Association Between Improvement in Left Ventricular Ejection Fraction and Prognosis of Patients with Cardiac Sarcoidosis

Abstract

Changes in the left ventricular ejection fraction (LVEF) of patients with cardiac sarcoidosis (CS) have been reported; however, the prognostic implications remain unknown. This study aimed to investigate the predictive factors for LVEF improvement in patients with CS and the association between LVEF improvement and prognosis. This was a post hoc analysis of the ILLUMINATE-CS registry, a multicenter retrospective study on CS. Patients with a baseline LVEF ≥ 50% were excluded. LVEF improvement was defined as the difference between the baseline and follow-up echocardiographic results. Patients were stratified based on tertiles of LVEF improvement: 1st (≤ 0%, least improved), 2nd (0-9%), and 3rd (> 9%, most improved) tertile groups. The primary outcome was all-cause mortality after follow-up echocardiography. Overall, 188 patients with CS (age: 62.1 ± 10.7 years; male proportion: 42.6%) were analyzed. In the multivariate linear regression analysis, narrower QRS duration, lower baseline LVEF, and no prescription of beta-blockers at baseline were independently associated with greater LVEF improvement. During the median follow-up period of 407 days, 26 deaths occurred. The Kaplan-Meier curves showed a significant difference between the 3 groups (log-rank test, P = 0.002). In the adjusted Cox proportional hazard analysis, the 1st and 2nd tertile groups showed progressively higher mortality rates than the 3rd tertile group. Independent of other variables, LVEF improvement as a continuous variable was associated with a lower mortality rate. Among patients with CS, LVEF improvement was significantly associated with favorable outcomes. LVEF should be monitored if baseline LVEF is decreased.