Impact of early initiation of corticosteroid therapy on cardiac function and rhythm in patients with cardiac sarcoidosis

Background: There is limited data on the effect of corticosteroicl therapy in patients with cardiac sarcoiclosis (CS). We sought to examine the impact of early initiation of corticosteroicl therapy, within a month of CS diagnosis, on left ventricular ejection fraction (LVEF), ventricular arrhythmias (VAs), and atrioventricular (AV) block. Methods: We retrospectively identified 30 CS patients from a large university sarcoidosis clinic. The effect of early initiation of corticosteroicl therapy on LVEF was assessed by serial echocardiography, and on VAs and AV block was assessed by Holter monitoring and/or device interrogations. Results: The median time from diagnosis of extra-cardiac sarcoidosis to CS was 40 months. 90% (27/30) of the CS patients received corticosteroid therapy and 85% percent (23/27) had early initiation of corticosteroid therapy. Fourteen patients (47%) had reduced EF < 50%. 9/14 patients who had early initiation of corticosteroid therapy had improvement in mean EF (25% to 46%, P < 0.001); 5, patients who had a delay in initiation or who did not receive corticosteroids had no improvement in mean EF (41% to 37%, P = 0.47). Fourteen patients (47%) had VAs and 5 patients (17%) had advanced AV block. Early initiation of corticosteroid therapy resulted in no VA recurrences in 8/11 patients (72%), and complete recovery of AV conduction in 2/3 patients (67%). Patients with VAs (n = 3) or advanced AV block (n = 2) who failed to receive early corticosteroid therapy did not show improvement. Conclusions: There is often a delay in manifestation of cardiac sarcoidosis for several years from the diagnosis of extra-cardiac sarcoidosis. Prompt initiation of corticosteroid therapy in CS patients may improve outcomes whereas delayed initiation of corticosteroids or failure to use corticosteroids may be associated with worse outcomes. (C) 2016 Elsevier Ireland Ltd. All rights reserved.