Sex Differences in Patients with Suspected Cardiac Sarcoidosis Assessed by Cardiovascular Magnetic Resonance Imaging

Rajat Kalra, Shray Malik, Ko Hsuan Amy Chen, Fredrick Ogugua, Pal Satyajit Singh Athwal, Andrew C. Elton, Pratik S Velangi, Mohamed F. Ismail, Sanya Chhikara, Jeremy S Markowitz, Prabhjot S. Nijjar, Lisa Von Wald, Henri Roukoz, Maneesh Bhargava, David Perlman, Chetan Shenoy

Research output: Contribution to journalArticlepeer-review

Abstract

Background: There are few data on sex differences in suspected cardiac sarcoidosis. Methods: Consecutive patients with histologically proven sarcoidosis and suspected cardiac involvement were studied. We investigated sex differences in presenting features, cardiac involvement, and the long-term incidence of a primary composite end point of all-cause death or significant ventricular arrhythmia and secondary end points of all-cause death and significant ventricular arrhythmia. Results: Among 324 patients, 163 (50.3%) were female and 161 (49.7%) were male patients. Female patients had a greater prevalence of chest pain (37.4% versus 23.6%; P=0.010) and palpitations (39.3% versus 26.1%; P=0.016) than male patients but not dyspnea, presyncope, syncope, or arrhythmias at presentation. Female patients had a lower prevalence of late gadolinium enhancement on cardiovascular magnetic resonance imaging (20.2% versus 35.4%; P=0.003) and less often met criteria for a clinical diagnosis of cardiac sarcoidosis (Heart Rhythm Society consensus criteria, 22.7% versus 36.0%; P=0.012 and 2016 Japanese Circulation Society guideline criteria, 8.0% versus 19.3%; P=0.005), indicating lesser cardiac involvement. However, the long-term incidence of all-cause death or significant ventricular arrhythmia was not different between female and male patients (23.2% versus 23.2%; P=0.46). Among the secondary end points, the incidence of all-cause death was not different between female and male patients (20.7% versus 14.3%; P=0.51), while female patients had a lower incidence of significant ventricular arrhythmia compared with male patients (4.3% versus 13.0%; P=0.022). On multivariable analyses, sex was not associated with the primary end point (hazard ratio for female patients, 1.36 [95% CI, 0.77-2.43]; P=0.29). Conclusions: We observed distinct sex differences in patients with suspected cardiac sarcoidosis. A paradox was identified wherein female patients had a greater prevalence of chest pain and palpitations than male patients, but lesser cardiac involvement, and a similar long-term incidence of all-cause death or significant ventricular arrhythmia.

Original languageEnglish (US)
JournalCirculation: Arrhythmia and Electrophysiology
DOIs
StatePublished - Sep 2021

Bibliographical note

Funding Information:
This work was supported by the National Institutes of Health grant K23HL132011, a University of Minnesota Clinical and Translational Science Institute KL2 Scholars Career Development Program Award (National Institutes of Health grant KL2TR000113-05), a University of Minnesota Clinical and Translational Science Institute K-R01 Transition to Independence Grant (supported by the National Institutes of Health grant UL1TR002494), and a Lillehei Heart Institute Red Heart Soiree Seed Grant, all awarded to C. Shenoy.

Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.

Keywords

  • arrhythmias, cardiac
  • cardiomyopathies
  • magnetic resonance imaging
  • prevalence
  • prognosis
  • sarcoidosis
  • sex characteristics

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