Study Compares Suspected Cardiac Sarcoidosis Between Sexes

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by Margarida Maia PhD |

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Females with suspected cardiac sarcoidosis experience chest pain and palpitations more frequently than males, but their heart is affected less severely by the condition, a study suggests.

Yet, the incidence of either death from all causes or significant ventricular arrhythmia — an abnormal rhythm in the heart’s lower chambers — in the long term was similar in both male and female patients.

“The findings make a strong argument for the routine and systematic inclusion of sex-specific analyses in sarcoidosis research,” Chetan Shenoy, MD, an associate professor at the University of Minnesota Medical School and the study’s lead author, said in a press release.

“Such practices could eventually lead to an improved understanding of sex differences in the diagnosis, treatment and [prognosis] of patients with suspected cardiac sarcoidosis and promote improved outcomes in both sexes,” he said.

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Study Compares Suspected Cardiac Sarcoidosis Between Sexes

The study, “Sex differences in patients with suspected cardiac sarcoidosis assessed by cardiovascular magnetic resonance imaging,” was published in Circulation: Arrhythmia and Electrophysiology.

Sarcoidosis is a disease in which small clusters of inflammatory cells (granulomas) form in different tissues and organs. Cardiac sarcoidosis is the name given to this disease when granulomas affect the heart. Its symptoms include chest pain and an irregular heartbeat (arrhythmia) or heart block, as the granulomas interfere with the electrical signals that make the heart muscle contract.

Women are more likely to develop sarcoidosis than men. They also are more likely to die in the hospital from heart complications and to experience sudden cardiac death. However, “there are few data on sex differences in suspected cardiac sarcoidosis,” the research team wrote.

“Although biological factors differ between the sexes, sex differences in patients with suspected cardiac sarcoidosis have not been systematically studied,” said Shenoy. “Our purpose was to investigate sex differences in the clinical presentation of patients with suspected cardiac sarcoidosis, cardiac involvement on cardiovascular magnetic resonance imaging and long-term clinical outcomes.”

The study involved 324 patients with suspected cardiac sarcoidosis, including 163 females and 161 males. While females and males had a similar prevalence of symptoms such as shortness of breath, near fainting or fainting, or abnormal hearth rhythms, females more commonly had chest pain (37.4% vs. 23.6%) and palpitations (39.3% vs. 26.1%) than males.

In contrast, the heart was less severely affected in females: characteristic findings of late gadolinium enhancement were less common among females than males (20% vs. 35%). Gadolinium enhancement is a technique used in cardiac magnetic resonance imaging to detect heart disease, including cardiac sarcoidosis.

Moreover, a smaller proportion of females met the Heart Rhythm Society criteria (23% women vs. 36% men) and the 2016 Japanese Circulation Society guideline criteria (8% vs. 19%) for a clinical diagnosis of cardiac sarcoidosis.

There were no differences in a combined assessment of all-cause death or significant arrhythmia originating in the lower heart chambers (ventricular arrhythmia) in females and males. But females had a lower incidence of ventricular arrhythmia.

“We observed distinct sex differences in patients with suspected cardiac sarcoidosis,” the researchers wrote. “A paradox was identified wherein female patients had a greater prevalence of chest pain and palpitations than male patients, but lesser cardiac involvement.”

A larger, multicenter study is needed to confirm these findings, the researchers noted.

Shenoy also has received a grant from the National Institutes of Health’s National Heart, Lung, and Blood Institute to classify patients with cardiac sarcoidosis according to their risk of worse outcomes, on the basis of cardiac magnetic resonance imaging findings.