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Bobbio E, Hjalmarsson C, Björkenstam M, Polte CL, Oldfors A, Lindström U, Dahlberg P, Bartfay SE, Szamlewski P, Taha A, Sakiniene E, Karason K, Bergh N, Bollano E. Diagnosis, management, and outcome of cardiac sarcoidosis and giant cell myocarditis: a Swedish single center experience. BMC Cardiovasc Disord 2022; 22:192. [PMID: 35473644 PMCID: PMC9044839 DOI: 10.1186/s12872-022-02639-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 04/14/2022] [Indexed: 01/28/2023] Open
Abstract
Background Cardiac sarcoidosis (CS) and giant cell myocarditis (GCM) are rare diseases that share some similarities, but also display different clinical and histopathological features. We aimed to compare the demographics, clinical presentation, and outcome of patients diagnosed with CS or GCM. Method We compared the clinical data and outcome of all adult patients with CS (n = 71) or GCM (n = 21) diagnosed at our center between 1991 and 2020. Results The median (interquartile range) follow-up time for patients with CS and GCM was 33.5 [6.5–60.9] and 2.98 [0.6–40.9] months, respectively. In the entire cohort, heart failure (HF) was the most common presenting manifestation (31%), followed by ventricular arrhythmias (25%). At presentation, a left ventricular ejection fraction of < 50% was found in 54% of the CS compared to 86% of the GCM patients (P = 0.014), while corresponding proportions for right ventricular dysfunction were 24% and 52% (P = 0.026), respectively. Advanced HF (NYHA ≥ IIIB) was less common in CS (31%) than in GCM (76%). CS patients displayed significantly lower circulating levels of natriuretic peptides (P < 0.001) and troponins (P = 0.014). Eighteen percent of patients with CS included in the survival analysis reached the composite endpoint of death or heart transplantation (HTx) compared to 68% of patients with GCM (P < 0.001). Conclusion GCM has a more fulminant clinical course than CS with severe biventricular failure, higher levels of circulating biomarkers and an increased need for HTx. The histopathologic diagnosis remained key determinant even after adjustment for markers of cardiac dysfunction. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02639-0.
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Affiliation(s)
- Emanuele Bobbio
- Departments of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Clara Hjalmarsson
- Departments of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marie Björkenstam
- Departments of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christian L Polte
- Departments of Clinical Physiology and Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Oldfors
- Departments of Clinical Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ulf Lindström
- Departments of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Pia Dahlberg
- Departments of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sven-Erik Bartfay
- Departments of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Piotr Szamlewski
- Departments of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Amar Taha
- Departments of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Egidija Sakiniene
- Departments of Rheumatology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kristjan Karason
- Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Niklas Bergh
- Departments of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Entela Bollano
- Departments of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden. .,Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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