Incidence and Predictors of Relapse After Weaning Immune Suppressive Therapy in Cardiac Sarcoidosis.

Autor: Arps K; Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina. Electronic address: kelly.arps@duke.edu., Doss J; Duke University Medical Center, Durham, North Carolina., Geiger K; Duke University Medical Center, Durham, North Carolina., Flores-Rosario K; Duke University Medical Center, Durham, North Carolina., DeVore AD; Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina., Karra R; Duke University Medical Center, Durham, North Carolina., Kim HW; Duke University Medical Center, Durham, North Carolina., Piccini JP; Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina., Pokorney SD; Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina., Sun AY; Duke University Medical Center, Durham, North Carolina; Durham Veterans Affairs Medical Center, Durham, North Carolina.
Jazyk: angličtina
Zdroj: The American journal of cardiology [Am J Cardiol] 2023 Oct 01; Vol. 204, pp. 249-256. Date of Electronic Publication: 2023 Aug 08.
DOI: 10.1016/j.amjcard.2023.07.088
Abstrakt: Cardiac sarcoidosis (CS) is a relapsing-remitting disease, and immune suppression (IS) is the mainstay of therapy. Predictors of relapse for patients with CS in remission are not well characterized. We assessed incidence of relapse in consecutive patients with CS treated with high-dose steroids and/or steroid-sparing agents (SSA) in our center from 2000 to 2020. Remission was defined as reaching maintenance therapy (no IS, SSA, and/or prednisone ≤5 mg/d) for ≥1 month. Relapse was defined as recurrence of CS syndrome requiring IS intensification: heart failure, ventricular arrhythmia, decrease in left ventricular ejection fraction, or increased disease burden on imaging. Among 68 patients, the mean age was 50.7±9.0 years; 25 (37%) were women, and 32 (47%) were Black. In total, 59 patients (87%) reached remission. Over a median follow-up of 39.5 months (interquartile range 17.6, 92.5), 28 (48%) relapsed. Greater percentage of late gadolinium enhancement (LGE) on pretreatment magnetic resonance imaging corresponded with increased likelihood of relapse (odds ratio 1.396 per 5% increase [95% confidence interval (CI) 1.04 to 1.88]; p = 0.028). LGE ≥11% predicted elevated risk of relapse (adjusted odds ratio 4.998 [1.34 to 18.64]; p = 0.017). Shorter time to relapse was observed with isolated CS (adjusted hazard ratio 4.084 [1.44,11.56]; p = 0.008) and LGE ≥11% (adjusted hazard ratio 3.007 [1.01, 8.98]; p = 0.049). Approximately 1 in 2 patients with CS in remission experienced relapse. Greater burden of LGE on cardiac magnetic resonance imaging and isolated CS are associated with greater risk of relapse. Future work is needed to refine risk stratification for relapse and to optimize surveillance strategies on the basis of the burden of disease.
Competing Interests: Declaration of Competing Interest Kelly Arps has received research support from Medtronic and honoraria from MedIQ. Jonathan P. Piccini is supported by R01AG074185 from the National Institutes of Aging; receives grants for clinical research from Abbott, American Heart Association, the Association for the Advancement of Medical Instrumentation, Bayer, Boston Scientific, iRhythm, and Philips; and serves as a consultant to Abbott, Abbvie, Ablacon, Altathera, ARCA Biopharma, Biotronik, Boston Scientific, Bristol Myers Squibb, LivaNova, Medtronic, Mile-stone, ElectroPhysiology Frontiers, Pfizer, Sanofi, Philips, and UpToDate. Sean D. Pokorney reports grants from Janssen Pharmaceuticals and the US Food and Drug Administration; grants and personal fees from Bristol-Myers Squibb, Pfizer, Boston Scientific, and Janssen Pharmaceuticals; and personal fees from Medtronic and Philips Albert Y. Suna reports research support from Medtronic and Merit Medical and advisory board/consulting support from Biosense Webster, Medtronic, and Merit Medical. The remaining authors have no competing interests to declare.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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