Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Department of Cardiology and Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
Am J Cardiol. 2021 Jun 15;149:112-118. doi: 10.1016/j.amjcard.2021.03.017. Epub 2021 Mar 20.
Sarcoidosis is a multisystem inflammatory condition with occasional cardiac involvement (CS), which may be associated with risk of venous thromboembolism (VTE). As data on VTE in CS are sparse and corticosteroid therapy has not been previously examined, we aim to determine the association between CS, corticosteroid treatment for CS, and VTE. Patients referred to our institution with concern for sarcoidosis and underwent a positron emission tomography (PET) scan were retrospectively assessed. Chi-squared and multivariate regression analyses were conducted to determine the association between a diagnosis of sarcoidosis, CS, corticosteroid use, and VTE events. Six hundred and forty nine patients were split into 3 categories: 235 with no sarcoidosis (NS), 91 with extra-cardiac sarcoidosis only (ECS), and 323 with CS (isolated CS and/or CS with extra cardiac sarcoid). Thirty nine CS, 7 ECS, and 9 NS patients developed PE while 44 CS, 3 ECS, and 18 NS patients developed DVT. On multivariate regression, neither CS nor ECS was an independent risk factor for VTE (p >0.05) but corticosteroid use was independently associated with VTE (HR 3.06, p = 0.007 for PE, HR 6.21, p <0.0001 for DVT). On logistic regression analysis, corticosteroid dose was found to be independently associated with both PE (p = 0.001) and DVT (p = 0.007). Optimal threshold for defining VTE risk with corticosteroid therapy was a prednisone-equivalent dose of 17.5 mg. In conclusion, contrary to previous studies, this current study found that neither sarcoidosis nor CS is an independent risk factor for VTE. Rather, corticosteroid therapy was associated with an increased risk of VTE.
结节病是一种多系统炎症性疾病，偶尔会累及心脏（CS），可能与静脉血栓栓塞（VTE）的风险相关。由于 CS 中关于 VTE 的数据很少，并且皮质类固醇治疗以前没有被检查过，我们旨在确定 CS、CS 的皮质类固醇治疗与 VTE 之间的关联。我们回顾性评估了因怀疑结节病而到我们机构就诊并接受正电子发射断层扫描（PET）扫描的患者。进行了卡方检验和多变量回归分析，以确定结节病、CS、皮质类固醇使用和 VTE 事件之间的关联。649 名患者分为 3 类：235 名无结节病（NS）、91 名仅有心脏外结节病（ECS）和 323 名 CS（孤立性 CS 和/或 CS 合并心脏外结节病）。39 名 CS、7 名 ECS 和 9 名 NS 患者发生 PE，而 44 名 CS、3 名 ECS 和 18 名 NS 患者发生 DVT。多变量回归分析显示，CS 或 ECS 均不是 VTE 的独立危险因素（p>0.05），但皮质类固醇的使用与 VTE 独立相关（PE 的 HR 为 3.06，p=0.007，DVT 的 HR 为 6.21，p<0.0001）。在逻辑回归分析中，发现皮质类固醇剂量与 PE（p=0.001）和 DVT（p=0.007）均独立相关。皮质类固醇治疗定义 VTE 风险的最佳阈值为泼尼松等效剂量 17.5mg。总之，与以前的研究相反，本研究发现结节病或 CS 均不是 VTE 的独立危险因素。相反，皮质类固醇治疗与 VTE 风险增加相关。
