Impact of Corticosteroid Use on the Clinical Response and Prognosis in
Patients with Cardiac Sarcoidosis who Underwent an Upgrade to Cardiac
Resynchronization Therapy
Abstract
Aims Corticosteroids are widely used in patients with cardiac
sarcoidosis (CS). In addition, upgrading to cardiac resynchronization
therapy (CRT) is sometimes needed. This study aimed to investigate the
impact of corticosteroid use on the clinical outcomes following CRT
upgrades. Methods A total of 48 consecutive patients with non-ischemic
cardiomyopathies who underwent CRT upgrades were retrospectively
reviewed and divided into three groups: group 1 included CS patients
taking corticosteroids before the CRT upgrade (n = 7), group 2, CS
patients not taking corticosteroids before the CRT upgrade (n = 10), and
group 3, non-CS patients (n = 31). The echocardiographic response, heart
failure hospitalizations, and cardiovascular deaths were evaluated.
Results The baseline characteristics during CRT upgrades exhibited no
significant differences in the echocardiographic data between the three
groups. After the CRT upgrade, responses regarding the ejection fraction
(EF) and end-systolic volume (ESV) were significantly lower in CS
patients than non-CS patients (ΔEF: group 1, 6.7% vs. group 2, 7.7%
vs. group 3, 13.6%; p=0.039, ΔESV: 3.0 mL vs. -12.7 mL vs. -37.2 mL; p
= 0.008). The rate of an echocardiographic response was lowest in group
1 (29%). There were, however, no significant differences in the
cumulative freedom from a composite outcome among the three groups (p =
0.19). No cardiovascular deaths occurred in group 1. Conclusion CS
patients taking corticosteroids before the CRT upgrade had lower
echocardiographic responses but higher freedom rates from a composite
endpoint. The timing of corticosteroid use would affect the clinical
course following a CRT upgrade.