Prognostic determinants of long-term survival in Japanese patients with cardiac sarcoidosis treated with prednisone

Yazaki, Yoshikazu; Isobe, Mitsuaki; Hiroe, Michiaki; Morimoto, Shin-ichiro; Hiramitsu, Shinya; Nakano, Takeshi; Izumi, Tohru; Sekiguchi, Morie

doi:10.1016/s0002-9149(01)01978-6

Cited by 573 publications

(477 citation statements)

References 15 publications

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“…Although these estimates are better than the earlier figures, even for 5‐year survival (40–75%),19, 20, 21 CS remains a potentially fatal disease. With current heart failure therapy, including use of mechanical support devices and heart transplantation, the overwhelming majority of deaths from CS are caused by sudden cardiac arrests.…”

Section: Discussionmentioning

confidence: 58%

Magnetic Resonance Imaging as a Predictor of Survival Free of Life‐Threatening Arrhythmias and Transplantation in Cardiac Sarcoidosis

Ekström

Lehtonen

Hänninen

et al. 2016

JAHA

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BackgroundCardiac magnetic resonance imaging has a key role in today's diagnosis of cardiac sarcoidosis. We set out to investigate whether cardiac magnetic resonance imaging also helps predict outcome in cardiac sarcoidosis.Methods and ResultsOur work involved 59 patients with cardiac sarcoidosis (38 female, mean age 46±10 years) seen at our hospital since February 2004 and followed up after contrast‐enhanced cardiac magnetic resonance imaging. The extent of myocardial late gadolinium enhancement (measured as percentage of left ventricular mass), the volumes and ejection fractions of the left and right ventricles, and the thickness of the basal interventricular septum were determined and analyzed for prognostic significance. By April 2015, 23 patients had reached the study's end point, consisting of a composite of cardiac death (n=3), cardiac transplantation (n=1), and occurrence of life‐threatening ventricular tachyarrhythmias (n=19; ventricular fibrillation in 5 and sustained ventricular tachycardia in 14 patients). In univariate analysis, myocardial extent of late gadolinium enhancement predicted event‐free survival, as did scar‐like thinning (<4 mm) of the basal interventricular septum and the ejection fraction of the right ventricle (P<0.05 for all). In multivariate Cox regression analysis, extent of late gadolinium enhancement was the only independent predictor of outcome events on cardiac magnetic resonance imaging, with a hazard ratio of 2.22 per tertile (95% CI 1.07–4.59). An extent of late gadolinium enhancement >22% (third tertile) had positive and negative predictive values for serious cardiac events of 75% and 76%, respectively.ConclusionsFindings on cardiac magnetic resonance imaging and the extent of myocardial late gadolinium enhancement in particular help predict serious cardiac events in cardiac sarcoidosis.

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Section: Discussionmentioning

confidence: 58%

Magnetic Resonance Imaging as a Predictor of Survival Free of Life‐Threatening Arrhythmias and Transplantation in Cardiac Sarcoidosis

Ekström

Lehtonen

Hänninen

et al. 2016

JAHA

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“…Traditionally, steroids have been reserved for patients with LVEF <50%, advanced AV block, VT, or positive cardiac biopsy, 6 but the approach was bound with high mortality risk. 38,39 These findings suggest that there is a tipping point of steroid efficacy where responsive active granulomatous inflammation/infiltration transforms toward nonresponsive fibrosis. Prolonged steroid therapy is not without risk, but an ominous mortality curve and resistance to treatment of advanced disease compel early action.…”

Section: Endomyocardial Biopsymentioning

confidence: 97%

“…38 Similarly, Yazaki et al found that 75 patients treated with steroids had a significantly better 5-year survival (75% vs 10%) compared with untreated patients. 39 Most compelling was 89% 5-year survival when steroids were started with the LVEF >50%. 39 Yogodawa also found that CS patients with a preserved LVEF showed a significant reduction in the number of PVCs and prevalence of nonsustained ventricular tachycardia compared with those with advanced LV dysfunction.…”

Section: Endomyocardial Biopsymentioning

confidence: 99%

“…39 Most compelling was 89% 5-year survival when steroids were started with the LVEF >50%. 39 Yogodawa also found that CS patients with a preserved LVEF showed a significant reduction in the number of PVCs and prevalence of nonsustained ventricular tachycardia compared with those with advanced LV dysfunction. 40 Yogodawa et al found from a cohort of 31 CS patients that the group with less-advanced LV dysfunction showed a significantly higher prevalence of gallium-67 uptake compared with the advanced-LV dysfunction group.…”

Section: Endomyocardial Biopsymentioning

confidence: 99%

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Cardiac Sarcoid: A Clinician's Review on How to Approach the Patient With Cardiac Sarcoid

Mantini

Williams

Stewart

et al. 2012

Clinical Cardiology

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Cardiac sarcoid is an infiltrative, granulomatous disease of the myocardium. It is more prevalent entity than once believed, especially subclinical disease. It affects heart mechanics causing ventricular failure, and disrupts the cardiac electrical system leading to third degree heart block, malignant ventricular arrhythmias, and sudden cardiac death. This makes early diagnosis and treatment of this devastating disease essential. Based on reviewed literature this paper proposes step‐wise diagnostic and therapeutic algorithms for patients with suspected cardiac sarcoidoisis who do or do not have prior history of systemic sarcoidosis. Clin. Cardiol. 2012 DOI: 10.1002/clc.21982The authors have no funding, financial relationships, or conflicts of interest to disclose.Special thanks to Dr. Maziar Zafari for his help with the editing process.

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“…The most frequent cardiac manifestations of cardiac sarcoidosis (CS) include conduction disturbances and arrhythmias, sudden death and congestive heart failure (CHF), the latter being reported in up to 30% of affected patients (3)(4)(5)(6)(7)(8)(9). Increased awareness, early medical treatment, the use of pacemakers and implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy with ICD (CRTD) are changing the causes of death in CS patients, with CHF becoming the most common cause.…”

Section: Introductionmentioning

confidence: 99%

Deterioration of Cardiac Function during the Progression of Cardiac Sarcoidosis: Diagnosis and Treatment

Terasaki

Ishizaka

2014

Intern. Med.

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The cardiac involvement of sarcoidosis causes progressive heart failure symptoms and is a life-threatening condition; thus, an early and appropriate diagnosis of this condition is crucial. On the other hand, the decline in the cardiac function is rapid; therefore, patients usually have moderate-severe left ventricular dysfunction when diagnosed with cardiac sarcoidosis, which may decrease the effectiveness of therapies. We herein report three illustrative cases of heart failure due to cardiac sarcoidosis in patients who were or were not diagnosed with preceding systemic sarcoidosis. We also discuss the currently available diagnostic modalities and possible biomarkers for the diagnosis of cardiac sarcoidosis.

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Prognostic determinants of long-term survival in Japanese patients with cardiac sarcoidosis treated with prednisone

Cited by 573 publications

References 15 publications

Magnetic Resonance Imaging as a Predictor of Survival Free of Life‐Threatening Arrhythmias and Transplantation in Cardiac Sarcoidosis

Magnetic Resonance Imaging as a Predictor of Survival Free of Life‐Threatening Arrhythmias and Transplantation in Cardiac Sarcoidosis

Cardiac Sarcoid: A Clinician's Review on How to Approach the Patient With Cardiac Sarcoid

Deterioration of Cardiac Function during the Progression of Cardiac Sarcoidosis: Diagnosis and Treatment

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