EXPLORING ENVIRONMENTAL AND OCCUPATIONAL EXPOSURES IN PATIENTS WITH CARDIAC SARCOIDOSIS: A CASE-CONTROL STUDY

Abstract

Sarcoidosis is a condition of unknown etiology. A number of environmental and occupational exposures have been found to be associated with the development of pulmonary and dermatological sarcoidosis (e.g. insecticides). Patients who present with clinically manifest cardiac sarcoidosis (CS) have a distinct phenotype, often with minimal or no pulmonary sarcoidosis and no dermatologic/ophthalmic disease. We sought to explore, for the first time, the environmental/occupational exposures associated with CS. Three groups of patients were recruited from a prospective registry. Group 1: Patients with clinically manifest CS; Group 2: Patients with biopsy proven extra-cardiac sarcoidosis and no cardiac involvement on MRI; Group 3: Age and sex-matched control patients without sarcoidosis. A validated survey, which has previously been widely used in pulmonary sarcoidosis, was sent to all patients. A total of 146 patients met the inclusion criteria and were sent the survey, of whom 102/146 (70%) completed the survey. There were no statistically significant differences between groups 1 and 2. Selected data from the survey, comparing CS patients (group 1) and controls (group 3) are shown in Table 1. A significant positive association was found between mold exposure and CS, OR 2.97 (95% CI 1.14-7.76; P= 0.02), and a significant negative association was found between smoking and CS, OR 0.31 (95%CI 0.12-0.83; P=0.02). We found a significant three-fold increase in mold exposure in patients with CS compared to controls. We also found a negative association between smoking and the diagnosis of CS. We plan to extend these observations to a larger cohort with additional sub-phenotyping, including patterns of FDG uptake on PET scans and biomarker involvement.