Sex and Race Differences in Cardiac Sarcoidosis Presentation, Treatment and Outcomes

J Card Fail. 2023 Aug;29(8):1135-1145. doi: 10.1016/j.cardfail.2023.03.022. Epub 2023 Apr 14.

Abstract

Background: Although sex- and race-based patterns have been described in the extracardiac organ involvement of sarcoidosis, cardiac sarcoidosis (CS)-specific studies are lacking.

Methods: We studied CS presentation, treatment and outcomes based on sex and race in a tertiary-center cohort. Multivariable adjusted Cox proportional hazards and survival analyses were performed for primary composite outcomes (left ventricular assist device, heart transplantation, all-cause death) and for secondary outcomes (ventricular arrhythmia and all-cause death.

Results: We identified 252 patients with CS (108 female, 109 Black). At presentation with CS, females vs males (P = 0.001) and Black vs White individuals (P = 0.001) more commonly had symptomatic heart failure (HF), with HF most common in Black females (ANOVA P < 0.001). Treatment differences included more corticosteroid use (90% vs 79%; P = 0.020), higher 1-year prednisone dosage (13 vs 10 mg; P = 0.003) and less frequent early steroid-sparing agent use in males (29% vs 40%; P = 0.05). Black participants more frequently received a steroid-sparing agent (75% vs 60%; P = 0.023). Composite outcome-free survival did not differ by sex or race. Male sex had an adjusted hazard ratio of 2.34 (95% CI 1.13, 4.80; P = 0.021) for ventricular arrhythmia.

Conclusion: CS course may differ by sex and race and may contribute to distinct clinical CS phenotypes.

Keywords: Cardiomyopathy; arrhythmia; cardiac sarcoidosis; heart failure; race; sex differences.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Arrhythmias, Cardiac
  • Cardiomyopathies* / diagnosis
  • Cardiomyopathies* / drug therapy
  • Female
  • Heart Failure* / diagnosis
  • Heart Failure* / etiology
  • Heart Failure* / therapy
  • Humans
  • Male
  • Myocarditis* / complications
  • Race Factors
  • Retrospective Studies
  • Sarcoidosis* / diagnosis
  • Sarcoidosis* / drug therapy
  • Sarcoidosis* / epidemiology
  • Treatment Outcome