Impact of early initiation of corticosteroid therapy on cardiac function and rhythm in patients with cardiac sarcoidosis

详细信息    查看全文

• 作者：Santosh K. Padala^a ; ^{santoshpadala@gmail.com} ; Samuel Peaslee^b ; Mandeep S. Sidhu^b ; David A. Steckman^c ; Marc A. Judson^d
• 关键词：Cardiac sarcoidosis ; Corticosteroids ; Left ventricular systolic dysfunction ; Atrioventricular block ; Ventricular arrhythmias
• 刊名：International Journal of Cardiology
• 出版年：2017
• 出版时间：15 January 2017
• 年：2017
• 卷：227
• 期：Complete
• 页码：565-570
• 全文大小：394 K
• 卷排序：227

文摘

There is limited data on the effect of corticosteroid therapy in patients with cardiac sarcoidosis (CS). We sought to examine the impact of early initiation of corticosteroid therapy, within a month of CS diagnosis, on left ventricular ejection fraction (LVEF), ventricular arrhythmias (VAs), and atrioventricular (AV) block.MethodsWe retrospectively identified 30 CS patients from a large university sarcoidosis clinic. The effect of early initiation of corticosteroid therapy on LVEF was assessed by serial echocardiography, and on VAs and AV block was assessed by Holter monitoring and/or device interrogations.ResultsThe median time from diagnosis of extra-cardiac sarcoidosis to CS was 40 months. 90% (27/30) of the CS patients received corticosteroid therapy and 85% percent (23/27) had early initiation of corticosteroid therapy. Fourteen patients (47%) had reduced EF < 50%. 9/14 patients who had early initiation of corticosteroid therapy had improvement in mean EF (25% to 46%, P < 0.001); 5/14 patients who had a delay in initiation or who did not receive corticosteroids had no improvement in mean EF (41% to 37%, P = 0.47). Fourteen patients (47%) had VAs and 5 patients (17%) had advanced AV block. Early initiation of corticosteroid therapy resulted in no VA recurrences in 8/11 patients (72%), and complete recovery of AV conduction in 2/3 patients (67%).  Patients with VAs (n = 3) or advanced AV block (n = 2) who failed to receive early corticosteroid therapy did not show improvement.ConclusionsThere is often a delay in manifestation of cardiac sarcoidosis for several years from the diagnosis of extra-cardiac sarcoidosis. Prompt initiation of corticosteroid therapy in CS patients may improve outcomes whereas delayed initiation of corticosteroids or failure to use corticosteroids may be associated with worse outcomes.