered sufficient. Management revolves around the control of myocardial inflammation by employing immunosuppression. However, data regarding efficacy are merely based on observational evidence. Prevention of SCD is of particular importance and several guidelines provide recommendations regarding device therapy. In patients with manifest CS, outcome data indicate a 5-year survival of around 90% and a 10-year survival in the range of 80%. Data for patients with silent CS are conflicting; some studies suggest an overall benign course of disease while others reported contrasting observations. Future research challenges involve better understanding of the immunologic pathogenesis of the disease for a targeted therapy, improving imaging to aid early diagnosis, assessing the need for screening of asymptomatic patients and randomized trials.

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“…Large registry studies have shown that patients with CS have as good post-transplant survival and a similar risk of late complications as the non-CS transplant recipients. 169 , 170 Recurrence of CS in the allograft is rare and has not resulted in graft failure. 171 …”

Section: Introductionmentioning

confidence: 99%

Cardiac sarcoidosis: phenotypes, diagnosis, treatment, and prognosis

Lehtonen

Uusitalo

Pöyhönen

et al. 2023

European Heart Journal

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Cardiac sarcoidosis (CS) results from epithelioid cell granulomas infiltrating the myocardium and predisposing to conduction disturbances, ventricular tachyarrhythmias, and heart failure. Manifest CS, however, constitutes only the top of an iceberg as advanced imaging uncovers cardiac involvement 4 to 5 times more commonly than what is clinically detectable. Definite diagnosis of CS requires myocardial biopsy and histopathology, but a sufficient diagnostic likelihood can be achieved by combining extracardiac histology of sarcoidosis with clinical manifestations and findings on cardiac imaging. CS can appear as the first or only organ manifestation of sarcoidosis or on top of pre-existing extracardiac disease. Due to the lack of controlled trials, the care of CS is based on observational evidence of low quality. Currently, the treatment involves corticosteroid-based, tiered immunosuppression to control myocardial inflammation with medical and device-based therapy for symptomatic atrioventricular block, ventricular tachyarrhythmias, and heart failure. Recent outcome data indicate 90% to 96% 5-year survival in manifest CS with the 10-year figures ranging from 80% to 90%. Major progress in the care of CS awaits the key to its molecular–genetic pathogenesis and large-scale controlled clinical trials.

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Heart transplantation outcomes in cardiac sarcoidosis

Cited by 17 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

Cardiac Sarcoidosis—Diagnostic and Therapeutic Challenges

Cardiac sarcoidosis: phenotypes, diagnosis, treatment, and prognosis

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