Sairaku Akinori, Yoshida Yukihiko, Nakano Yukiko, Hirayama Haruo, Maeda Mayuho, Hashimoto Haruki, Kihara Yasuki
Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
Department of Cardiology, Cardiovascular Center, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
Europace. 2017 May 1;19(5):824-830. doi: 10.1093/europace/euw223.
Sarcoidosis with cardiac involvement is a rare pathological condition, and therefore cardiac resynchronization therapy (CRT) for patients with cardiac sarcoidosis is even further rare. We aimed to clarify the clinical features of patients with cardiac sarcoidosis who received CRT.
We retrospectively reviewed the clinical data on CRT at three cardiovascular centres to detect cardiac sarcoidosis patients. We identified 18 (8.9%) patients with cardiac sarcoidosis who met the inclusion criteria out of 202 with systolic heart failure who received CRT based on the guidelines. The majority of the patients were female [15 (83.3%)] and underwent an upgrade from a pacemaker or implantable cardioverter defibrillator [13 (72.2%)]. We found 1 (5.6%) cardiovascular death during the follow-up period (mean ± SD, 4.7 ± 3.0 years). Seven (38.9%) patients had a composite outcome of cardiovascular death or hospitalization from worsening heart failure within 5 years after the CRT. Twelve (66.7%) patients had a history of sustained ventricular arrhythmias or those occurring after the CRT. Among the overall patients, no significant improvement was found in either the end-systolic volume or left ventricular ejection fraction (LVEF) 6 months after the CRT. A worsening LVEF was, however, more likely to be seen in 5 (27.8%) patients with ventricular arrhythmias after the CRT than in those without (P = 0.04). An improved clinical composite score was seen in 10 (55.6%) patients.
Cardiac sarcoidosis patients receiving CRT may have poor LV reverse remodelling and a high incidence of ventricular arrhythmias.
结节病累及心脏是一种罕见的病理状况，因此针对心脏结节病患者的心脏再同步治疗（CRT）更为罕见。我们旨在阐明接受CRT治疗的心脏结节病患者的临床特征。
我们回顾性分析了三个心血管中心有关CRT的临床数据，以找出心脏结节病患者。在202例根据指南接受CRT治疗的收缩性心力衰竭患者中，我们确定了18例（8.9%）符合纳入标准的心脏结节病患者。大多数患者为女性[15例（83.3%）]，并且是从起搏器或植入式心脏复律除颤器升级而来[13例（72.2%）]。我们发现在随访期间（平均±标准差，4.7±3.0年）有1例（5.6%）发生心血管死亡。7例（38.9%）患者在CRT后5年内出现心血管死亡或因心力衰竭恶化而住院的复合结局。12例（66.7%）患者有持续性室性心律失常病史或在CRT后发生室性心律失常。在所有患者中，CRT后6个月时，左心室收缩末期容积或左心室射血分数（LVEF）均未发现明显改善。然而，与未发生室性心律失常的患者相比，CRT后有5例（27.8%）发生室性心律失常的患者更有可能出现LVEF恶化（P = 0.04）。10例（55.6%）患者的临床综合评分有所改善。
接受CRT治疗的心脏结节病患者可能左心室逆向重构较差且室性心律失常发生率较高。
