Current Practices and Emerging Therapies to Optimize Heart Failure Management in Cardiac Sarcoidosis: A Systematic Review.

Autor:	Palvia AR; Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA., Kaur A; Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA., Azeez GA; Pathophysiology, St George's University, St George's, GRD.; Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA., Thirunagari M; Internal Medicine, Davao Medical School Foundation, Davao City, PHL., Fatima N; Clinical Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA., Anand A; Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA., Nassar ST; Medicine and Surgery, Jordan University of Science and Technology, Amman, JOR.; Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2024 Aug 09; Vol. 16 (8), pp. e66515. Date of Electronic Publication: 2024 Aug 09 (Print Publication: 2024).
DOI:	10.7759/cureus.66515
Abstrakt:	Cardiac sarcoidosis (CS) is a distinctive manifestation of sarcoidosis, a multisystemic inflammatory disorder that is characterized by non-necrotizing granulomas. CS can lead to arrhythmias, heart failure (HF), and sudden cardiac death. The diagnosis of CS involves imaging in the form of a two-dimensional echocardiogram, cardiac magnetic resonance imaging (MRI), an 18-fluoro-deoxyglucose positron emission tomography (FDG-PET) scan, and an endomyocardial biopsy. Treatment of CS entails corticosteroids, immunosuppressive agents, monoclonal antibodies, and, in advanced cases, heart transplantation (HTx). This systematic review follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, focusing on HF in sarcoidosis patients. Eligibility criteria include recent (2019-2024) research papers on sarcoidosis-induced heart failure, excluding other causes. The databases searched were PubMed, Google Scholar, and ScienceDirect. From 36,755 initial articles, 2,060 remained after filtering, and 17 were selected for quality assessment. Based on quality assessment, 11 studies were included in the final review. In CS, a variety of treatment strategies can be implemented. Corticosteroids are the first-line therapeutic options, and in the majority of cases, they are very successful in controlling the disease progression. Immunosuppressive agents like methotrexate and azathioprine are used to avoid long-term steroid use. Both corticosteroids and immunosuppressives act by reducing inflammation and preventing myocardial scarring. Biological agents like infliximab and adalimumab prevent disease progression by targeting specific inflammatory pathways and are used in refractory cases. Regular HF management drugs like angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), sodium-glucose transport protein 2 (SGLT2) inhibitors, beta-blockers, and diuretics help in optimizing cardiac function. In severe cases, a left ventricular assist device (LVAD) may be required. The ultimate treatment for end-stage CS is HTx, which has to be supplemented with a strong, individualized regimen of glucocorticoids and immunosuppressives to avoid graft rejection and to control sarcoidosis. Due to a lack of standard protocols for management and limited knowledge about CS, the ideal treatment of HF is still a matter of debate. Hence, further research and clinical trials need to be performed to optimize patient outcomes. Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work. (Copyright © 2024, Palvia et al.)
Databáze:	MEDLINE
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