The sooner patients with cardiac sarcoidosis start corticosteroid therapy, the better are their chances of improvement and positive outcomes,a new study published in the International Journal of Cardiology reports.
The study, “Impact Of Early Initiation Of Corticosteroid Therapy On Cardiac Function And Rhythm In Patients With Cardiac Sarcoidosis,” was conducted by a team of researchers in the U.S.
Clinical manifestations of cardiac sarcoidosis include left ventricular systolic dysfunction, ventricular arrhythmias (VAs), and atrioventricular (AV) conduction anomalies, which may lead to heart failure and death.
To investigate the efficacy of an early use of corticosteroid therapy in patients presenting these symptoms, researchers analyzed 446 sarcoidosis patients, attending a sarcoid clinic at Albany Medical Center, from May 2011 through December 2014.
Of that initial group, 30 patients (mean age 58) had confirmed cardiac sarcoidosis and a complete record of their follow-up. The median time from diagnosis of cardiac sarcoidosis was 40 months. Clinically significant cardiac manifestations were seen in 22 patients, of which 14 had left ventricular systolic dysfunction, 14 had VAs, and 5 had advanced AV block.
Among these patients, 90 percent (27 patients) received corticosteroid therapy, and 23 of the 27 (85 percent) had started it early. The others either began corticosteroid therapy several months after diagnosis or never started the therapy at all.
Of the 14 patients with left ventricular systolic dysfunction, 9 were put on corticosteroid therapy soon after being diagnosed with cardiac sarcoidosis and showed improvement, while remaining 5 who either had delayed therapy initiation or no therapy did not.
In patients with VAs (14) or advanced AV block (5), early start of corticosteroid treatment resulted in no VA recurrences in 8 of 11 patients, and complete recovery of AV conduction in 2 of 3 patients. Those who did not receive early therapy — 3 VA patients and 2 VA block patients — did not show any improvement.
Overall, these results show that early corticosteroid therapy was consistently associated clinical improvement or stability.
“Early initiation of corticosteroid therapy in cardiac sarcoidosis patients with heart failure appeared to improve left ventricular systolic dysfunction irrespective of the severity of the left ventricular dysfunction in our cohort,” the researchers wrote. “Early corticosteroid initiation may potentially decrease the overall burden of ventricular arrhythmias and atrioventricular block in these patients.”
And, they concluded: “Our data suggest that a delay in diagnosis or initiation of corticosteroid therapy might attenuate these potential beneficial effects of … therapy in cardiac sarcoidosis and affect important clinical outcomes. Future prospective trials will be required in larger sarcoidosis populations to validate this conjecture.”