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We previously surveyed the prognosis of cardiac sarcoidosis(CS) diagnosed before 1997 and identified the severity of heart failure and ventricular remodeling as independent predictors of mortality (AJC 2001). During the past few decades, we have introduced modified immunosuppression including a higher maintenance dose of prednisolone (PSL) and addition of methotrexate(MTX), and neurohumoral blockade for heart failure in the treatment of CS. We therefore hypothesized that the prognosis of CS improves due to such advances in the medical treatment.
To confirm our hypothesis, we analyzed 45 CS patients diagnosed between 1988 and 2007 and treated with corticosteroids. We classified two sequential referral patients diagnosed between 1988 and 1997 (n=19) and between 1998 and 2007 (n=26), and compared treatment and prognosis.
Although the severity of heart failure and echocardiographic variables were similar between the two cohort, survival in the 1988-1997 referral cohort was significantly worse (log-rank=4.41, p<0.05). The 1998-2006 referral cohort showed significantly higher incidence of rennin-angiotensin-aldosterone inhibitors (69% versus 42%, p<0.05), β-blocker use (46% versus 6%, p<0.01) and addition of MTX (27% versus 0%, p<0.05), and increased maintenance dose of PSL (7.6±2.0 versus 5.0±0.9 mg/day, p<0.01) compared to the 1988-1997 cohort. Multivariate analysis identified diagnosis between 1988 and 1997 (hazard ratio [HR]: 19.8, p<0.01) and left ventricular ejection fraction (LVEF) (HR: 0.83/1% increase, p<0.01) as independent predictors of mortality. Addition of MTX improved diabetes(HbA1c:7.6±1.9 to 7.2±2.0%, p<0.05) and lipid profile(Triglyceride levels: 226±124 to 167±118mg/dl, p<0.05) associated with reduced maintenance doses of PSL (8.3±3.4 to 6.4±2.2mg/day, p<0.05). In patients with 5-year survivor of the recent cohort, LVEF was significantly improved (42±15 to 53±15%, p<0.01) and LV diameter was unchanged (49±9 to 51±9mm, n.s.) during the follow-up periods.
Modified immunosuppression and neurohumoral blockade may prevent ventricular remodeling and improve clinical outcome in patients with CS.
Moderated Poster Contributions
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Potential Ways to Improve Myocardial Function with Pre-Existing Therapies
Abstract Category: 23. Pericardial/Myocardial Disease
Presentation Number: 1206M-144
- 2013 American College of Cardiology Foundation