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

Publication ,  Journal Article
Arps, K; Doss, J; Geiger, K; Flores-Rosario, K; DeVore, AD; Karra, R; Kim, HW; Piccini, JP; Pokorney, SD; Sun, AY
Published in: Am J Cardiol
October 1, 2023

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.

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Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

October 1, 2023

Volume

204

Start / End Page

249 / 256

Location

United States

Related Subject Headings

  • Weaning
  • Ventricular Function, Left
  • Stroke Volume
  • Sarcoidosis
  • Myocarditis
  • Middle Aged
  • Male
  • Magnetic Resonance Imaging, Cine
  • Magnetic Resonance Imaging
  • Incidence
 

Citation

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ICMJE
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Arps, K., Doss, J., Geiger, K., Flores-Rosario, K., DeVore, A. D., Karra, R., … Sun, A. Y. (2023). Incidence and Predictors of Relapse After Weaning Immune Suppressive Therapy in Cardiac Sarcoidosis. Am J Cardiol, 204, 249–256. https://doi.org/10.1016/j.amjcard.2023.07.088
Arps, Kelly, Jayanth Doss, Kelly Geiger, Karen Flores-Rosario, Adam D. DeVore, Ravi Karra, Han W. Kim, Jonathan P. Piccini, Sean D. Pokorney, and Albert Y. Sun. “Incidence and Predictors of Relapse After Weaning Immune Suppressive Therapy in Cardiac Sarcoidosis.Am J Cardiol 204 (October 1, 2023): 249–56. https://doi.org/10.1016/j.amjcard.2023.07.088.
Arps K, Doss J, Geiger K, Flores-Rosario K, DeVore AD, Karra R, et al. Incidence and Predictors of Relapse After Weaning Immune Suppressive Therapy in Cardiac Sarcoidosis. Am J Cardiol. 2023 Oct 1;204:249–56.
Arps, Kelly, et al. “Incidence and Predictors of Relapse After Weaning Immune Suppressive Therapy in Cardiac Sarcoidosis.Am J Cardiol, vol. 204, Oct. 2023, pp. 249–56. Pubmed, doi:10.1016/j.amjcard.2023.07.088.
Arps K, Doss J, Geiger K, Flores-Rosario K, DeVore AD, Karra R, Kim HW, Piccini JP, Pokorney SD, Sun AY. Incidence and Predictors of Relapse After Weaning Immune Suppressive Therapy in Cardiac Sarcoidosis. Am J Cardiol. 2023 Oct 1;204:249–256.
Journal cover image

Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

October 1, 2023

Volume

204

Start / End Page

249 / 256

Location

United States

Related Subject Headings

  • Weaning
  • Ventricular Function, Left
  • Stroke Volume
  • Sarcoidosis
  • Myocarditis
  • Middle Aged
  • Male
  • Magnetic Resonance Imaging, Cine
  • Magnetic Resonance Imaging
  • Incidence