Abstract 13467: Impact of Basal Thinning of the Interventricular Septum on Long-term Prognosis in Patients With Cardiac Sarcoidosis
Backgrounds: Basal thinning of the interventricular septum (IVS) is one of the key findings for diagnosing cardiac sarcoidosis (CS), and ideal cut-off thickness of basal IVS was previously reported. However long-term prognostic significance of basal thinning of the IVS in CS remains unclear.
Methods: We examined 74 consecutive patients who were initially diagnosed as CS by clinical and/or pathological findings and clearly evaluated basal IVS by echocardiogram. We measured the thickness A which was 10mm distant from the aortic annulus on the IVS and the thickness B which was the one-third point nearby the annulus, and calculated the ratio A/B by the long axis view of the left ventricle at the end-diastolic phase. Patients were divided into two groups according to the presence or absence of basal IVS thinning, defined as thickness A≦4mm and/or ratio A/B≦0.6, as previously reported.
Results: Basal IVS thinning was observed in 21 patients. Age, gender, left ventricular (LV) end-diastolic dimension, LV ejection fraction (LVEF), angiotensin converting enzyme (ACE) activity, lysozyme and brain natriuretic peptide (BNP) levels, use of and dose of corticosteroid therapy were comparable between the two groups. During follow-up periods (4.7±2.5 years), 30 patients underwent adverse events including all-cause death, symptomatic arrhythmias, and heart failure admission. Presence of basal IVS thinning was associated with higher long-term adverse events (log-rank test, p=0.001, figure). Multivariate analysis showed basal IVS thinning (HR 2.76, 95% CI 1.28-5.91) and use of corticosteroid therapy (HR 0.39, 95% CI 0.18-0.93) were independent determinants of long-term adverse events among variables including age, gender, LVEF, LV diastolic dimension, ACE activity, and lysozyme and BNP levels.
Conclusions: Basal IVS thinning at initial diagnosis of CS was associated with poor long-term clinical outcomes, suggesting its novel prognostic significance in patients with CS.
- © 2013 by American Heart Association, Inc.