Elsevier

The American Journal of Cardiology

Volume 188, 1 February 2023, Pages 24-29
The American Journal of Cardiology

Clinical Outcomes of Radiologic Relapse in Patients With Cardiac Sarcoidosis Under Immunosuppressive Therapies

https://doi.org/10.1016/j.amjcard.2022.10.048Get rights and content

Although nuclear imaging can detect cardiac involvement of cardiac sarcoidosis (CS), including subclinical states, little is known about the prevalence and outcomes of radiologic relapse under prednisolone (PSL) therapy. This study aimed to investigate the clinical characteristics and outcomes in patients with radiologic relapse. A total of 80 consecutive patients with CS whose disease activity on nuclear imaging decreased at least once after initiation of immunosuppressive therapy were identified through a retrospective chart review. Radiologic relapse of CS was diagnosed using 18F-fluoro-2-deoxyglucose positron emission tomography or gallium-67 scintigraphy. Composite adverse events were defined as at least 1 of the following: all-cause death, hospitalization for heart failure, or lethal arrhythmia. During the follow-up period (median 2.9 years), radiologic relapse was observed in 31 patients (38.8% of overall patients) at 30 months (median) after immunosuppressive therapy initiation. After radiologic relapse was detected, all patients were treated with intensified immunosuppressive therapies (increasing PSL, n = 26 [83.9%], adding other immunosuppressive therapies to PSL, n = 5 [16.1%]). There were no differences in occurrences of composite adverse events in patients with and patients without radiologic relapse. Radiologic relapse under immunosuppressive therapy was observed in many patients with CS, but it was not associated with clinical outcomes under intensified immunosuppressive therapy.

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Methods

This study adheres to the principles of the Declaration of Helsinki and was approved by our institutional Ethics Committee (R19079). The study was designed to be carried out without obtaining individual informed consent according to the “opt-out” principle. Instead, we published a summary of the study protocol with the contact information for our office on the institution's website, which provided patients with the ability to refuse enrollment to the study.

In our department, we identified 102

Results

Clinical characteristics of the 80 patients are summarized in Table 1. There were no significant differences in demographic data between the enrolled patients and the excluded patients except age (72-year-old vs 60-year-old, the excluded patients vs enrolled patients, respectively, p <0.05). The median age at diagnosis was 60 years (IQR 55 to 67), and 64% were female. In 94% of the enrolled patients, the initial oral dose of PSL was 30 mg (median initial PSL dose: 30 mg). After the initiation

Discussion

Radiologic relapse was observed in 38.8% of patients in the overall enrolled patients. The median PSL dose at the radiologic relapse was 10 mg, indicating that the onset of relapse occurred during the maintenance phase of CTx. Because CS is essentially an inflammatory disease, the risk of relapse often remains after tapering PSL. A study reported a case of a patient with CS and severe HF who had recurrence of CS during a standard immunosuppressive therapy (including PSL) after heart

Acknowledgment

The authors thank the research coordinator and assistants in our institute for the data collection.

Disclosures

The authors have no conflicts of interest to declare.

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Funding: None

This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

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