Prediction of corticosteroid responder in newly diagnosed cardiac sarcoidosis patients with complete heart block

Abstract

Background: Complete heart block (CHB) is a serious complication of cardiac sarcoidosis (CS) which requires pacemaker implantation. Some patients recover from CHB after steroid therapy. Aims and Objectives: To investigate whether cardiac imaging features including echocardiography (Echo), 18F-fluoro-2-deoxyglucose positron emission tomography (FDG-PET), cardiac magnetic resonance imaging (CMR) or cardiac CT could predict recovery of CHB. Methods: Seventeen CS patients newly diagnosed with CHB who received steroid therapy were included. The presence of basal thinning of the interventricular septum (IVS) on Echo was evaluated. Focal myocardial FDG uptake on FDG-PET and delayed enhancement (DE) on CMR or CT were considered to be positive. The extent of the DE was classified into “none or mild fibrosis = less than one layer of the 3 myocardial layers” or “moderate or severe fibrosis = greater than 2 layers of the 3 myocardial layers”. Results: Six patients (35%) recovered from CHB and the remaining 11 patients (65%) did not. Six patients with recovery; no patients (0%) had basal thinning of the IVS (p = 0.02 vs without recovery), and 6 patients showed none or mild fibrosis of the basal IVS (p Conclusion: When Echo did not show basal thinning of the IVS and CMR or CT showed none or mild fibrosis of the basal IVS, the patients may recover from CHB.