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A Positive Endomyocardial Biopsy Result for Sarcoid Is Associated with Poor Prognosis in Patients with Initially Unexplained Cardiomyopathy

Citation

Ardehali, Hossein; Howard, David L; .; Hariri, Arvin; Qasim, Atif; Hare, Joshua M.; Baughman, Kenneth L.; & Kasper, Edward K. (2005). A Positive Endomyocardial Biopsy Result for Sarcoid Is Associated with Poor Prognosis in Patients with Initially Unexplained Cardiomyopathy. American Heart Journal, 150(3), 459-463.

Abstract

Background: Sarcoidosis is a systemic granulomatous disorder of unknown etiology. In patients with cardiomyopathy, the diagnosis of sarcoidosis has important treatment implications. We studied the prognostic implications of a cardiac biopsy diagnosis of sarcoidosis in patients with unexplained cardiomyopathy.
Methods: We evaluated 1235 patients with unexplained cardiomyopathy who underwent endomyocardial biopsy (EMBx) between 1982 and 1997 at the Johns Hopkins Hospital. Twenty-eight patients were referred with a clinical diagnosis of sarcoidosis.
Results: Seven of these 28 patients (25%) plus 3 more with other initial diagnoses had sarcoidosis on heart biopsy. Of these 10 patients, 3 (30%) died with a median survival time after biopsy of 0.69 years. Of the remaining 21 patients with a clinical diagnosis of sarcoidosis, 20 had negative biopsy results for sarcoidosis and 7 (35%) died with a median survival time of 2.34 years. The odds of death within 1, 2, and 3 years were higher for those with than for those without an EMBx-proven cardiac sarcoid (crude OR 4.75 [P = .23], 8.1 [P = .09], and 1.28 [P = .78], respectively), but the differences failed to reach significance at the .05 level. However, the difference in the odds of death within 2 years did achieve marginal significance.
Conclusions: Only a quarter of patients with cardiomyopathy and clinical diagnosis of sarcoid have a noncaseating granuloma on EMBx. Of those with a clinical diagnosis of sarcoidosis, heart biopsy results that are positive for sarcoidosis appear to be associated with a shorter median survival time than heart biopsy results that are negative for sarcoidosis. Finally, a noncaseating granuloma on EMBx is a rare finding in patients with cardiomyopathy without a history of sarcoidosis.

URL

http://dx.doi.org/10.1016/j.ahj.2004.10.006

Reference Type

Journal Article

Year Published

2005

Journal Title

American Heart Journal

Author(s)

Ardehali, Hossein
Howard, David L
.
Hariri, Arvin
Qasim, Atif
Hare, Joshua M.
Baughman, Kenneth L.
Kasper, Edward K.