Effects of immunosuppressive therapy on the clinical outcomes in patients with cardiac sarcoidosis

Abstract Background Cardiac sarcoidosis (CS) is an inflammatory disease that can manifest as heart block, ventricular tachycardia (VT), heart failure, or sudden death. Immunosuppressive drugs (ISDs) are frequently prescribed; however, their effectiveness in improving outcomes needs to be clarified. Purpose This study aims to elucidate the effects of ISDs on disease progression and survival. Methods We prospectively studied 86 patients diagnosed with CS, assessing VT occurrences, worsening heart failure, and progression of AV block. The cohort was divided into two groups: those who did not receive ISDs and those who did; the latter group was further divided into patients on glucocorticoid monotherapy and those on dual ISD therapy. The groups were compared for changes in LV EF, heart failure NYHA class, and rates of VT and ventricular pacing after one year of follow-up. Finally, we examined the occurrence of major adverse cardiovascular events (MACE), defined as death, heart transplantation, or LV assist device implantation. Results After one year, sustained VT occurred in 36 patients (41.9%). ISDs were initiated in 30/36 patients (83.3%) with VT and in 39/50 (78%) without VT; P = 0.594. During follow-up, VT recurred in 14 patients (16.3%), all of whom had prior VT episodes. VT recurrence rates were similar between groups: 15.9% in the ISD group vs. 17.6% in the non-ISD group; P = 0.865. Furthermore, VT recurrence rates under monotherapy and dual ISD therapy were also similar: monotherapy 12.5% vs. dual ISD therapy 17.8%; P = 0.736. Among 50 patients with devices, ventricular pacing under ISDs did not change significantly: mean VPstart 44.3 ± 44.8% vs. VPISD 48.5 ± 45.9%; P = 0.230. VPIST increased by ≥10% in 22% of patients, decreased by ≥10% in 20%, and changed by less than 10% in 29 patients. Importantly, the NYHA class showed significant improvement after one year with ISDs (Z = -3.67, P < 0.0001): NYHAstart 2.12 ± 0.80 vs. NYHAafter ISD 1.78 ± 0.78. LV EF also improved under ISDs: LV EFstart 43 ± 13.4% vs. LV EFafter ISD 46 ± 12.8%; P = 0.008. After one year, 7 MACE occurred in the non-ISD group, while 2 MACE were observed in the ISD group; P = 0.001. Conclusions In patients with CS, ISDs did not reduce the rates of VT or ventricular pacing. However, an improvement in heart failure under ISDs was observed. ISD therapy was also associated with fewer deaths, heart transplantations, and LVAD implantations. Dual ISD therapy was not associated with better outcomes compared to glucocorticoids alone.