From the Guidelines
Cardiac sarcoidosis should be treated with corticosteroids, typically starting with prednisone 40-60 mg daily, as this approach has been shown to improve outcomes in patients with symptomatic cardiac sarcoidosis 1. The treatment of cardiac sarcoidosis is crucial to prevent morbidity and mortality, and the use of corticosteroids is a common practice in symptomatic patients.
- The diagnosis of cardiac sarcoidosis should involve a combination of imaging studies, including echocardiography, Holter monitoring, and advanced imaging such as cardiac MRI or PET scans 1.
- Cardiac MRI with late gadolinium enhancement is considered the imaging study of choice in patients suspected of having cardiac sarcoidosis, as it can identify inflammation and fibrotic changes in the myocardium 1.
- The prognosis of patients with symptomatic cardiac sarcoidosis is poor, with a high risk of cardiac complications and mortality, emphasizing the need for prompt diagnosis and treatment 1.
- Important predictors of mortality in cardiac sarcoidosis include left ventricular end-diastolic diameter, New York Heart Association functional class, and sustained ventricular tachycardia 1.
- In addition to corticosteroids, other immunosuppressive therapies such as methotrexate, azathioprine, and infliximab may be used in the treatment of cardiac sarcoidosis, particularly in severe cases or those who do not respond to corticosteroids 1.
- Cardiac-specific management, including antiarrhythmic medications, implantable cardioverter-defibrillators, and standard heart failure therapy, is essential to prevent sudden cardiac death and improve outcomes in patients with cardiac sarcoidosis 1.
From the Research
Cardiac Sarcoidosis Overview
- Cardiac sarcoidosis is a condition where sarcoidosis, a chronic inflammatory disease, affects the heart, leading to granulomatous inflammation and potential fibrosis 2.
- The condition can occur in 2-7% of patients with sarcoidosis, but occult involvement may be higher, affecting over 20% of patients 2.
- Cardiac involvement can lead to arrhythmias, conduction defects, and congestive heart failure, with sudden death being a potential presenting feature 2, 3.
Diagnosis of Cardiac Sarcoidosis
- The definitive diagnosis of isolated cardiac sarcoidosis is challenging, with a low yield of endomyocardial biopsies 2.
- Radionuclide scans, such as 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) and gadolinium-enhanced magnetic resonance imaging (MRI), are key imaging modalities for diagnosis 2, 3.
- Advanced cardiac imaging studies are crucial in the diagnostic pathway, particularly in suspected isolated cardiac sarcoidosis, to rule out alternative diagnoses 4.
Treatment and Management of Cardiac Sarcoidosis
- Corticosteroids, alone or combined with additional immunosuppressive medications, remain the mainstay of treatment for cardiac sarcoidosis 2, 3.
- Immunosuppressive therapy, such as prednisone, can lead to complete or partial treatment response, with moderate to high doses showing favorable outcomes 5.
- Prednisone-tapering regimens containing infliximab may be superior to those containing prednisone alone or prednisone plus methotrexate in achieving treatment goals 6.
- Implantable cardioverter-defibrillators and heart transplantation may be considered in patients with cardiac sarcoidosis and serious ventricular arrhythmias or heart block, or those with end-stage disease refractory to medical therapy 2, 3.