Sudden death in cardiac sarcoidosis: an analysis of nationwide clinical and cause-of-death registries.

Abstract:

AIMS:The present study was done to assess the role of sudden cardiac death (SCD) among the presenting manifestations of and fatalities from cardiac sarcoidosis (CS). METHODS AND RESULTS:We analysed altogether 351 cases of CS presenting from year 1998 through 2015 in Finland. There were 262 patients with a clinical diagnosis and treatment of CS, 27 patients with an initial lifetime diagnosis of giant cell myocarditis that was later converted to CS, and 62 cases detected at autopsy and identified by screening >820 000 death certificates from the national cause-of-death registry. The total case series comprised 253 females and 98 males aged on average 52 years at presentation. High-grade atrioventricular block was the most common first sign of CS (n = 147, 42%) followed by heart failure (n = 58, 17%), unexpected fatal (n = 38) or aborted (n = 12) SCD (14%), and sustained ventricular tachycardia (n = 48, 14%). Severe coronary artery disease was found at autopsy concomitant with CS in four of the 38 cases presenting with fatal SCD. Of all deaths recorded till the end of 2015, 64% (n = 54/84) were unexpected SCDs from CS that had either been silent during life or defied all attempts at diagnosis. The Kaplan-Meier estimate (95% CI) of survival from symptom onset was 85% (80-90%) at 5 years and 76% (68-84%) at 10 years. CONCLUSION:Together fatal and aborted SCD constitute 14% of the presenting manifestations of CS. Nearly two-thirds of all fatalities from CS are caused by undiagnosed granulomas in the heart.

journal_name

Eur Heart J

journal_title

European heart journal

authors

Ekström K,Lehtonen J,Nordenswan HK,Mäyränpää MI,Räisänen-Sokolowski A,Kandolin R,Simonen P,Pietilä-Effati P,Alatalo A,Utriainen S,Rissanen TT,Haataja P,Kokkonen J,Vihinen T,Miettinen H,Kaikkonen K,Kerola T,Kupari M

doi

10.1093/eurheartj/ehz428

subject

Has Abstract

pub_date

2019-10-01 00:00:00

pages

3121-3128

issue

37

eissn

0195-668X

issn

1522-9645

pii

5522188

journal_volume

40

pub_type

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