Effect of Corticosteroid Therapy on Long-Term Clinical Outcome and Left Ventricular Function in Patients With Cardiac Sarcoidosis

Nagai, Toshiyuki; Nagano, Nobutaka; Sugano, Yasuo; Asaumi, Yasuhide; Aiba, Takeshi; Kanzaki, Hideaki; Kusano, Kengo; Noguchi, Teruo; Yasuda, Satoshi; Ogawa, Hisao; Anzai, Toshihisa

doi:10.1253/circj.cj-14-1275

Cited by 70 publications

(44 citation statements)

References 32 publications

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“…Cardiac involvement is a major cause of sarcoid-related death [2], and affects 25% of patients with systemic sarcoidosis [3]. Corticosteroid therapy, a standard treatment for cardiac sarcoidosis (CS), improves the survival rate of CS patients by preventing left ventricular (LV) remodelling induced by repeated granulomatous inflammation and post-inflammatory fibrosis [4]. This powerful standard treatment for sarcoidosis, however, is only effective for CS patients with a preserved LV ejection fraction, and not those with advanced LV dysfunction [5].…”

Section: Introductionmentioning

confidence: 99%

Immunohistochemical identification of Propionibacterium acnes in granuloma and inflammatory cells of myocardial tissues obtained from cardiac sarcoidosis patients

et al. 2017

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BackgroundAlthough rare, cardiac sarcoidosis (CS) is potentially fatal. Early diagnosis and intervention are essential, but histopathologic diagnosis is limited. We aimed to detect Propionibacterium acnes, a commonly implicated etiologic agent of sarcoidosis, in myocardial tissues obtained from CS patients.Methods and resultsWe examined formalin-fixed paraffin-embedded myocardial tissues obtained by surgery or autopsy and endomyocardial biopsy from patients with CS (n = 26; CS-group), myocarditis (n = 15; M-group), or other cardiomyopathies (n = 39; CM-group) using immunohistochemistry (IHC) with a P. acnes-specific monoclonal antibody. We found granulomas in 16 (62%) CS-group samples. Massive (≥14 inflammatory cells) and minimal (<14 inflammatory cells) inflammatory foci, respectively, were detected in 16 (62%) and 11 (42%) of the CS-group samples, 10 (67%) and 10 (67%) of the M-group samples, and 1 (3%) and 18 (46%) of the CM-group samples. P. acnes-positive reactivity in granulomas, massive inflammatory foci, and minimal inflammatory foci were detected in 10 (63%), 10 (63%), and 8 (73%) of the CS-group samples, respectively, and in none of the M-group and CM-group samples.ConclusionsFrequent identification of P. acnes in sarcoid granulomas of originally aseptic myocardial tissues suggests that this indigenous bacterium causes granuloma in many CS patients. IHC detection of P. acnes in massive or minimal inflammatory foci of myocardial biopsy samples without granulomas may be useful for differentiating sarcoidosis from myocarditis or other cardiomyopathies.

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Section: Introductionmentioning

confidence: 99%

Immunohistochemical identification of Propionibacterium acnes in granuloma and inflammatory cells of myocardial tissues obtained from cardiac sarcoidosis patients

et al. 2017

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“…Indeed, corticosteroid therapy may need to be started in the earlier stages of CS to ensure a beneficial effect on LV systolic function. In contrast, CS patients with severe LV dysfunction may represent end‐stage myocardial fibrosis, which is refractory to corticosteroid therapy . In the current study, all CS patients had severe LV dysfunction with a LVEF < 0.35.…”

Section: Discussionmentioning

confidence: 56%

Outcome of Patients With Cardiac Sarcoidosis Who Received Cardiac Resynchronization Therapy: Comparison With Dilated Cardiomyopathy Patients

Yufu

Kondo

Shinohara

et al. 2016

Cardiovasc electrophysiol

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“…They also reported that the presence of heart failure and the cardiac function before the corticosteroid treatment is the most important factor for estimating their prognosis, indicating that the early initiation of corticosteroids is important. Nagai et al 25 also reported the beneficial effects of corticosteroids (mean maintenance doses of 7.3 mg daily) in patients with CS. Daily doses of 60–80 mg of corticosteroids and tapered to around 10 mg are generally used, but a study from Japan indicated that the effects of an initial high dose (>40 mg daily) did not differ from those of a low dose (<30 mg daily),3 and thus, a dose adjustment for each patient with CS should be performed.…”

Section: Treatmentmentioning

confidence: 98%

Diagnosis and treatment of cardiac sarcoidosis

Kusano

Sato

2015

Heart

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Sarcoidosis is a systemic granulomatous disease of unknown aetiology. The frequency of cardiac involvement (cardiac sarcoidosis (CS)) varies in the different geographical regions, but it has been reported that it is an absolutely important prognostic factor in this disease. Complete atrioventricular block is the most common, and ventricular tachycardia/ventricular fibrillation the second most common arrhythmia in this disease, both of which are associated with cardiac sudden death. Diagnosing CS is sometimes difficult because of the non-specific ECG and echocardiographic findings, and CS is sometimes misdiagnosed as dilated cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy or an idiopathic ventricular aneurysm, and therefore, endomyocardial biopsy is important, but has a low sensitivity. Another problem is the recognition of isolated types of CS. Recently, MRI and (18)F-fluorodeoxyglucose positron emission tomography have been demonstrated to be useful tools for the non-invasive diagnosis of CS as well as therapeutic evaluation tools, but are still unsatisfactory. Treatment of CS is usually done by corticosteroid therapy to control inflammation, prevent fibrosis and protect from any deterioration of the cardiac function, but the long-term outcome is still in debate. Despite the advancement of non-pharmacological approaches for CS (pacing, defibrillators and catheter ablation) to improve the prognosis, there are still many issues remaining to resolve diagnosing and managing CS. Here, we attempt a review of the clinical evidence, with special focus on the current understanding of this disease and showing the current strategies and remaining problems of diagnosing and managing CS.

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Effect of Corticosteroid Therapy on Long-Term Clinical Outcome and Left Ventricular Function in Patients With Cardiac Sarcoidosis

Cited by 70 publications

References 32 publications

Immunohistochemical identification of Propionibacterium acnes in granuloma and inflammatory cells of myocardial tissues obtained from cardiac sarcoidosis patients

Immunohistochemical identification of Propionibacterium acnes in granuloma and inflammatory cells of myocardial tissues obtained from cardiac sarcoidosis patients

Outcome of Patients With Cardiac Sarcoidosis Who Received Cardiac Resynchronization Therapy: Comparison With Dilated Cardiomyopathy Patients

Diagnosis and treatment of cardiac sarcoidosis

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