Diagnoses, management patterns, and outcomes of cardiac sarcoidosis in South Africa.

BACKGROUND

Sarcoidosis is an idiopathic multiorgan disease characterized by tissue infiltration by noncaseating granulomas. Clinical cardiac involvement is reported in approximately 5% of patients. However, the frequency of cardiac involvement is found to be higher on autopsy and in advanced imaging studies such as cardiac magnetic resonance imaging.

OBJECTIVE

The purpose of this study was to determine contemporary diagnoses, management, and outcomes of cardiac sarcoidosis (CS) in South Africa.

METHODS

Clinical records of patients diagnosed with CS between January 2000 and December 2021 were reviewed.

RESULTS

Twenty-two patients were diagnosed with CS during the study period. The patients had a mean (± SD) age of 45.2 ± 12.3 years at the time of presentation. CS diagnostic rates increased from 4.5% in 2000-2005 to 45.5% in 2016-2021. Fifteen of the 22 patients (68.2%) were newly diagnosed with sarcoidosis at the time of CS diagnosis, and 9 of the 15 (60%) had pulmonary involvement. Of the 22 patients diagnosed with CS, 13 (59.1%) presented in combination with heart block, 10 (45.5%) with ventricular arrhythmias, and 4 (18.2%) with heart failure. Five endomyocardial biopsies were performed, and all were nondiagnostic. However, 8 of 8 endobronchial ultrasound (EBUS)-guided biopsies of thoracic lymph nodes were diagnostic of sarcoidosis and, notably, excluded tuberculosis. Fourteen patients (63.6%) were treated with corticosteroids, 7 (31.8%) with azathioprine, 9 (40.9%) with amiodarone, and 16 (72.7%) with a cardiac implantable electronic device. After a mean follow-up period of 64.5 ± 50.5 months, no deaths had occurred.

CONCLUSION

CS diagnostic rates have increased over time. Diagnostic endomyocardial biopsies have a low diagnostic yield, whereas EBUS-guided biopsy of thoracic lymph nodes is of crucial diagnostic utility.