Propensity-Matched Five-Year Cardiac Resynchronization Therapy Outcomes in Sarcoidosis With Heart Failure.

INTRODUCTION

Cardiac resynchronization therapy (CRT) improves clinical outcomes in patients with heart failure with reduced ejection fraction (HFrEF). However, data on its efficacy in patients with sarcoidosis and HFrEF are limited.

METHODS

Using the TriNetX network, we identified patients with sarcoidosis, heart failure with a left ventricular ejection fraction (LVEF) below 35%, and either left bundle branch block (LBBB) or prolonged QRS duration ( > 150 ms) between 2014 and 2019. Patients were categorized into two cohorts: (1) those who received CRT and (2) those who received an ICD-only implant. Five-year outcomes included all-cause mortality, all-cause hospitalization, heart failure exacerbation, and the proportion of patients with improvement in LVEF to greater than 40% and greater than 50%.

RESULTS

Out of 245 eligible patients, we identified a cohort of 87 patients (mean age 62.6 ± 9.5 years) who received CRT and 87 patients (mean age 62.1 ± 11.1 years) who received ICD-only implant, with similar propensity scores, and included them in a comparative analysis. At 5-year follow-up, the CRT group demonstrated outcomes comparable to the ICD-only implant group for all-cause mortality (14.9% vs. 20.7%; HR 0.63; 95% CI 0.31-1.28; p = 0.19), all-cause hospitalization (83.9% vs. 77.0%; HR 1.24; 95% CI 0.89-1.73; p = 0.19), and heart failure exacerbation (28.7% vs. 28.7%; HR 0.90; 95% CI 0.52-1.57; p = 0.72). The proportion of patients with improvement in LVEF to greater than 40% and greater than 50% was also similar in both groups (LVEF > 40%, 43.7% vs. 33.3%; HR 1.30; 95% CI 0.80-2.10; p = 0.29; LVEF > 50%, 31.0% vs. 17.2%; HR 1.72; 95% CI 0.92-3.24; p = 0.09).

CONCLUSION

CRT implantation had similar long-term outcomes compared to ICD-only implantation in patients with sarcoidosis and HFrEF, particularly all-cause mortality, all-cause hospitalization, heart failure exacerbation, and the proportion of patients with improvement in LVEF to greater than 40% and greater than 50%.