Sex Differences In Presentation And Outcomes Of Cardiac Sarcoidosis

Abstract

<h3>Background</h3> Sex differences exist in myocarditis, with male predominance. Sarcoidosis causes an inflammatory cardiomyopathy with proposed shared mechanisms to myocarditis. Sarcoidosis is typically female predominant, but most published cohorts of <i>cardiac</i> sarcoidosis (CS) are majority male. Sex differences in CS have not been reported. <h3>Methods</h3> A single center retrospective cohort of 254 CS patients was studied. Medical records were reviewed for CS presentation, treatment and outcomes. Sex differences were analyzed using two sample t-test, chi-squared test, or Fisher's exact test. <h3>Results</h3> : Of 254 patients with CS,149 (57%) were male and 109 (43%) were female. Males were more likely to present with ventricular tachycardia (VT) (26% vs 15%, p=0.04). Rates of reduced LVEF <50% (53% vs 45%, p=0.25) were similar, but females were more likely to present with clinical HF (47% vs 28%, p=0.002) at CS diagnosis. Initial PET scan demonstrated cardiac FDG uptake in 73% of males and 77% of females (p=0.22). Rates of steroid-sparing agent treatment were similar by sex, however females were more likely to receive an upfront (within 60 days of initiating treatment for CS) steroid-sparing agent (40% vs 29%, p=0.05). Among 114 patients with follow-up cardiac FDG-PET scans, there were no differences in improvement or worsening from initial scan based on sex. One year after CS diagnosis, 23% of males and 18% of females had reduced LVEF (p=0.86). Among patients who initially presented with reduced LVEF, rates of EF recovery (>50%) were similar among males and females (14% vs 14%, p=0.59). Males were more likely to have new or recurrent VT after CS treatment initiation (26% vs 12%, p=0.01), and to undergo VT ablation (17% vs 8%, p=0.056). Rates of LVAD and heart transplantation were similar. For the combined endpoint of new or recurrent VT, LVAD, OHT or death, the probability of event free survival was significantly lower for men (p=0.006). <h3>Conclusions</h3> : In this sample, males with CS were more likely to experience VT both at time of CS presentation and after treatment. Females were more likely to present with clinical HF. The cardiac phenotypes of CS may prompt further evaluation for CS with these sex differences in mind. These findings call for further investigations into patient-related and mechanistic differences based on sex in CS.