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


METHODS
We 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.


RESULTS
The median time from diagnosis of extra-cardiac sarcoidosis to CS was 40months. 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.


CONCLUSIONS
There 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.
Division of Cardiac Electrophysiology, Virginia Commonwealth University, Richmond, VA 23284, USA. Electronic address: santoshpadala@gmail.com.
Santosh K
SK
Padala
Department of Medicine, Albany Medical College, Albany Medical Center, Albany, NY 12208, USA.
Samuel
S
Peaslee
Department of Medicine, Albany Medical College, Albany Medical Center, Albany, NY 12208, USA.
Mandeep S
MS
Sidhu
Division of Cardiac Electrophysiology, Albany Medical Center, Albany, NY 12208, USA.
David A
DA
Steckman
Division of Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY 12208, USA.
Marc A
MA
Judson
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D009202:Cardiomyopathies / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D016009:Chi-Square Distribution; D015331:Cohort Studies; D004334:Drug Administration Schedule; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012507:Sarcoidosis / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000188:drug therapy*
D000305:Adrenal Cortex Hormones
Atrioventricular block; Cardiac sarcoidosis; Corticosteroids; Left ventricular systolic dysfunction; Ventricular arrhythmias