Enhanced oxidative stress and presence of ventricular aneurysm for risk prediction in cardiac sarcoidosis

Abstract

ObjectiveSudden cardiac death (SCD) is the major cause of death in cardiac sarcoidosis (CS). We aimed to identify the prognostic markers for sustained ventricular tachycardia (sVT) and SCD in patients with CS.MethodsWe performed a prospective observational cohort study for patients with CS diagnosed according to the Japanese or Heart Rhythm Society guidelines between June 2008 and March 2020 in our hospital. The primary endpoint was a composite of the first sVT and SCD. The levels of urinary 8-hydroxy-2′-deoxyguanosine (U-8-OHdG), a marker of oxidative DNA damage that reflects the inflammatory activity of CS, other biomarkers, and indices of cardiac function and renal function were measured on admission.ResultsEighty-nine consecutive patients with CS were enrolled; 28 patients with no abnormal 18F-fluorodeoxyglucose (18F-FDG) accumulation in the heart were excluded and 61 patients with abnormal 18F-FDG accumulation were followed up for a median of 46 months (IQR: 20–84). During the follow-up period, 15 of 61 patients showed sVT (n=12) or SCD (n=3). A Cox proportional hazard model showed that U-8-OHdG concentration and presence of ventricular aneurysm (VA) were independent predictors of first sVT/SCD. The cut-off U-8-OHdG concentration for predicting first sVT/SCD was 14.9 ng/mg·Cr. Patients with U-8-OHdG concentration ≥14.9 ng/mg·Cr and VA showed a significantly increased risk of sVT/SCD.ConclusionsU-8-OHdG and presence of VA were powerful predictors of first sVT/SCD in patients with CS, facilitating the stratification of cardiac events and providing relevant information about the substrates of ventricular tachycardia.

Heartbeat: delayed and inadequate treatment of acute coronary syndromes during the COVID-19 pandemic

“…sudden cardiac death (n=3) were the presence of a ventricular aneurysm and urinary 8-hydroxy-2′-deoxyguanosine (U-8-OHdG), a marker of oxidative DNA damage that reflects the inflammatory activity of CS. 3 In patients with an U-8-OHdG level ≥14.9 ng/mg•Cr, the event rate per 100 patient-years was 0.6 (95% CI 0.015 to 3.303) compared with 12.3 (95% CI 6.739 to 20.681) in those with higher U-8OHdG levels (figure 3).…”

“…In patients with cardiac sarcoidosis (CS), improved prediction of the risk of heart failure and sudden death would allow individualised therapy. In a consecutive series of 61 patients with CS and abnormal 8 F-fluorodeoxyglucose ( 18 F-FDG) accumulation in the heart, followed for a median of 46 months, independent predictors or sustained ventricular tachycardia (N-12) or sudden cardiac death (n=3) were the presence of a ventricular aneurysm and urinary 8-hydroxy-2′-deoxyguanosine (U-8-OHdG), a marker of oxidative DNA damage that reflects the inflammatory activity of CS 3. In patients with an U-8-OHdG level ≥14.9 ng/mg·Cr, the event rate per 100 patient-years was 0.6 (95% CI 0.015 to 3.303) compared with 12.3 (95% CI 6.739 to 20.681) in those with higher U-8OHdG levels (figure 3).…”

Cardiac Sarcoidosis: Indications for Implantable Cardioverter-Defibrillator Therapy

“…Notably, ventricular aneurysm formation and high levels of oxidative stress (and systemic inflammation) markers recently have been suggested to be important predictors of a first episode of sustained VAs/sudden cardiac death in patients with CS. 4 Therefore, these novel findings may lead to an expansion of ICD indications in the setting of CS. 4 Based on the aforementioned information, we wonder about the specific indication(s) for ICD implantation in this patient (including low LVEF).…”

“… 4 Therefore, these novel findings may lead to an expansion of ICD indications in the setting of CS. 4 Based on the aforementioned information, we wonder about the specific indication(s) for ICD implantation in this patient (including low LVEF). 1 Did the patient also undergo EPS for VA stimulation and evaluation of atrioventricular node functions?…”

Cardiac oxidative stress: a potential tool for risk stratification in cardiac sarcoidosis

“…In this context, this journal issue presents a prospective study by Yoshitomi et al on the utility and prognostic stratification of patients with 12CS (article reference). Having previously shown the promising use of urinary 8-OHdG in CS, this research group sought to prospectively enrol and follow-up 61 patients with CS who had active inflammation on PET scan.…”