Division of Cardiology, Electrophysiology Section University of California, San Francisco CA.
Department of Epidemiology and Biostatistics University of California, San Francisco CA.
J Am Heart Assoc. 2021 Feb;10(5):e017692. doi: 10.1161/JAHA.120.017692. Epub 2021 Feb 18.
Background Sarcoidosis is a granulomatous disease usually affecting the lungs, although cardiac morbidity may be common. The risk of these outcomes and the characteristics that predict them remain largely unknown. This study investigates the epidemiology of heart failure, atrioventricular block, and ventricular tachycardia among patients with and without sarcoidosis. Methods and Results We identified California residents aged ≥21 years using the Office of Statewide Health Planning and Development ambulatory surgery, emergency, or inpatient databases from 2005 to 2015. The risk of sarcoidosis on incident heart failure, atrioventricular block, and ventricular tachycardia were each determined. Linkage to the Social Security Death Index was used to ascertain overall mortality. Among 22 527 964 California residents, 19 762 patients with sarcoidosis (0.09%) were identified. Sarcoidosis was the strongest predictor of heart failure (hazard ratio [HR], 11.2; 95% CI, 10.7-11.7), atrioventricular block (HR, 117.7; 95% CI, 103.3-134.0), and ventricular tachycardia (HR, 26.1; 95% CI, 24.2-28.1) identified among all risk factors. The presence of any cardiac involvement best predicted each outcome. Approximately 22% (95% CI, 18%-26%) of the relationship between sarcoidosis and increased mortality was explained by the presence of at least 1 of these cardiovascular outcomes. Conclusions The magnitude of risk associated with sarcoidosis as a predictor of heart failure, atrioventricular block, and ventricular tachycardia, exceeds all established risk factors. Surveillance for and anticipation of these outcomes among patients with sarcoidosis is indicated, and consideration of a sarcoidosis diagnosis may be prudent among patients with heart failure, atrioventricular block, or ventricular tachycardia.
结节病是一种肉芽肿性疾病，通常影响肺部，但心脏发病率可能较为常见。这些结果的风险和预测这些结果的特征在很大程度上尚不清楚。本研究调查了有和没有结节病的患者中心力衰竭、房室传导阻滞和室性心动过速的流行病学。
我们使用加利福尼亚州卫生规划和发展办公室的门诊手术、急诊或住院数据库，从 2005 年到 2015 年，确定了年龄≥21 岁的加利福尼亚居民。确定了结节病对新发心力衰竭、房室传导阻滞和室性心动过速的风险。与社会安全死亡索引的链接用于确定总体死亡率。在 22527964 名加利福尼亚居民中，确定了 19762 名患有结节病的患者（0.09%）。结节病是心力衰竭（风险比[HR]，11.2；95%置信区间，10.7-11.7）、房室传导阻滞（HR，117.7；95%置信区间，103.3-134.0）和室性心动过速（HR，26.1；95%置信区间，24.2-28.1）的最强预测因素。在所有危险因素中，任何心脏受累的存在均能最好地预测每种结果。在结节病与死亡率增加之间的关系中，大约 22%（95%置信区间，18%-26%）可以用至少存在 1 种心血管结局来解释。
结节病作为心力衰竭、房室传导阻滞和室性心动过速的预测因素，其相关风险的幅度超过了所有已确定的危险因素。对结节病患者的这些结果进行监测和预测是必要的，而对于心力衰竭、房室传导阻滞或室性心动过速的患者，考虑结节病的诊断可能是谨慎的。
