Risk of Adverse Cardiovascular Events in Cardiac Sarcoidosis Independent of Left Ventricular Function
This study investigated the association between left ventricular ejection fraction (LVEF) and the risk of ventricular arrhythmias (VA), heart transplantation, and death in cardiac sarcoidosis (CS). We identified 110 CS patients meeting 2014 Heart Rhythm Society (HRS) diagnostic criteria with baselin...
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| Veröffentlicht in: | The American journal of cardiology 2020-07, Vol.127, p.142-148 |
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| container_title | The American journal of cardiology |
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| creator | Rosenthal, David G. Cheng, Richard K. Petek, Bradley J. Masri, Sofia Carolina Mikacenic, Carmen Raghu, Ganesh Patton, Kristen K. |
| description | This study investigated the association between left ventricular ejection fraction (LVEF) and the risk of ventricular arrhythmias (VA), heart transplantation, and death in cardiac sarcoidosis (CS). We identified 110 CS patients meeting 2014 Heart Rhythm Society (HRS) diagnostic criteria with baseline LVEF |
| doi_str_mv | 10.1016/j.amjcard.2020.04.025 |
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We identified 110 CS patients meeting 2014 Heart Rhythm Society (HRS) diagnostic criteria with baseline LVEF <35% (n = 32) or ≥35% (n = 78). The primary end point was sustained VA or sudden cardiac death (SCD), and secondary end points included risk of heart transplantation, death, or a composite. Logistic regression determined risk factors for VA/SCD, and Cox proportional hazards regression analysis was performed for secondary end points. Receiver operating curve analysis determined the best discrimination point of LVEF for each end point; sensitivity analyses evaluated the effects of higher LVEF on each end point. Over a follow-up of 2.6 (range 1.0 to 5.8) years, 49 (44.5%) CS patients experienced VA/SCD, including 19 of 32 (59.4%) with LVEF <35%, and 30 of 78 (38.5%) with LVEF ≥35%. After adjustment, LVEF <35% was not significantly associated with an increased risk of VA/SCD compared with LVEF ≥35% (odds ratio 1.3, 95% confidence intervals 0.5 to 3.7). Although LVEF <35% was associated with an increased risk of heart transplantation and death (28.1% vs 12.8%, p = 0.05), this was not significant after adjustment (hazard ratio 1.7, 95% confidence intervals 0.5 to 9.0, p = 0.53). In conclusion, patients with CS experience high rates of VA, SCD, and heart transplantation, even when LVEF is mildly impaired or normal. Patients with LVEF <35% are at particularly elevated risk of VA/SCD. Our findings highlight the imperative to investigate arrhythmia risk in all patients with CS, even in the setting of an otherwise reassuring LVEF.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2020.04.025</identifier><identifier>PMID: 32402485</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Arrhythmia ; Blood pressure ; Cardiovascular disease ; Cardiovascular diseases ; Confidence intervals ; Death ; Diagnostic systems ; Health hazards ; Health risks ; Heart failure ; Heart transplantation ; Medical prognosis ; Mortality ; Regression analysis ; Risk analysis ; Risk factors ; Sarcoidosis ; Sensitivity analysis ; Statistical analysis ; Transplantation ; Ultrasonic imaging ; Ventricle</subject><ispartof>The American journal of cardiology, 2020-07, Vol.127, p.142-148</ispartof><rights>2020 Elsevier Inc.</rights><rights>Copyright © 2020 Elsevier Inc. All rights reserved.</rights><rights>2020. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c393t-5166f4935bab1f0a32691496dc90b319a36777e498aeb45164063ca1f0a3fb7f3</citedby><cites>FETCH-LOGICAL-c393t-5166f4935bab1f0a32691496dc90b319a36777e498aeb45164063ca1f0a3fb7f3</cites><orcidid>0000-0002-9034-6966 ; 0000-0003-2728-7745</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002914920303945$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32402485$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rosenthal, David G.</creatorcontrib><creatorcontrib>Cheng, Richard K.</creatorcontrib><creatorcontrib>Petek, Bradley J.</creatorcontrib><creatorcontrib>Masri, Sofia Carolina</creatorcontrib><creatorcontrib>Mikacenic, Carmen</creatorcontrib><creatorcontrib>Raghu, Ganesh</creatorcontrib><creatorcontrib>Patton, Kristen K.</creatorcontrib><title>Risk of Adverse Cardiovascular Events in Cardiac Sarcoidosis Independent of Left Ventricular Function</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>This study investigated the association between left ventricular ejection fraction (LVEF) and the risk of ventricular arrhythmias (VA), heart transplantation, and death in cardiac sarcoidosis (CS). We identified 110 CS patients meeting 2014 Heart Rhythm Society (HRS) diagnostic criteria with baseline LVEF <35% (n = 32) or ≥35% (n = 78). The primary end point was sustained VA or sudden cardiac death (SCD), and secondary end points included risk of heart transplantation, death, or a composite. Logistic regression determined risk factors for VA/SCD, and Cox proportional hazards regression analysis was performed for secondary end points. Receiver operating curve analysis determined the best discrimination point of LVEF for each end point; sensitivity analyses evaluated the effects of higher LVEF on each end point. Over a follow-up of 2.6 (range 1.0 to 5.8) years, 49 (44.5%) CS patients experienced VA/SCD, including 19 of 32 (59.4%) with LVEF <35%, and 30 of 78 (38.5%) with LVEF ≥35%. After adjustment, LVEF <35% was not significantly associated with an increased risk of VA/SCD compared with LVEF ≥35% (odds ratio 1.3, 95% confidence intervals 0.5 to 3.7). Although LVEF <35% was associated with an increased risk of heart transplantation and death (28.1% vs 12.8%, p = 0.05), this was not significant after adjustment (hazard ratio 1.7, 95% confidence intervals 0.5 to 9.0, p = 0.53). In conclusion, patients with CS experience high rates of VA, SCD, and heart transplantation, even when LVEF is mildly impaired or normal. Patients with LVEF <35% are at particularly elevated risk of VA/SCD. Our findings highlight the imperative to investigate arrhythmia risk in all patients with CS, even in the setting of an otherwise reassuring LVEF.</description><subject>Arrhythmia</subject><subject>Blood pressure</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular diseases</subject><subject>Confidence intervals</subject><subject>Death</subject><subject>Diagnostic systems</subject><subject>Health hazards</subject><subject>Health risks</subject><subject>Heart failure</subject><subject>Heart transplantation</subject><subject>Medical prognosis</subject><subject>Mortality</subject><subject>Regression analysis</subject><subject>Risk analysis</subject><subject>Risk factors</subject><subject>Sarcoidosis</subject><subject>Sensitivity analysis</subject><subject>Statistical analysis</subject><subject>Transplantation</subject><subject>Ultrasonic imaging</subject><subject>Ventricle</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkU1r3DAQhkVpaDZJf0KKoZdc7I4-LK9OISz5goVC2vQqZHkMcneljWQv9N9HG2966KUXiUHPvDN6X0IuKVQUqPw2VGY7WBO7igGDCkQFrP5AFnTZqJIqyj-SBQCwUlGhTslZSkMuKa3lJ3LKmQAmlvWC4JNLv4vQFzfdHmPCYpUlXdibZKeNicXtHv2YCufnB2OLHyba4LqQXCoefYc7zIcfDxpr7MfiVy6im7vvJm9HF_wFOenNJuHn431Onu9uf64eyvX3-8fVzbq0XPGxrKmUvVC8bk1LezCcycP2srMKWk6V4bJpGhRqabAVmRYguTVvaN82PT8nV7PuLoaXCdOoty5Z3GyMxzAlnb_NgQvBIKNf_0GHMEWft8sUq6Xk2aJM1TNlY0gpYq930W1N_KMp6EMOetDHHPQhBw1C5xxy35ej-tRusfvb9W58Bq5nALMde4dRJ-vQW-xcRDvqLrj_jHgFFfiatQ</recordid><startdate>20200715</startdate><enddate>20200715</enddate><creator>Rosenthal, David G.</creator><creator>Cheng, Richard K.</creator><creator>Petek, Bradley J.</creator><creator>Masri, Sofia Carolina</creator><creator>Mikacenic, Carmen</creator><creator>Raghu, Ganesh</creator><creator>Patton, Kristen K.</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>M7Z</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9034-6966</orcidid><orcidid>https://orcid.org/0000-0003-2728-7745</orcidid></search><sort><creationdate>20200715</creationdate><title>Risk of Adverse Cardiovascular Events in Cardiac Sarcoidosis Independent of Left Ventricular Function</title><author>Rosenthal, David G. ; 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We identified 110 CS patients meeting 2014 Heart Rhythm Society (HRS) diagnostic criteria with baseline LVEF <35% (n = 32) or ≥35% (n = 78). The primary end point was sustained VA or sudden cardiac death (SCD), and secondary end points included risk of heart transplantation, death, or a composite. Logistic regression determined risk factors for VA/SCD, and Cox proportional hazards regression analysis was performed for secondary end points. Receiver operating curve analysis determined the best discrimination point of LVEF for each end point; sensitivity analyses evaluated the effects of higher LVEF on each end point. Over a follow-up of 2.6 (range 1.0 to 5.8) years, 49 (44.5%) CS patients experienced VA/SCD, including 19 of 32 (59.4%) with LVEF <35%, and 30 of 78 (38.5%) with LVEF ≥35%. After adjustment, LVEF <35% was not significantly associated with an increased risk of VA/SCD compared with LVEF ≥35% (odds ratio 1.3, 95% confidence intervals 0.5 to 3.7). Although LVEF <35% was associated with an increased risk of heart transplantation and death (28.1% vs 12.8%, p = 0.05), this was not significant after adjustment (hazard ratio 1.7, 95% confidence intervals 0.5 to 9.0, p = 0.53). In conclusion, patients with CS experience high rates of VA, SCD, and heart transplantation, even when LVEF is mildly impaired or normal. Patients with LVEF <35% are at particularly elevated risk of VA/SCD. Our findings highlight the imperative to investigate arrhythmia risk in all patients with CS, even in the setting of an otherwise reassuring LVEF.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>32402485</pmid><doi>10.1016/j.amjcard.2020.04.025</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-9034-6966</orcidid><orcidid>https://orcid.org/0000-0003-2728-7745</orcidid></addata></record> |
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| source | Elsevier ScienceDirect Journals |
| subjects | Arrhythmia Blood pressure Cardiovascular disease Cardiovascular diseases Confidence intervals Death Diagnostic systems Health hazards Health risks Heart failure Heart transplantation Medical prognosis Mortality Regression analysis Risk analysis Risk factors Sarcoidosis Sensitivity analysis Statistical analysis Transplantation Ultrasonic imaging Ventricle |
| title | Risk of Adverse Cardiovascular Events in Cardiac Sarcoidosis Independent of Left Ventricular Function |
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