Williamson Katrina A, Davison Jenna M, Rosenbaum Andrew N, Chareonthaitawee Panithaya, Kolluri Nikhil, Bois John P, Abou Ezzeddine Omar F, Schirger John A, Kapa Suraj, Siontis Konstantinos C, Cooper Leslie T, Arment Courtney A
Department of Rheumatology, University of Alabama, United States.
Department of Internal Medicine Mayo Clinic, United States.
Int J Cardiol Heart Vasc. 2025 Aug 30;61:101777. doi: 10.1016/j.ijcha.2025.101777. eCollection 2025 Dec.
Cardiac sarcoidosis (CS) is an inflammatory cardiomyopathy for which sex differences outcomes are not well described.
This study aimed to understand differences in CS presentation, complications, and outcomes between females and males.
Patients meeting Japanese Circulation Society or Heart Rhythm Society criteria for CS were evaluated at a single institution from January 1, 1999, to December 31, 2023 (n = 455). Presenting characteristics including demographics, symptoms, conduction abnormalities, arrhythmias and left ventricular ejection fraction (LVEF) between females and males were compared. Sex-based differences in hospitalizations, LVAD implantation, transplantation and death were analyzed.
The cohort was mostly male (60.7 %). Females presented at an older age (58.5, IQR 51-65 in females, vs 54, IQR 45-61 in males, = 0.001), and more females experienced palpitations (46.4 %, = 0.04), chest pain (34.6 % = 0.02), and fatigue (53.6 % = 0.01) at presentation. Females had higher New York Heart Association (NYHA) class (III or IV) (31.5 % vs 21.8 %; = 0.05), and higher NT-proBNP (467 in females vs 257.5 in males, = 0.03) at presentation. Cardiovascular hospitalization-free survival, LVAD/transplant-free survival, and overall survival were not significantly different.
Females presented at an older age and were more symptomatic with higher NYHA class symptoms than males, suggesting that females are presenting or being diagnosed with CS later than males. LVEF, rates of heart block, and ventricular arrhythmias were similar between sexes, suggesting greater heart failure severity in females with CS may be related to greater left ventricular stiffening or worse valvular disease. Differences in survival outcomes were not significant.
心脏结节病（CS）是一种炎症性心肌病，其性别差异结果尚无充分描述。
本研究旨在了解女性和男性在CS表现、并发症及预后方面的差异。
对1999年1月1日至2023年12月31日期间在单一机构就诊且符合日本循环学会或心律学会CS标准的患者进行评估（n = 455）。比较了女性和男性的人口统计学、症状、传导异常、心律失常及左心室射血分数（LVEF）等表现特征。分析了住院、左心室辅助装置植入、移植及死亡方面的性别差异。
该队列中男性居多（60.7%）。女性发病年龄较大（女性为58.5岁，四分位数间距为51 - 65岁；男性为54岁，四分位数间距为45 - 61岁，P = 0.001），且更多女性在发病时出现心悸（46.4%，P = 0.04）、胸痛（34.6%，P = 0.02）及疲劳（53.6%，P = 0.01）。女性发病时纽约心脏协会（NYHA）分级（III或IV级）更高（31.5%对21.8%；P = 0.05），N末端B型利钠肽原（NT-proBNP）水平也更高（女性为467，男性为257.5，P = 0.03）。心血管无住院生存期、无左心室辅助装置/移植生存期及总生存期无显著差异。
女性发病年龄较大，且与男性相比NYHA分级症状更明显，提示女性比男性更晚出现或被诊断为CS。两性之间的LVEF、心脏传导阻滞发生率及室性心律失常相似，提示CS女性患者心力衰竭严重程度更高可能与左心室僵硬度增加或瓣膜疾病更严重有关。生存结局差异不显著。
