Abstract 13909: Predicting Factors for Chronic Phase Ventricular Tachycardia in Cardiac Sarcoidosis Under Corticosteroid Therapy

Abstract

Background: Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Ventricular tachycardia (VT) is frequently observed in cardiac sarcoidosis (CS), which can be sometimes fatal. Corticosteroid therapy is effective for suppression of the lethal arrhythmias with CS, however, the lethal ventricular arrhythmia still occurs even in chronic phase under corticosteroids therapy. In the present study, we retrospectively evaluated the predictors for chronic phase VT in the patients with CS with corticosteroid therapy. Methods: The study population consisted of 37 consecutive patients diagnosed with CS. Corticosteroid therapy was indicated in all patients with a mean follow-up period of 59.9 ± 42.2 months. To exclude the events during unstable acute phase of the therapy, we focused on the occurrence of VT at least 3 months after the initiation of corticosteroids therapy as chronic phase events. Various clinical parameters including echocardiographic parameters, 12-lead electrocardiogram (ECG) and findings of laboratory data at 6, 12 and 24 months after the initiation of corticosteroid therapy, were obtained and compared between patients with and without chronic phase VT (VT and non-VT group). To adjust for the baseline diversity, all data were evaluated as change from baseline data, e.g., ▹QRS calculated by subtracting the baseline QRS duration from the QRS data at each month. Results: Out of the 37 patients, 7 exhibited VT in the chronic phase (19%). In the echocardiographic parameters, VT group showed larger ▹left ventricular end-diastolic diameter (LVDd) in 6 months (5.7±1.5 vs. -1.7±5.3 mm, p=0.028) and 24 months (4.5±1.0 vs. -0.8±7.2 mm, p=0.009) compared with those in the non-VT group (n=30), but there was no significant difference in ▹ejection fraction (EF). In the 12-lead ECG parameters, VT group showed longer ▹QRS in 6 months (30.0±19.8 vs. -6.1±11.2 ms, p=0.001) compared with those in the non-VT group. There were no significant differences in findings of laboratory data including the changes of brain natriuretic peptide (BNP) and angiotensin-converting enzyme (ACE) between 2 groups. Conclusions: Serial changes in echocardiographic parameters and QRS duration may predict chronic phase VT in CS after corticosteroid therapy.