Efficacy of corticosteroids in sarcoidosis presenting with atrioventricular block.
BACKGROUND
The usefulness of corticosteroid therapy for cardiac sarcoidosis has not yet been fully clarified.


METHODS
Of 40 patients diagnosed with cardiac sarcoidosis, twenty patients complicated by atrioventricular block but normal cardiac function (left ventricular ejection fraction > or = 50%) were divided retrospectively into one group (n = 7) receiving corticosteroids and another (n = 13) not receiving these agents. Over a mean observation period of 79.4 +/- 39.9 months, long-term outcome and laboratory findings were compared between the two groups and side effects also were noted.


RESULTS
There were no deaths in the corticosteroid-treated group. In the untreated group, 2 patients died (15.4%). Atrioventricular block resolved in 4 of the 7 patients in the treated group (57.1%), but did not resolve or improve in any of the untreated patients (p < 0.05). Left ventricular ejection fraction did not differ significantly between the treated and untreated groups at the time of initial evaluation (66.7 +/- 6.5% vs. 60.5 +/- 6.4%). In the follow-up period, a marked decline in the ejection fraction had occurred in the untreated group (37.6 +/- 17.3%), but not in the treated group (62.1 +/- 4.4%; p < 0.005). Ventricular tachycardia was not present at the initial assessment in any patient in either group. In the follow-up period, ventricular tachycardia occurred in only 1 of 7 treated patients (14.3%), but was present in 8 of 13 untreated patients (61.5%; p < 0.05). However, side effects of corticosteroid therapy were noted in 6 of the 7 treated patients (85.7%).


CONCLUSIONS
Our findings suggest that corticosteroids are useful in the treatment of cardiac sarcoidosis complicated by atrioventricular block but with normal cardiac function. However, these agents must be used with caution, with the maintenance dose kept as low as possible.
Kato
Yasuchika
Y
Division of Cardiology, Department of Internal Medicine, Fujita Health University School of Medicine, Tobyoake, Aichi, Japan.
Morimoto
Shin-ichiro
S
Uemura
Akihisa
A
Hiramitsu
Shinya
S
Ito
Teruo
T
Hishida
Hitoshi
H
D000305:Adrenal Cortex Hormones / Q000494:pharmacology*; D000368:Aged; D000369:Aged, 80 and over; D009202:Cardiomyopathies / Q000150:complications* / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006327:Heart Block / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012507:Sarcoidosis / Q000150:complications* / Q000188:drug therapy* / Q000473:pathology; D013318:Stroke Volume; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones