Silent Relapses in Cardiac Sarcoidosis

Relapse Patterns and Clinical Outcomes in Cardiac Sarcoidosis: Insights from a Retrospective Single-Centre Cohort Study

SUMMARY

Cardiac sarcoidosis (CS) is a granulomatous inflammatory cardiomyopathy with a wide range of presentations, from palpitations to heart failure and sudden cardiac arrest. Despite advances in imaging and immunosuppressive (IS) therapy, they note that relapse patterns and long-term outcomes remain poorly defined. The authors aimed to characterise relapse and identify predictors of relapse and major adverse cardiac events (MACE) in a real-world CS cohort.

They conducted a retrospective single-centre study including 25 adults diagnosed with CS at Geneva University Hospitals between 2016 and 2024, classified according to the 2024 American Heart Association diagnostic criteria. They defined relapse as clinical, arrhythmic, or imaging deterioration requiring treatment escalation. They defined MACE as cardiovascular hospitalisation, device therapy, left ventricular assist device, heart transplant, or death. Statistical methods included Kaplan–Meier analysis with log-rank tests and multivariable Cox regression adjusted for age and sex.

They found that relapse occurred in 13 patients (56%), often subclinical (61.5%) and detected incidentally on routine PET-CT during IS tapering. In their multivariate model, predictors of relapse included right ventricular FDG uptake and second-line immunosuppression duration ≤24 months. Patients who remained relapse-free were more often maintained on dual or triple IS therapy and low-dose prednisone (<10 mg>

The authors conclude that relapse is common in CS, often subclinical, and associated with PET-CT findings and premature IS tapering. They emphasise that maintenance therapy may reduce risk and that multimodal imaging remains critical for disease monitoring, though tracers with higher specificity are needed. They recommend further research to refine relapse definitions and support personalised treatment strategies.

Full article: https://doi.org/10.3390/jcm14176234

WHY IS THIS IMPORTANT?

Cardiac sarcoidosis is a rare inflammation of the heart that can cause rhythm disturbances, heart failure, or even sudden death. This study from Geneva University Hospitals (HUG) followed 25 patients over eight years to understand how often the disease returns (“relapse”) and what predicts it. More than half relapsed, often silently, detected only by PET-CT scans during treatment reduction. The study found that early tapering of immunosuppressive therapy and right-heart inflammation predicted relapse. Continuous, low-dose therapy appeared protective. These findings highlight the importance of careful treatment planning and regular imaging to prevent unnoticed inflammation that may damage the heart over time.

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